Box 1.

Licensing and guidelines.

Licensing

• Gardasil, Gardasil-9 and Cervarix vaccines have been approved for marketing and used in females and males from the age of 9 years throughout the world to prevent cervical cancer.

• The European Medicines Agency (EMA) and US Food and Drug Administration (FDA) granted marketing approval for Gardasil in 2006, and for Cervarix in 2007 and 2009, respectively.

• Gardasil-9 was approved in 2014 by the FDA and in 2015 by the EMA, but it is not currently used in the UK.

• The EMA has licensed all three vaccines for females and males with no upper age limit. The FDA has licensed Gardasil up to age 26 and Gardasil-9 up to age 45 for females and males, and Cervarix for females only up to age 25.

Guidelines

• The US Centers for Disease Control and Prevention recommends ‘routine vaccination at age 11 or 12 years. (Vaccination can be started at age 9.) The Advisory Committee on Immunization Practices also recommends vaccination for females aged 13 through 26 years not adequately vaccinated previously’.3

• The UK uses Gardasil. Public Health England advises girls to be vaccinated from age 12–18 years. Immunisation Scotland offer the vaccine for girls aged 11–13 years. There is a planned roll-out to boys aged 12–13 in England and Scotland.