HPV Vaccination Dosing Recommendations
The recommended number of HPV vaccine doses is 2 doses for individuals who initiate vaccination before age 15, and 3 doses for those who start at age 15 or older or who are immunocompromised. 1
Age-Based Dosing Schedule
- For individuals initiating vaccination before their 15th birthday, a 2-dose schedule is recommended with doses administered at 0 and 6-12 months 2, 1
- For individuals 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, 3
- For immunocompromised individuals, a 3-dose schedule is recommended regardless of age at initiation 1, 3
Specific Timing Recommendations
- For the 2-dose schedule, the second dose should be administered 6-12 months after the first dose 2, 1
- For the 3-dose schedule, the minimum intervals are 4 weeks between the first and second doses and 12 weeks between the second and third doses 1
- The immune response is more robust when the interval between doses in a 2-dose schedule is 12 months rather than just 6 months 2
Special Populations
- Immunocompromised individuals require 3 doses regardless of age at initiation 1, 4
- Catch-up vaccination is recommended for all persons through age 26 years who are not adequately vaccinated 1, 3
- Shared clinical decision-making regarding HPV vaccination is recommended for adults aged 27-45 years 3
Clinical Considerations
- HPV vaccination can be started as early as age 9 years at the discretion of the physician 2, 1
- The rationale for administering the HPV vaccine routinely at the 11-12 year visit is to provide protection before potential exposure through sexual activity 2
- Antibody responses are highest in individuals aged 9-15 years compared to those aged 16-26 years 2
- If a vaccine recipient receives a dose earlier than the recommended interval, the minimum interval for it to count in the series is 4 weeks between doses 1 and 2, and 12 weeks between doses 2 and 3 2
Implementation Considerations
- HPV vaccine can be administered at the same visit as other age-appropriate vaccines, using a separate syringe at a different anatomic site 2, 1
- Vaccination should be deferred for people with moderate or severe acute illness 2, 1
- The vaccine should not be given to people with a history of immediate hypersensitivity to yeast or any vaccine component 2, 1
Impact of Dosing Schedule Changes
- The shift from a 3-dose to a 2-dose schedule for younger adolescents was approved by the FDA in 2016 and subsequently recommended by the Advisory Committee on Immunization Practices 5
- This change was based on evidence that the 2-dose schedule in younger individuals produces an immune response comparable to the 3-dose schedule in older individuals 2, 5
- Studies have shown that approximately 28.6% of US teens who initiated HPV vaccination before age 15 received their second dose at least 6 months after the first, meeting the current WHO criteria for up-to-date vaccination 6