What is the recommended Human Papillomavirus (HPV) vaccine for a 44-year-old receiving it for the first time?

HPV Vaccination for a 44-Year-Old First-Time Recipient

For a 44-year-old receiving the HPV vaccine for the first time, the 9-valent HPV vaccine (Gardasil 9) is recommended through shared clinical decision-making, as it is the only HPV vaccine currently available in the United States. 1

Vaccine Type and Availability

• The 9-valent HPV vaccine (9vHPV, Gardasil 9) is currently the only HPV vaccine distributed in the United States 1
• Previously available vaccines included:
  • Quadrivalent vaccine (4vHPV, Gardasil) - targeted HPV types 6,11,16, and 18
  • Bivalent vaccine (2vHPV, Cervarix) - targeted HPV types 16 and 18
• The 9vHPV vaccine provides protection against:
  • HPV types 16 and 18 (responsible for approximately 70% of cervical cancers)
  • HPV types 6 and 11 (responsible for approximately 90% of genital warts)
  • Five additional high-risk types: 31,33,45,52, and 58 1

Vaccination Recommendations for Adults Aged 27-45

For adults aged 27-45 years (including a 44-year-old):

• HPV vaccination is not routinely recommended for all adults in this age group
• Vaccination should be considered through shared clinical decision-making 1, 2
• The FDA expanded the approved age range for 9vHPV use to include adults aged 27-45 years in 2018 1
• The Advisory Committee on Immunization Practices (ACIP) recommends shared clinical decision-making for adults in this age group 1, 2

Efficacy in Adults Aged 27-45

• In the efficacy trial that supported 9vHPV licensure for adults through age 45:
  • Per-protocol efficacy of 4vHPV among women aged 24-45 years was 88.7% (95% CI = 78.1-94.8)
  • Intention-to-treat efficacy was 47.2% (95% CI = 33.5-58.2) against a combined endpoint of persistent infections, extragenital lesions, and CIN 1+ related to HPV types 6,11,16, or 18 1
• Effectiveness might be lower in persons with multiple lifetime sexual partners due to likely previous exposure to vaccine-type HPV 2

Vaccination Schedule for Adults

• For adults aged 15 years and older (including a 44-year-old):
  • A 3-dose schedule is recommended
  • Doses given at 0,1-2, and 6 months 2
• The vaccine is administered by intramuscular injection into the deltoid muscle of the arm or the high anterolateral area of the thigh 1

Important Considerations for Decision-Making

Factors to consider when deciding on HPV vaccination at age 44:

1. Risk of new HPV infection: Having new sex partners at any age is a risk factor for acquiring new HPV infections 2
2. Previous exposure: Most sexually active adults have already been exposed to some HPV types, though not necessarily all vaccine-targeted types 2
3. Benefit-risk assessment:
   • The incremental benefit of vaccinating adults aged 27-45 years is minimal compared to vaccinating younger individuals 2
   • Number needed to vaccinate (NNV) increases significantly with age:
     • 120 for anogenital warts
     • 800 for high-grade lesions
     • 6,500 for cancer for adults through age 45 years 2

Contraindications and Side Effects

• Contraindications include:
  • Severe allergic reaction to a previous dose of HPV vaccine
  • Severe allergic reaction to yeast
  • Moderate or severe acute illness (temporary precaution) 2
• Common side effects include:
  • Injection site reactions
  • Headache
  • Fever 2

Important Reminders

• No prevaccination testing (e.g., HPV testing) is recommended 2
• HPV vaccination does not eliminate the need for cervical cancer screening, and vaccinated individuals should continue screening per guidelines 2
• HPV vaccines are prophylactic (prevent new infections) but do not treat existing HPV infections or HPV-related disease 2

Remember that while vaccination at age 44 may provide some benefit, the protection will be limited compared to vaccination at younger ages, particularly if you have already been exposed to some HPV types through previous sexual activity.