What is the recommended vaccination schedule for Gardasil (Human Papillomavirus vaccine)?

Gardasil (HPV) Vaccination Schedule

The recommended HPV vaccination schedule for Gardasil consists of 2 doses for individuals who start vaccination before age 15, with doses given 6-12 months apart, or 3 doses for those who start at age 15 or older, with the second dose given 1-2 months after the first dose and the third dose given 6 months after the first dose. 1

Age-Based Vaccination Schedule

For individuals 9-14 years old:

• 2-dose schedule is recommended:
  • Dose 1: Initial dose
  • Dose 2: 6-12 months after the first dose
• If the second dose is given earlier than 5 months after the first dose, a third dose should be administered at least 4 months after the second dose 1, 2

For individuals 15-45 years old:

• 3-dose schedule is recommended:
  • Dose 1: Initial dose
  • Dose 2: 2 months after the first dose
  • Dose 3: 6 months after the first dose 1, 2

For immunocompromised individuals:

• 3-dose schedule is recommended regardless of age 1, 3

Special Considerations

Minimum Intervals Between Doses

• For the 2-dose schedule: Minimum of 5 months between doses
• For the 3-dose schedule: Minimum of 4 weeks between doses 1 and 2, and minimum of 12 weeks between doses 2 and 3 1

Catch-Up Vaccination

• Catch-up vaccination is recommended through age 26 years for all individuals who have not been adequately vaccinated 1
• For males, routine catch-up vaccination is recommended through age 21, but may be given through age 26, especially for men who have sex with men and immunocompromised individuals 1

Interrupted Schedules

• If the vaccination schedule is interrupted, the series does not need to be restarted
• Individuals who started the series should complete it even if they are now older than the recommended age 1

Efficacy and Protection

The HPV vaccine is highly effective in preventing HPV-related diseases, including:

• 70% of cervical cancers (HPV types 16/18)
• 90% of genital warts (HPV types 6/11)
• High efficacy against anal HPV infection and anal intraepithelial neoplasia 1, 4

The vaccine provides the highest antibody responses in ages 9-15 years and offers protection for at least 5 years without evidence of waning protection 1. Early vaccination before potential exposure to HPV through sexual activity provides optimal protection, though vaccination is still beneficial for sexually active individuals 5.

Important Clinical Considerations

• No prevaccination testing (Pap or HPV testing) is recommended 1
• HPV vaccination does not eliminate the need for cervical cancer screening 1
• The vaccine can be administered at the same time as other recommended vaccines 2
• Patients should be observed for 15 minutes after administration due to risk of syncope 1
• Common side effects include injection site reactions, headache, and fever 2

Contraindications

• Severe allergic reaction to a previous dose of HPV vaccine
• Severe allergic reaction to yeast
• Moderate or severe acute illness (temporary precaution) 2

The HPV vaccination schedule has evolved based on evidence showing that a 2-dose regimen in younger individuals produces an immune response similar to the 3-dose regimen in older individuals 6, allowing for a simplified vaccination approach while maintaining protection against HPV-related diseases.