---
title: "36-Month Immunogenicity of Mixed 2-Dose HPV Schedules (9vHPV and 2vHPV)"
id: "pubmed-42691819"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42691819"
content_type: "clinical_feed_article"
specialty: "Infectious Disease"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42691819/"
doi: "10.1016/j.vaccine.2026.129107"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# 36-Month Immunogenicity of Mixed 2-Dose HPV Schedules (9vHPV and 2vHPV)
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42691819
- **Specialty:** [Infectious Disease](https://medichelpline.com/clinical-feed/infectious-disease.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42691819/)
- **DOI:** [10.1016/j.vaccine.2026.129107](https://doi.org/10.1016%2Fj.vaccine.2026.129107)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Randomized trial enrolled boys and girls aged 9–10 years and randomized them 1:1 to either two doses of **nonavalent HPV (9vHPV)** or a mixed two-dose schedule combining **bivalent HPV (2vHPV)** and 9vHPV administered six months apart. - The analysis population reported in the abstract comprised 337 participants who were evaluated at 36 months according-to-protocol (168 in the homologous 9vHPV arm; 169 in the mixed arm). - Seropositivity for **HPV16** and **HPV18** persisted in 100% of participants at 36 months across both schedules. - Seropositivity for the other 9vHPV-targeted HPV types was 94–100% in the mixed-schedule group versus 100% in the two-dose 9vHPV group at 36 months. - Geometric mean concentrations (GMCs) for HPV16 and HPV18 were higher in mixed schedules compared with homologous 9vHPV; reported GMCs (point estimates and 95% CIs) are provided in the abstract for each comparison. - The mixed schedule 9vHPV + 2vHPV generated higher GMCs than the 2vHPV + 9vHPV sequence for HPV16/18. - Differences in GMCs for HPV types not included in the bivalent vaccine narrowed between 7 and 36 months, indicating attenuation of earlier between-group differences. - Sex-stratified analyses showed no substantial differences between boys and girls in antibody persistence or GMC patterns. - Clinical effectiveness and implementation outcomes were not reported in the abstract; authors noted the need for further research to inform policy despite sustained serological responses through 36 months. - Trial registration: ClinicalTrials.gov NCT02567955.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 3. # Follow up immunogenicity of a mixed vaccination schedule with one dose of nonavalent and one dose of bivalent HPV vaccines 36 months post-vaccination among boys and girls [Iulia Gabriela Ionescu](https://pubmed.ncbi.nlm.nih.gov/?term=Ionescu+IG&cauthor_id=42691819)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#full-view-affiliation-1 "Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada."), [Manale Ouakki](https://pubmed.ncbi.nlm.nih.gov/?term=Ouakki+M&cauthor_id=42691819)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#full-view-affiliation-1 "Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada."), [Olivier Breton](https://pubmed.ncbi.nlm.nih.gov/?term=Breton+O&cauthor_id=42691819)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#full-view-affiliation-2 "Axe maladies infectieuses et immunitaires, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada."), [Gitika Panicker](https://pubmed.ncbi.nlm.nih.gov/?term=Panicker+G&cauthor_id=42691819)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#full-view-affiliation-3 "Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga, USA."), [Elizabeth R Unger](https://pubmed.ncbi.nlm.nih.gov/?term=Unger+ER&cauthor_id=42691819)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#full-view-affiliation-3 "Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga, USA."), [Vladimir Gilca](https://pubmed.ncbi.nlm.nih.gov/?term=Gilca+V&cauthor_id=42691819)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#full-view-affiliation-1 "Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada."), [Chantal Sauvageau](https://pubmed.ncbi.nlm.nih.gov/?term=Sauvageau+C&cauthor_id=42691819)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#full-view-affiliation-4 "Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada; Axe maladies infectieuses et immunitaires, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Québec, Canada. Electronic address: chantal.sauvageau@inspq.qc.ca.") Affiliations Expand ### Affiliations * 1 Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada. * 2 Axe maladies infectieuses et immunitaires, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada. * 3 Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga, USA. * 4 Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada; Axe maladies infectieuses et immunitaires, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Québec, Canada. Electronic address: chantal.sauvageau@inspq.qc.ca. * PMID: **42691819** * DOI: [ 10.1016/j.vaccine.2026.129107 ](https://doi.org/10.1016/j.vaccine.2026.129107) Free article Item in Clipboard Randomized Controlled Trial # Follow up immunogenicity of a mixed vaccination schedule with one dose of nonavalent and one dose of bivalent HPV vaccines 36 months post-vaccination among boys and girls Iulia Gabriela Ionescu et al. Vaccine. 2026. Free article Show details Display options Display options Format Abstract PubMed PMID Vaccine Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Vaccine%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Vaccine%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42691819/) . 2026 Oct 24:92:129107. doi: 10.1016/j.vaccine.2026.129107. Epub 2026 Sep 3. ### Authors [Iulia Gabriela Ionescu](https://pubmed.ncbi.nlm.nih.gov/?term=Ionescu+IG&cauthor_id=42691819)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#short-view-affiliation-1 "Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada."), [Manale Ouakki](https://pubmed.ncbi.nlm.nih.gov/?term=Ouakki+M&cauthor_id=42691819)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#short-view-affiliation-1 "Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada."), [Olivier Breton](https://pubmed.ncbi.nlm.nih.gov/?term=Breton+O&cauthor_id=42691819)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#short-view-affiliation-2 "Axe maladies infectieuses et immunitaires, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada."), [Gitika Panicker](https://pubmed.ncbi.nlm.nih.gov/?term=Panicker+G&cauthor_id=42691819)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#short-view-affiliation-3 "Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga, USA."), [Elizabeth R Unger](https://pubmed.ncbi.nlm.nih.gov/?term=Unger+ER&cauthor_id=42691819)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#short-view-affiliation-3 "Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga, USA."), [Vladimir Gilca](https://pubmed.ncbi.nlm.nih.gov/?term=Gilca+V&cauthor_id=42691819)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#short-view-affiliation-1 "Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada."), [Chantal Sauvageau](https://pubmed.ncbi.nlm.nih.gov/?term=Sauvageau+C&cauthor_id=42691819)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42691819/#short-view-affiliation-4 "Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada; Axe maladies infectieuses et immunitaires, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Québec, Canada. Electronic address: chantal.sauvageau@inspq.qc.ca.") ### Affiliations * 1 Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada. * 2 Axe maladies infectieuses et immunitaires, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada. * 3 Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga, USA. * 4 Direction des risques biologiques-immunisation, Institut national de santé publique du Québec, Québec, Québec, Canada; Axe maladies infectieuses et immunitaires, Centre de Recherche du Centre Hospitalier Universitaire de Québec-Université Laval, Québec, Québec, Canada; Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, Québec, Canada. Electronic address: chantal.sauvageau@inspq.qc.ca. * PMID: **42691819** * DOI: [ 10.1016/j.vaccine.2026.129107 ](https://doi.org/10.1016/j.vaccine.2026.129107) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Background:** Following up on previously published short-term findings, we assessed the persistence of the immune response at 36 months following mixed-HPV vaccination schedules using one nonavalent (9vHPV) dose and one bivalent (2vHPV) dose (administered interchangeably) compared to a homologous two-dose 9vHPV schedule. **Methods:** Girls and boys aged 9-10 years were randomized (1:1) to receive (I) two doses of 9vHPV (n = 168 according-to-protocol (ATP)) or (II) a mixed schedule (n = 169 ATP) of 2vHPV + 9vHPV (n = 86) or 9vHPV + 2vHPV (n = 83) with a 6-month interval. The proportion of participants with detectable antibodies and geometric mean concentrations (GMCs) for HPV types 6/11/16/18/31/33/45/52/58 were measured using M9ELISA at 7 and 36 months after the first dose. **Results:** Antibodies to HPV16 and HPV18 persisted in all 337 participants (100%) at 36 months. Antibodies to the other 9vHPV-targeted types were detectable in 94-100% of participants vaccinated with a mixed schedule versus 100% for those vaccinated with a 2-dose 9vHPV schedule. GMCs for HPV16 and HPV18 were significantly higher in those vaccinated with a mixed schedule (9vHPV + 2vHPV and 2vHPV + 9vHPV) compared to the 9vHPV + 9vHPV schedule: 184.6 (145.5-234.3) and 151.7 (121.2-189.8) vs 97.7 (83.6-114.1) for HPV16, and 70.4 (53.5-92.7) and 72.7 (57.0-92.8) vs 40.3 (34.9-46.6) for HPV18. Additionally, the 9vHPV + 2vHPV mixed schedule resulted in higher GMCs when compared to the 2vHPV + 9vHPV schedule. GMC ratios (homologous/mixed schedules) decreased for HPV types not included in the bivalent vaccine, indicating that differences observed at 7 months were reduced at 36 months. Sex-stratified analyses showed no substantial differences between boys and girls. **Conclusion:** Serological responses of mixed-HPV vaccination schedules are sustained for at least 36 months post-vaccination and comparable to a 2-dose 9vHPV schedule, for HPV16/18. These findings provide immunogenicity evidence supporting the feasibility of mixed 2-dose HPV schedules, while further research on clinical effectiveness and implementation is needed to inform policy decisions. **Clinical trial registration:** clinicaltrials.gov ([NCT02567955](http://clinicaltrials.gov/show/NCT02567955 "See in ClinicalTrials.gov")). **Keywords:** Bivalent HPV vaccine; Boys; Human papillomavirus (HPV); Immunogenicity; Mixed schedule; Nonavalent HPV vaccine. Copyright © 2026. Published by Elsevier Ltd. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Chantal Sauvageau is an active member of the Quebec immunization committee and the National Advisory Committee on Immunization (NACI) HPV working group. Other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ## Similar articles * [ Immune response after one dose of HPV vaccine among girls and boys and the impact of a second dose given after 3 or more years. ](https://pubmed.ncbi.nlm.nih.gov/40664165/) Guzun N, Ouakki M, Panicker G, Ionescu IG, Mayrand MH, Unger ER, Sauvageau C.Guzun N, et al.Vaccine. 2025 Aug 30;62:127475. doi: 10.1016/j.vaccine.2025.127475. Epub 2025 Jul 14.Vaccine. 2025.PMID: 40664165Clinical Trial. * [ Immunogenicity and safety of an Escherichia coli-produced bivalent human papillomavirus vaccine (Cecolin) in girls aged 9-14 years in Ghana and Bangladesh: a randomised, controlled, open-label, non-inferiority, phase 3 trial. ](https://pubmed.ncbi.nlm.nih.gov/40120597/) Agbenyega T, Schuind AE, Adjei S, Antony K, Aponte JJ, Buabeng PBY, Clemens JD, Hossain L, Kemp TJ, Mercer LD, Pinto LA, Qadri F, Sukraw K, Bhat N, Zaman K.Agbenyega T, et al.Lancet Infect Dis. 2025 Aug;25(8):861-872. doi: 10.1016/S1473-3099(25)00031-3. Epub 2025 Mar 19.Lancet Infect Dis. 2025.PMID: 40120597Free PMC article.Clinical Trial. * [ Comparison of different human papillomavirus (HPV) vaccine types and dose schedules for prevention of HPV-related disease in females and males. ](https://pubmed.ncbi.nlm.nih.gov/31755549/) Bergman H, Buckley BS, Villanueva G, Petkovic J, Garritty C, Lutje V, Riveros-Balta AX, Low N, Henschke N.Bergman H, et al.Cochrane Database Syst Rev. 2019 Nov 22;2019(11):CD013479. doi: 10.1002/14651858.CD013479.Cochrane Database Syst Rev. 2019.PMID: 31755549Free PMC article. * [ Human papillomavirus (HPV) type 16 and type 18 ant
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