At what age can you get the Human Papillomavirus (HPV) vaccine?

HPV Vaccination Age Guidelines

HPV vaccination is routinely recommended at age 11-12 years, but can be started as early as age 9 years, and catch-up vaccination is recommended for all persons through age 26 years who are not adequately vaccinated. 1

Routine Vaccination Recommendations

Primary Target Age Group

• Ages 11-12 years: This is the ideal age for routine HPV vaccination 1
• Ages 9-10 years: Vaccination can be started as early as age 9 years 1
  • Starting at age 9 provides additional time to complete the series by the 13th birthday 2
  • The American Academy of Pediatrics and American Cancer Society have endorsed starting at age 9 2

Dosing Schedule

• For persons initiating vaccination before their 15th birthday: 2-dose series (0,6-12 month schedule) 1
• For persons initiating vaccination on or after their 15th birthday or for immunocompromised individuals: 3-dose series (0,1-2,6 month schedule) 1

Catch-Up Vaccination

Ages 13-26 years

• Catch-up vaccination is recommended for all persons through age 26 years who are not adequately vaccinated 1
• Females aged 13-26 years and males aged 13-21 years who have not been previously vaccinated should receive the vaccine 1
• Males aged 22-26 years may be vaccinated 1
• Special populations (men who have sex with men and immunocompromised persons, including those with HIV) should receive vaccination through age 26 years 1

Ages 27-45 years

• Catch-up HPV vaccination is NOT routinely recommended for all adults aged >26 years 1
• Shared clinical decision-making is recommended for some adults aged 27-45 years who are not adequately vaccinated 1
• Healthcare providers should inform individuals aged 22-26 years who have not been previously vaccinated that vaccination at older ages is less effective in lowering cancer risk 1

Beyond Age 45

• HPV vaccines are not licensed for use in adults aged >45 years 1

Rationale for Age Recommendations

The recommended age for vaccination is based on several key factors:

• Maximum effectiveness: Vaccination is most effective when administered before exposure to HPV through sexual activity 1, 3
• Immune response: Higher antibody titers are achieved after vaccination at age 11-12 years 1
• HPV epidemiology: Data on HPV transmission and age of sexual debut in the United States shows high probability of HPV acquisition within several years of sexual debut 1
• Duration of protection: The vaccine has been demonstrated to provide protection for at least 5 years without evidence of waning protection 1
• Healthcare visits: Aligns with established adolescent health-care visits when other vaccines are also recommended 1

Clinical Considerations

• No prevaccination testing (e.g., Pap or HPV testing) is recommended to establish the appropriateness of HPV vaccination 1
• Sexually active individuals may still benefit from vaccination if they haven't been exposed to all vaccine HPV types 1
• The vaccine is prophylactic (prevents new HPV infections) but does not treat existing HPV infections or HPV-related disease 1
• The 9-valent HPV vaccine (9vHPV) is the only formulation currently distributed in the United States 1
• The vaccine prevents approximately 92% of HPV-attributable cancers, including cervical, oropharyngeal, anal, vaginal, vulvar, and penile cancers 1, 3

Common Pitfalls to Avoid

1. Delaying vaccination: Waiting until older adolescence reduces effectiveness as exposure to HPV often occurs soon after sexual debut 3
2. Missing the opportunity for catch-up vaccination: Many adolescents and young adults who missed vaccination at the recommended age can still benefit 1
3. Assuming prior HPV exposure negates vaccine benefit: Even sexually active individuals may not have been exposed to all vaccine HPV types 1
4. Requiring HPV testing before vaccination: No prevaccination testing is recommended 1
5. Neglecting special populations: Immunocompromised individuals and men who have sex with men should be vaccinated through age 26 years 1

By following these age-specific recommendations, healthcare providers can maximize the cancer prevention benefits of HPV vaccination while ensuring optimal immune response and protection before potential exposure to the virus.