What is the recommended HPV (Human Papillomavirus) vaccination schedule for adults?

HPV Vaccination Schedule Recommendations for Adults

For adults, HPV vaccination is routinely recommended as catch-up vaccination through age 26 years, while for adults aged 27-45 years, vaccination is based on shared clinical decision-making as the population benefit is minimal in this age group. 1

Age-Based Recommendations and Dosing Schedules

Adults Through Age 26 Years

• Catch-up HPV vaccination is recommended for all persons through age 26 years who are not adequately vaccinated 1, 2
• For adults initiating vaccination before their 15th birthday, a 2-dose schedule is recommended with doses administered at 0 and 6-12 months 2
• For adults initiating vaccination at age 15 years or older, a 3-dose schedule is recommended with doses administered at 0,1-2, and 6 months 1, 2

Adults Aged 27-45 Years

• Catch-up HPV vaccination is not routinely recommended for all adults aged >26 years 1
• Shared clinical decision-making regarding HPV vaccination is recommended for adults aged 27-45 years who are not adequately vaccinated 1, 3
• HPV vaccines are not licensed for use in adults aged >45 years 1
• The population-level benefit of vaccinating adults aged 27-45 years is minimal compared to vaccination at younger ages 1, 4

Dosing Intervals and Administration

• For a 2-dose schedule (those starting before age 15): second dose should be administered 6-12 months after the first dose 2
• For a 3-dose schedule (those starting at age 15 or older): doses should be administered at 0,1-2, and 6 months 1, 2
• Minimum intervals for a 3-dose schedule are 4 weeks between first and second doses, and 12 weeks between second and third doses 2
• No prevaccination testing (e.g., Pap or HPV testing) is recommended to establish the appropriateness of HPV vaccination 1, 2

Special Populations and Medical Conditions

Immunocompromised Individuals

• A 3-dose schedule is recommended for individuals with certain immunocompromising conditions, regardless of age at initiation 1, 2
• Vaccine effectiveness might be lower among persons with certain immunocompromising conditions 1

Pregnancy and Breastfeeding

• HPV vaccination should be delayed until after pregnancy 1
• Pregnancy testing is not needed before vaccination 1
• Persons who are breastfeeding or lactating can receive HPV vaccine 1

Considerations for Shared Decision-Making (Ages 27-45)

Factors Supporting Vaccination

• New sex partners at any age increase risk for acquiring new HPV infections 1
• HPV vaccine efficacy is high among persons who have not been exposed to vaccine-type HPV before vaccination 1
• Some adults may not have been exposed to all HPV types targeted by vaccination 1

Factors Limiting Vaccine Benefit

• Most sexually active adults have already been exposed to some HPV types 1
• Persons in long-term, mutually monogamous relationships are not likely to acquire new HPV infections 1
• No clinical antibody test can determine whether a person is already immune or still susceptible to any given HPV type 1
• HPV vaccines are prophylactic and do not treat existing infections or diseases 1

Effectiveness and Cost-Effectiveness

• The current HPV vaccination program focusing on adolescents is predicted to reduce cervical cancer cases by 59% and non-cervical HPV-associated cancers by 39% over 100 years 4
• Extending vaccination to adults aged 27-45 years is predicted to reduce these outcomes by only an additional 0.2 percentage points each 4
• The number needed to vaccinate (NNV) to prevent one case of cancer increases dramatically with age: 202 for current program vs. 6,500 for extending to age 45 years 1
• Vaccinating adults up to age 45 years costs approximately $1.47 million per quality-adjusted life-year gained, which is substantially less cost-effective than the current recommendation 4

Current Vaccination Coverage and Awareness

• As of 2017, only 36.3% of young adults (19-26 years) and 9.7% of mid-adults (27-45 years) had received at least one HPV vaccine dose 3
• Gender disparities exist, with higher vaccination rates among females (51.5% for young adult females vs. 21.2% for young adult males) 3
• While most adults aged 27-45 years are aware of HPV (72.9%) and HPV vaccination (67.1%), knowledge about HPV causing non-cervical cancers is limited (36.1%) 5

Clinical Implications

• HPV vaccination does not change cervical cancer screening recommendations 1, 2
• HPV vaccines prevent infection with HPV types that cause most cervical cancers, anal cancers, and a subset of vulvar, vaginal, penile, and oropharyngeal cancers 6
• HPV vaccines are prophylactic only and do not treat existing HPV infections or HPV-related diseases 1

Common Pitfalls and Caveats

• Delaying vaccination until adulthood significantly reduces vaccine effectiveness due to prior HPV exposure 1, 7
• Assuming that older adults cannot benefit from vaccination; some may still benefit, particularly those with new sexual partners 1, 7
• Failing to recognize that the immune response from natural HPV infection may not provide complete protection against re-infection 7
• Overlooking the importance of completing the full vaccination series (2 or 3 doses depending on age at initiation) 2
• Using prevaccination testing to determine vaccination appropriateness, which is not recommended 1