What is the recommended interval between Human Papillomavirus (HPV) vaccine doses?

From the Guidelines

The recommended interval between Human Papillomavirus (HPV) vaccine doses is 6-12 months for individuals who initiate vaccination before the 15th birthday, with a two-dose schedule being sufficient. For those who start the series at age 15 or older, or who are immunocompromised, the full three-dose schedule is still recommended, with the second dose given 1-2 months after the first dose and the third dose given 6 months after the first dose 1. The HPV vaccine protects against HPV types that cause most cervical cancers and other HPV-related diseases. Key points to consider include:

• The vaccine is most effective when given before potential exposure to HPV through sexual activity, which is why it's routinely recommended for adolescents around age 11-12 1.
• If someone falls behind on the recommended schedule, they don't need to restart the series but should complete it as soon as possible 1.
• The timing between doses is important because it allows the immune system to develop a stronger response to the vaccine 1.
• A study on the immune response with a 12-month interval between the 2 doses showed that it was more robust than that measured when the interval was only 6 months 1.
• The American Cancer Society recommends that all children be vaccinated at age 11 or 12 years to protect against HPV infections that lead to several cancers and precancers 1.

From the FDA Drug Label

The anti-HPV GMTs at one month after the last dose among 9- through 14-year-old girls and boys who received 2 doses of GARDASIL 9 were non-inferior to anti-HPV GMTs among 16- through 26-year-old girls and women who received 3 doses of GARDASIL 9 (Table 12). One month following the last dose of the assigned regimen, between 97. 9% and 100% of subjects across all groups became seropositive for antibodies against the 9 vaccine HPV types (Table 12) The 2-dose regimen (0,6): vaccination at Day 1 and Month 6; 2-dose regimen (0,12): vaccination at Day 1 and Month 12; 3-dose regimen (0,2,6): vaccination at Day 1, Month 2, and Month 6.

The recommended interval between Human Papillomavirus (HPV) vaccine doses is:

• For a 2-dose regimen: 0 and 6 months or 0 and 12 months
• For a 3-dose regimen: 0,2, and 6 months 2

From the Research

HPV Vaccine Dose Interval

The recommended interval between Human Papillomavirus (HPV) vaccine doses varies depending on the age of initiation and the number of doses received.

• For individuals who initiate the vaccination series at ages 9 through 14 years, a 2-dose schedule is recommended, with doses spaced at least 6 months apart 3.
• For persons who initiate the vaccination series at ages 15 through 26 years and for immunocompromised persons, three doses are recommended 3.
• Some studies suggest that a 2-dose schedule may be effective for adolescents, with one study finding that the median time to receive the second dose of HPV vaccine was 2.6 months after the first dose, and the median time to receive the third dose was 4.9 months after the second dose 4.
• The World Health Organization (WHO) recommends a 2-dose schedule, with doses spaced a minimum of 6 months apart, for teens who begin the series before age 15 4.

Effectiveness of Different Dose Schedules

Research has shown that:

• Two doses of HPV vaccine can provide satisfactory immunological outcomes in adolescent girls, with non-inferior or superior geometric mean concentrations (GMC) of antibodies against HPV16 and HPV18 compared to a three-dose schedule 5.
• One dose of HPV vaccine may be as effective as two or three doses in preventing high-grade disease in a high coverage setting 6.
• The effectiveness of HPV vaccine by number of doses has been evaluated in several studies, with most studies finding highest estimates of effectiveness with three doses, but significant effectiveness also found among two-dose and one-dose recipients 7.

Global Adoption of 2-Dose Schedule

• By February 2017,23 low and middle income and 25 high income countries had adopted a 2-dose HPV vaccination schedule 5.
• The adoption of a 2-dose schedule could improve vaccine coverage and the effectiveness of cervical cancer prevention, particularly in countries with the highest burden of cervical cancer 5.