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A nonavalent human papillomavirus (HPV) vaccine is a recombinant vaccine designed to prevent infections and associated diseases caused by nine specific types of HPV: 6, 11, 16, 18, 31, 33, 45, 52, and 58. These types include the most common high-risk strains responsible for approximately 90% of cervical cancers and several other HPV-related malignancies, as well as low-risk strains (6 and 11) that cause the majority of genital warts. The vaccine is composed of purified virus-like particles (VLPs) of the major capsid (L1) protein of each HPV type. Upon administration, it induces a humoral immune response, generating neutralizing antibodies that prevent the virus from entering host cells. The most prominent nonavalent vaccine is Merck's Gardasil 9, which is approved for use in males and females to prevent cervical, vulvar, vaginal, anal, and oropharyngeal cancers, as well as genital warts. Other nonavalent candidates, such as Xiamen Innovax's Cecolin 9, are in clinical development.
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