What are the guidelines for administering Gardasil (Human Papillomavirus vaccine) to adults?

Gardasil (HPV Vaccine) Administration Guidelines for Adults

HPV vaccination is recommended for all persons through age 26 years who are not adequately vaccinated, while shared clinical decision-making is recommended for adults aged 27-45 years based on individual risk factors for new HPV infection. 1

Age-Based Recommendations

Adults through age 26 years

• Catch-up HPV vaccination is universally recommended for all adults through age 26 years who have not been adequately vaccinated 1, 2
• For individuals who initiated vaccination before age 15: complete a 2-dose schedule (0,6-12 months) 2, 3
• For individuals who initiated vaccination at age 15 or older: complete a 3-dose schedule (0,1-2,6 months) 1, 2, 3

Adults aged 27-45 years

• Not routinely recommended for all adults in this age group 1
• Shared clinical decision-making is recommended based on risk factors 1, 2
• Consider vaccination for those most likely to benefit, particularly:
  • Individuals with new sexual partners
  • Men who have sex with men
  • Immunocompromised persons
  • Those not in long-term, mutually monogamous relationships 1, 2

Dosing Schedule

• Ages 9-14 years when initiating series: 2 doses (0,6-12 months)
• Ages 15+ years when initiating series: 3 doses (0,1-2,6 months)
• Immunocompromised persons: 3 doses regardless of age 2, 3

Special Populations

• Immunocompromised individuals: Require 3-dose schedule regardless of age 1, 2
• Men who have sex with men (MSM): Recommended through age 26 years 1, 2
• History of HPV-related conditions: Vaccination still recommended as it may protect against HPV types not yet acquired 1
• Pregnant women: Vaccination should be postponed until after pregnancy 2
• Breastfeeding women: Vaccination is safe to administer 2

Clinical Considerations

• No prevaccination testing (Pap or HPV testing) is recommended 1
• HPV vaccination does not eliminate the need for cervical cancer screening 3
• Vaccine is prophylactic only - it does not treat existing HPV infections or HPV-related diseases 1, 3
• The 9-valent HPV vaccine (Gardasil 9) is currently the only HPV vaccine distributed in the United States 1
• Vaccination efficacy is highest among individuals who have not been exposed to vaccine-type HPV 1, 4
• Vaccine effectiveness decreases with age, particularly after age 26 1, 4, 5

Administration Technique

• Administer via intramuscular injection in the deltoid region of the upper arm or anterolateral thigh 2, 3
• Observe patients for 15 minutes after administration due to risk of syncope 2, 3
• Can be administered at the same visit as other vaccines 2

Common Pitfalls to Avoid

1. Assuming prior HPV exposure makes vaccination useless: Even sexually active adults may not have been exposed to all vaccine-covered HPV types 1

2. Failing to complete the series: Individuals who started the series should complete it even if they are now older than the recommended age 2

3. Overlooking the need for continued screening: HPV vaccination does not replace cervical cancer screening; vaccinated individuals should continue screening per guidelines 1, 3

4. Using incorrect dosing schedule: The number of doses depends on age at first dose and immune status, not current age 2, 3

5. Misunderstanding vaccine limitations: The vaccine only prevents new infections and does not treat existing HPV infections or HPV-related diseases 1, 3