What are the dos and don'ts of the Human Papillomavirus (HPV) vaccine, and how effective is it?

HPV Vaccination: Dos, Don'ts, and Efficacy

The HPV vaccine is highly effective and should be routinely administered to all children aged 11-12 years (can start as early as age 9), with catch-up vaccination recommended through age 26 years for those not previously vaccinated. 1

Vaccination Schedule

Dos:

• Administer HPV vaccine according to age-appropriate schedules:
  • Ages 9-14 years: 2-dose schedule (0,6-12 months)
  • Ages 15-26 years: 3-dose schedule (0,1-2,6 months) 2, 1
• Prioritize vaccination before sexual debut for maximum effectiveness 2, 1
• Provide catch-up vaccination for all unvaccinated individuals through age 26 2
• Consider shared decision-making for adults aged 27-45 who may benefit from vaccination 2
• Administer HPV vaccine at the same visit as other age-appropriate vaccines 2

Don'ts:

• Don't delay vaccination until sexual activity begins 2, 1
• Don't administer during pregnancy (postpone until after pregnancy) 2
• Don't skip cervical cancer screening after vaccination 2, 1
• Don't require HPV testing or Pap tests before vaccination 2
• Don't assume vaccination is ineffective for sexually active individuals (they may still benefit from protection against HPV types they haven't been exposed to) 2

Efficacy

The HPV vaccine demonstrates excellent efficacy when administered before exposure to HPV:

• Prevents 70% of cervical cancers (HPV types 16/18) 2
• Prevents 90% of genital warts (HPV types 6/11) 2
• Prevents anal HPV infection and anal intraepithelial neoplasia with 77.5% efficacy 1, 3
• Highly immunogenic with highest antibody responses in ages 9-15 years 2
• Provides protection for at least 5 years without evidence of waning protection 2
• Reduces HPV prevalence in vaccinated populations, showing real-world effectiveness 3, 4

Special Populations

Immunocompromised Individuals:

• Require 3-dose schedule regardless of age 1
• Can safely receive the vaccine 2

Individuals with Abnormal Pap Tests:

• Can still receive HPV vaccination 2
• Should continue with recommended cervical cancer screening 2, 1

Breastfeeding Women:

• Can safely receive HPV vaccination 2

Common Pitfalls to Avoid

1. Delaying vaccination until sexual debut: Maximum benefit occurs when administered before any HPV exposure 2, 1

2. Assuming no benefit for sexually active individuals: Most sexually active people have not been exposed to all vaccine HPV types and can still benefit from vaccination 2

3. Discontinuing cervical cancer screening after vaccination: The vaccine does not protect against all HPV types that cause cervical cancer, so screening must continue 2, 1

4. Administering incorrect dosing schedule: Follow the 2-dose schedule for ages 9-14 and 3-dose schedule for ages 15+ 2, 1

5. Missing minimum intervals between doses: Minimum interval is 4 weeks between doses 1 and 2, and 12 weeks between doses 2 and 3 2

The current 9-valent HPV vaccine (Gardasil 9) protects against nine HPV types (6,11,16,18,31,33,45,52, and 58), providing broader coverage than earlier vaccine formulations 5, 3.