Up to what age can the Gardasil (Human Papillomavirus vaccine) be given?

Gardasil Vaccine Age Recommendations

The Gardasil vaccine can be given to individuals from age 9 through 45 years, with routine vaccination recommended for all persons through age 26 years and shared clinical decision-making recommended for adults aged 27 through 45 years. 1

Optimal Vaccination Age and Schedule

Routine Vaccination

• Primary target population: Ages 11-12 years 1
• Starting age: Can be given as early as 9 years of age 1
• Catch-up vaccination: Recommended for all persons through age 26 years 1

Dosing Schedule

• Ages 9-14 years: 2-dose schedule (doses at 0 and 6-12 months) 2
  • If second dose is given earlier than 5 months after first dose, a third dose is needed
• Ages 15-45 years: 3-dose schedule (doses at 0,2, and 6 months) 2
• Immunocompromised individuals: 3-dose schedule regardless of age 1

Vaccination Beyond Age 26

For adults aged 27-45 years, the Advisory Committee on Immunization Practices (ACIP) does not recommend routine catch-up vaccination but supports shared clinical decision-making 1. This recommendation is based on:

1. Most sexually active adults have already been exposed to HPV
2. New infections can still occur with new sexual partners
3. The vaccine is only effective against HPV types not previously acquired

Factors to consider for vaccination in the 27-45 age group include:

• Risk for new HPV infection (new sexual partners)
• History of previous HPV-related disease
• Immunocompromised status 1

Special Populations

• Immunocompromised individuals: Recommended through age 26 years with a 3-dose schedule 1
• Men who have sex with men: Recommended through age 26 years 1
• Pregnant women: Vaccination should be postponed until after pregnancy 1

Clinical Considerations

Efficacy Considerations

• Antibody responses are highest in individuals aged 9-15 years 1
• The vaccine is most effective when given before sexual debut and potential HPV exposure 1
• The vaccine does not treat existing HPV infections or HPV-related disease 2

Common Pitfalls to Avoid

1. Delaying vaccination: Maximum benefit occurs when administered before sexual activity begins
2. Stopping cervical cancer screening: Vaccinated women should continue routine cervical cancer screening as recommended 1
3. Assuming complete protection: The vaccine only protects against the included HPV types (6,11,16,18,31,33,45,52, and 58 for the 9-valent vaccine) 1
4. Administering during pregnancy: Although not contraindicated, vaccination should ideally be postponed until after pregnancy 1

Safety

• The vaccine is generally well-tolerated with headache being the most common side effect
• Syncope (fainting) can occur; patients should be observed for 15 minutes after administration 2
• Contraindicated in individuals with history of immediate hypersensitivity to yeast or any vaccine component 1

The Gardasil vaccine represents an important tool for preventing HPV-related cancers and diseases, with optimal protection achieved through vaccination at the recommended ages.