What is the recommended schedule for administering the Human Papillomavirus (HPV) vaccine, including Gardasil (quadrivalent human papillomavirus vaccine) and Gardasil 9 (nonavalent human papillomavirus vaccine)?

HPV Vaccination Schedule Recommendations

The recommended HPV vaccination schedule is a 2-dose series for individuals aged 9-14 years with doses administered at 0 and 6 months, and a 3-dose series (at 0,1-2, and 6 months) for those aged 15-26 years and immunocompromised individuals of any age. 1

Age-Based Vaccination Schedule

Children and Young Adolescents (9-14 years)

• Primary recommendation: 2-dose schedule
  • First dose: Day 0 (initial visit)
  • Second dose: 6 months after first dose
  • Minimum interval between doses: 6 months 1, 2
• Vaccination can begin as early as age 9, with routine vaccination recommended at age 11-12 years 1
• This age group shows the highest antibody responses to vaccination 3

Older Adolescents and Young Adults (15-26 years)

• 3-dose schedule required:
  • First dose: Day 0 (initial visit)
  • Second dose: 1-2 months after first dose
  • Third dose: 6 months after first dose 1
• Minimum intervals if needed: 4 weeks between doses 1 and 2, and 12 weeks between doses 2 and 3 3, 1

Special Populations

• Immunocompromised individuals: 3-dose schedule regardless of age 1, 2
• Men who have sex with men (MSM): Recommended through age 26 1
• Individuals with history of HPV-related conditions: Recommended through age 26 1

Vaccine Formulation

The 9-valent HPV vaccine (Gardasil 9) is currently preferred as it provides the broadest protection against HPV types 6,11,16,18,31,33,45,52, and 58 1, 4. This vaccine protects against:

• 70% of cervical cancers (HPV types 16/18)
• 90% of genital warts (HPV types 6/11)
• Additional cancer-causing types (31,33,45,52,58) that can prevent up to an additional 14% of anogenital cancers 4, 5

Important Clinical Considerations

Catch-up Vaccination

• All individuals who have not completed the full vaccine series should receive catch-up vaccination through age 26 3, 1
• Those who started the series should complete it even if they are now older than the recommended age 1

Administration Guidelines

• Administer via intramuscular injection 1
• Can be given at the same visit as other recommended vaccines 3
• Observe patients for 15 minutes after administration due to risk of syncope (fainting) 3, 1

Contraindications and Precautions

• Contraindication: History of immediate hypersensitivity to yeast or any vaccine component 3
• Precaution: Defer vaccination during moderate or severe acute illness 3
• Pregnancy: Postpone vaccination during pregnancy, but pregnancy testing is not required before vaccination 3, 1
• Breastfeeding: Safe to administer during breastfeeding 3, 1

Follow-up Care

• HPV vaccination does not replace cervical cancer screening 3, 1
• Vaccinated individuals should continue cervical cancer screening according to guidelines 1
• No pre-vaccination testing (Pap test, HPV DNA testing) is needed before vaccination 1

Emerging Evidence

Recent evidence from the National Advisory Committee on Immunization (NACI) in Canada suggests that a 1-dose schedule may be effective for individuals 9 to 20 years of age, with follow-up data available for up to 11 years post-vaccination 6. However, this has not yet been incorporated into the current US recommendations.

Common Pitfalls to Avoid

1. Delaying vaccination: Vaccination is most effective when administered before potential exposure to HPV through sexual activity 1
2. Incomplete series: Ensure patients complete the full recommended series for their age group
3. Neglecting cervical cancer screening: HPV vaccination does not protect against all HPV types that cause cancer; screening must continue 1
4. Incorrect dosing intervals: While minimum intervals exist (4 weeks between doses 1-2,12 weeks between doses 2-3), optimal immune response occurs with the recommended spacing 3, 1