What is the catch-up schedule for Gardasil9 (Human Papillomavirus 9-valent Vaccine)?

Gardasil 9 Catch-Up Vaccination Schedule

For individuals who did not receive HPV vaccination at the recommended age of 11-12 years, the catch-up schedule for Gardasil 9 includes vaccination through age 26 years for all persons, with a 2-dose or 3-dose schedule depending on age at first dose initiation. 1, 2

Dosing Schedule Based on Age at First Dose

Two-Dose Schedule

• For individuals who start vaccination at ages 9-14 years:
  • First dose: Day 0
  • Second dose: 6-12 months after first dose
  • Minimum interval between doses: 6 months 2, 3

Three-Dose Schedule

• For individuals who start vaccination at ages 15-26 years:
  • First dose: Day 0
  • Second dose: 1-2 months after first dose
  • Third dose: 6 months after first dose 1, 2
  • Minimum intervals: 4 weeks between doses 1 and 2; 12 weeks between doses 2 and 3 1

Special Populations

• Immunocompromised individuals: Always require a 3-dose schedule regardless of age at vaccination initiation 2
• Persons with history of sexual assault: Should be vaccinated starting at age 9 years 1

Managing Interrupted Schedules

• If the vaccination schedule is interrupted, the series does not need to be restarted 1
• If interrupted after the first dose:
  • Give second dose as soon as possible
  • For 3-dose schedule, ensure at least 12 weeks between second and third doses 2
• If the second dose is administered after a shorter-than-recommended interval, that dose should be readministered with proper spacing 1

Efficacy Considerations

• Vaccination is most effective when administered before potential exposure to HPV through sexual contact 1
• Even individuals who may have been exposed to HPV should complete vaccination, as they may still benefit from protection against HPV types they have not yet acquired 1
• Long-term studies show sustained immunogenicity and effectiveness through approximately 7-8 years following vaccination 4

Important Clinical Considerations

• No pre-vaccination testing (Pap test, HPV DNA, or antibody screening) is needed before vaccination at any age 1
• The vaccine is prophylactic, not therapeutic - it will not treat existing HPV infections but prevents new infections 2
• Sexually active individuals who have not been infected with all HPV vaccine types would still benefit from vaccination 1
• The 9-valent HPV vaccine (Gardasil 9) protects against HPV types 6,11,16,18,31,33,45,52, and 58, which are responsible for approximately 90% of cervical cancers and 90% of genital warts 2

Safety Profile

• The 9-valent HPV vaccine has a favorable safety profile based on post-licensure safety studies 5
• Most common adverse events include injection site reactions, syncope, and mild systemic symptoms 5

Remember that while catch-up vaccination is recommended through age 26 years, shared clinical decision-making is recommended for adults aged 27-45 years who were not adequately vaccinated earlier 1.