What is the recommended age limit for the Human Papillomavirus (HPV) vaccine?

HPV Vaccination Age Recommendations

HPV vaccination is routinely recommended for individuals aged 9-26 years, with catch-up vaccination recommended for all persons through age 26 years who are not adequately vaccinated, while vaccination is not recommended for adults over age 45 years due to minimal benefit. 1, 2

Age-Specific Recommendations

Children and Adolescents (Ages 9-14)

• Routine vaccination is recommended at age 11 or 12 years, but can start as early as age 9 1
• The American Cancer Society encourages providers to start offering the HPV vaccine at age 9 or 10 years to achieve higher on-time vaccination rates 1
• 2-dose schedule for those who start vaccination before age 15 (doses given 6-12 months apart) 2
• Highest efficacy when administered before sexual debut and potential HPV exposure 2

Adolescents and Young Adults (Ages 15-26)

• Catch-up vaccination recommended for all persons through age 26 years who are not adequately vaccinated 1
• 3-dose schedule for those who start at age 15 or older (0,1-2,6 month schedule) 1
• Providers should inform individuals aged 22-26 years that vaccination at older ages is less effective in lowering cancer risk 1

Adults (Ages 27-45)

• Catch-up HPV vaccination is not recommended for all adults aged >26 years 1
• The Advisory Committee on Immunization Practices (ACIP) recommends shared clinical decision-making for some adults aged 27-45 years 1
• However, the American Cancer Society does not endorse this recommendation due to:
  • Low effectiveness and minimal cancer prevention potential in this age group
  • Burden of decision-making on patients and clinicians
  • Lack of sufficient guidance on selecting individuals who might benefit 1

Adults (Ages >45)

• HPV vaccines are not licensed for use in adults aged >45 years 1, 2
• Not recommended due to limited supporting evidence of benefit 2

Effectiveness Considerations by Age

• Vaccine effectiveness decreases dramatically by age 18 years with minimal benefit by age 20-21 years 1
• Compared with vaccination through age 26 years, vaccination of adults through age 45 years was estimated to prevent only an additional:
  • 0.5% of cancer cases
  • 0.4% of cervical precancer cases
  • 0.3% of genital warts cases over the next 100 years 1

Special Populations

• Immunocompromised individuals: 3-dose schedule regardless of age 2
• Men who have sex with men: Recommended to receive vaccination through age 26 years 2
• Pregnant individuals: Vaccination should be delayed until after pregnancy 1
• Breastfeeding individuals: Can receive HPV vaccine 1

Common Pitfalls and Caveats

1. No pre-vaccination testing is recommended: There is no clinical antibody test to determine if a person is already immune or susceptible to any given HPV type 1, 2

2. Prophylactic, not therapeutic: HPV vaccines prevent new HPV infections but do not:

   • Prevent progression of existing HPV infection to disease
   • Decrease time to clearance of HPV infection
   • Treat HPV-related disease 1

3. Continued screening necessary: Vaccinated individuals should continue cervical cancer screening per guidelines 2

4. Declining effectiveness with age: The significant decline in HPV prevalence among vaccinated and unvaccinated females aged 14-24 years demonstrates both direct protection and herd effects 3, but these benefits diminish substantially with increasing age

The evidence clearly supports prioritizing vaccination at younger ages (9-26 years) when it provides the greatest benefit for preventing HPV-related cancers and diseases.