What are the current recommendations for Human Papillomavirus (HPV) vaccine administration, including age and dosing schedule?

HPV Vaccination Recommendations

HPV vaccination is routinely recommended for all individuals at age 11-12 years, can be started as early as age 9, and should be completed through age 26 years for those not adequately vaccinated earlier. 1, 2

Age Recommendations

• Primary target age group: 11-12 years (routine vaccination)
• Starting age: Can begin as early as 9 years
• Catch-up vaccination:
  • All individuals through age 26 years who were not previously vaccinated or did not complete the series
  • Special emphasis on completing vaccination by the 13th birthday for maximum effectiveness 2

Dosing Schedule

The number of doses depends on the age at first vaccination:

Two-Dose Schedule

• For individuals starting at ages 9-14 years:
  • First dose: Day 0
  • Second dose: 6-12 months after first dose 2, 3

Three-Dose Schedule

• For individuals starting at ages 15-26 years:
  • First dose: Day 0
  • Second dose: 1-2 months after first dose
  • Third dose: 6 months after first dose 2
• For immunocompromised individuals (including those with HIV):
  • Always requires a 3-dose schedule regardless of age at vaccination initiation 2

Special Populations

• Immunocompromised individuals: 3-dose schedule recommended regardless of age at vaccination initiation 2
• Men who have sex with men (MSM): Vaccination specifically recommended through age 26 1, 2
• Pregnant individuals: Vaccination should be delayed until after pregnancy; however, pregnancy testing is not needed before vaccination 1
• Breastfeeding individuals: Can receive HPV vaccine without restrictions 1

Adults Aged 27-45 Years

• Catch-up HPV vaccination is not routinely recommended for all adults aged >26 years 1, 4
• Shared clinical decision-making is recommended for some adults aged 27-45 years who are not adequately vaccinated 1, 2
• HPV vaccines are not licensed for use in adults aged >45 years 1

Clinical Considerations

Vaccine Effectiveness

• The vaccine is most effective when administered before exposure to HPV through sexual activity 1, 2
• The 9-valent HPV vaccine (Gardasil-9) protects against HPV types 6,11,16,18,31,33,45,52, and 58 2, 3
• These HPV types are responsible for approximately 92% of cervical, oropharyngeal, anal, vaginal, vulvar, and penile cancers 1

Common Pitfalls to Avoid

1. Delaying vaccination until perceived sexual debut:

   • Many parents express preferences to delay administration until the onset of sexual activity 5
   • This approach reduces vaccine effectiveness as the vaccine is prophylactic, not therapeutic 2

2. Missing opportunities for vaccination:

   • Studies show that 80.1% of unvaccinated girls had at least one missed opportunity to receive HPV vaccination before age 13 6
   • Administer all vaccines recommended for adolescents at the same visit 6

3. Improper spacing between doses:

   • If the vaccination schedule is interrupted, the series does not need to be restarted 2
   • If the second dose is administered after a shorter-than-recommended interval, that dose should be readministered with proper spacing 2

4. Assuming pre-vaccination testing is needed:

   • No prevaccination testing (e.g., Pap or HPV testing) is recommended before vaccination 1, 2

Implementation Strategies

• Starting HPV vaccination at age 9 can increase time to complete vaccination by the 13th birthday 7
• The American Academy of Pediatrics and American Cancer Society endorse starting vaccination at age 9 7
• Benefits of earlier initiation include additional spacing of recommended vaccines and more focused cancer prevention messaging 7

Cervical Cancer Screening

• All women should continue to follow current cervical cancer screening guidelines regardless of HPV vaccination status 1, 2

HPV vaccination represents one of our most effective tools for cancer prevention, with the potential to prevent tens of thousands of cancers annually when administered according to these recommendations.