What is the Human Papillomavirus (HPV) vaccine series schedule?

HPV Vaccination Schedule

The HPV vaccine series consists of 2 doses for individuals ages 9-14 years (given 6 months apart) and 3 doses for individuals ages 15-26 years (with the second dose given 1-2 months after the first dose and the third dose given 6 months after the first dose). 1

Recommended Schedule by Age Group

Ages 9-14 years

• 2-dose schedule:
  • First dose: at initial visit
  • Second dose: 6 months after first dose (minimum interval of 6 months between doses)
  • Routine vaccination is recommended to begin at ages 11-12 years, but can start as early as age 9 2, 1

Ages 15-26 years

• 3-dose schedule:
  • First dose: at initial visit
  • Second dose: 1-2 months after first dose
  • Third dose: 6 months after first dose (at least 24 weeks after the first dose) 2

Special Populations

Immunocompromised Individuals

• 3-dose schedule regardless of age at vaccination initiation 1
• Includes persons with HIV infection or other immunocompromising conditions

Men Who Have Sex With Men (MSM)

• Recommended through age 26 years 2
• Follow standard dosing schedule based on age at initiation

Catch-up Vaccination

• Females: Recommended through age 26 years if not previously vaccinated 2
• Males: Recommended through age 21 years if not previously vaccinated 2
• Males aged 22-26 years may be vaccinated (especially MSM and immunocompromised individuals) 2

Important Clinical Considerations

Delayed Dosing

• If the vaccination schedule is interrupted, the series does not need to be restarted 3
• Research shows that delays in receiving dose 2 or 3 do not significantly lower immune responses after completion of the series 3

Vaccine Types

• Multiple HPV vaccine formulations exist:
  • Bivalent (2vHPV): Protects against HPV types 16 and 18
  • Quadrivalent (4vHPV): Protects against HPV types 6,11,16, and 18
  • 9-valent (9vHPV): Protects against HPV types 6,11,16,18,31,33,45,52, and 58 2

Efficacy Considerations

• Vaccination is most effective when administered before potential exposure to HPV through sexual activity 2
• However, sexually active individuals should still be vaccinated according to age-based recommendations 2
• Individuals with a history of genital warts, abnormal Pap tests, or positive HPV DNA tests should still receive the vaccine 2

Common Pitfalls to Avoid

1. Unnecessarily restarting the series: If doses are delayed, simply continue the series; don't restart 3

2. Using incorrect intervals for 2-dose schedule: The minimum interval between doses for the 2-dose schedule is 6 months, not 1-2 months as in the 3-dose schedule 1, 4

3. Failing to recognize when a 3-dose schedule is needed: All individuals who start vaccination at age 15 or older require 3 doses, as do immunocompromised individuals regardless of age 1, 4

4. Stopping screening after vaccination: Vaccinated individuals should continue cervical cancer screening according to guidelines 1

By following these evidence-based recommendations, clinicians can optimize the effectiveness of HPV vaccination in preventing HPV-related cancers and diseases.