HPV Vaccination Guidelines
HPV vaccination is routinely recommended for all children at age 11 or 12 years, but can be started as early as age 9 years, with a 2-dose schedule for those starting before age 15 and a 3-dose schedule for those starting at age 15 or older. 1
Age-Based Recommendations
- Routine HPV vaccination should be initiated at age 11 or 12 years, though the vaccination series can be started as early as age 9 years 2
- For individuals who initiate vaccination before their 15th birthday, a 2-dose schedule is recommended with doses administered at 0 and 6-12 months 1
- For those who initiate vaccination at age 15 years or older, a 3-dose schedule is recommended with doses administered at 0,1-2, and 6 months 1
- Catch-up vaccination is recommended for all persons through age 26 years who have not been adequately vaccinated 2
Dosing Schedule and Intervals
- For the 2-dose schedule (individuals starting before age 15), the minimum interval between doses is 5 months 1
- For the 3-dose schedule (individuals starting at age 15 or older), the minimum intervals are 4 weeks between doses 1 and 2, and 12 weeks between doses 2 and 3 2, 1
- If a dose is administered earlier than the recommended interval, the minimum interval within which the dose can be counted in the series is 4 weeks between doses 1 and 2 and 12 weeks between doses 2 and 3 2
- HPV vaccine can be administered at the same visit as all other recommended vaccines 2, 1
Special Populations
- Vaccination is recommended through age 26 years for men who have sex with men and for immunocompromised persons (including those with HIV infection) who have not been vaccinated previously 2
- A 3-dose schedule is recommended for individuals with certain immunocompromising conditions, regardless of age at initiation 1
- HPV vaccine can be given when a patient has an abnormal or equivocal Papanicolaou test result, when a patient is breastfeeding, or when a patient is immunocompromised due to disease or medication 2
Contraindications and Precautions
- The vaccine should not be given to people with a history of immediate hypersensitivity to yeast or any vaccine component 2, 1
- Immunization should be deferred for people with moderate or severe acute illness 2
- For persons who are pregnant, HPV vaccination should be delayed until after pregnancy; however, pregnancy testing is not needed before vaccination 2
- If a vaccine recipient becomes pregnant, subsequent doses should be postponed until completion of the pregnancy 2
Clinical Considerations
- Vaccination at younger ages (9-12 years) provides better immune responses and is more effective than vaccination at older ages 3, 4
- Providers should inform individuals aged 22-26 years who have not been previously vaccinated or who have not completed the series that vaccination at older ages is less effective in lowering cancer risk 2
- HPV vaccination does not change cervical cancer screening recommendations (i.e., Papanicolaou testing) 2
- Administration of HPV vaccine does not change current counseling recommendations for use of barrier methods for the prevention of HPV and other sexually transmitted infections 2
- Recent evidence suggests that initiating the HPV vaccine at age ≤11 years increases completion of the HPV vaccine series compared to initiating at age ≥12 years (73.6% versus 45.1%, respectively) 5
Emerging Trends
- The American Academy of Pediatrics now recommends starting the HPV vaccine series between 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series 3
- Earlier initiation (age 9-10) may help disentangle HPV recommendations from discussions of sexuality and may alleviate vaccine hesitancy 3
- Clinicians report that recommending the HPV vaccine at ages 9-10 years is feasible, compatible with workflows, and generally acceptable to parents 4