What is the recommended Gardasil (Human Papillomavirus vaccine) schedule for individuals above 21 years old?

Gardasil Schedule for Adults Above 21 Years Old

For individuals above 21 years old, HPV vaccination is recommended through age 26 for females and males, with a 3-dose schedule administered at 0,1-2 months, and 6 months. 1

Age-Specific Recommendations

Ages 21-26 years:

• Females: Routine catch-up vaccination recommended through age 26 1
• Males: Routine catch-up vaccination recommended through age 21; may be vaccinated through age 26 1
• Special populations: Vaccination recommended through age 26 regardless of gender for:
  • Men who have sex with men
  • Immunocompromised individuals (including those with HIV)
  • Individuals with history of HPV-related conditions 1, 2

Ages 27-45 years:

• Not routinely recommended for all adults
• The American Cancer Society does not endorse vaccination in this age group due to:
  • Low effectiveness in cancer prevention
  • Minimal public health benefit (only 0.5% additional cancer cases prevented)
  • Vaccination at older ages is significantly less effective 1, 2

Dosing Schedule for Adults Above 21

For individuals above 21 years old, the recommended schedule is:

• 3-dose series:
  • First dose: Day 0 (baseline)
  • Second dose: 1-2 months after first dose
  • Third dose: 6 months after first dose 1, 2
• Minimum intervals between doses:
  • Between doses 1 and 2: 4 weeks
  • Between doses 2 and 3: 12 weeks 2

Vaccine Formulations

Three HPV vaccine formulations have been licensed:

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

The 9-valent vaccine is currently preferred as it provides the broadest protection 1, 3.

Clinical Considerations

Effectiveness by Age

• HPV vaccination is most effective when administered before potential exposure to HPV through sexual activity
• Effectiveness decreases dramatically by age 18 years
• Minimal benefit noted by age 20-21 years 1, 4
• Providers should inform individuals aged 22-26 years that vaccination at older ages is less effective in lowering cancer risk 1

Completion of Series

• Individuals who started the series should complete it even if they are now older than the recommended age
• No need to restart the series if doses were missed; simply continue where left off 2

Important Caveats

1. No pre-vaccination testing required: HPV DNA testing or Pap tests are not needed before vaccination 2

2. Continue cancer screening: Vaccination does not replace the need for regular cervical cancer screening according to guidelines 2, 5

3. Prior HPV infection: History of genital warts, abnormal Pap tests, or positive HPV DNA tests is not a contraindication; vaccination may still provide protection against HPV types not previously acquired 2

4. Pregnancy: Vaccination should be postponed during pregnancy, but pregnancy testing is not required before vaccination 2

By following these guidelines, healthcare providers can help reduce the burden of HPV-related cancers and diseases, even when vaccinating adults above 21 years of age, though the greatest benefit remains with vaccination at the recommended ages of 11-12 years.