Is there a benefit for women over 45 years to receive the Human Papillomavirus (HPV) vaccine, such as Gardasil 9 (Recombinant Human Papillomavirus 9-valent Vaccine)

HPV Vaccination for Women Over 45 Years of Age

HPV vaccination is not recommended for women over 45 years of age due to limited supporting evidence. 1

Current Recommendations by Age Group

• HPV vaccination is strongly recommended for all women through 26 years of age who have not been adequately vaccinated (high quality evidence) 1
• For women aged 27-45 years, catch-up vaccination can be considered through shared clinical decision-making (moderate quality evidence) 1
• For women over 45 years of age, HPV vaccination is not recommended due to limited supporting evidence (very low quality evidence) 1
• HPV vaccines are not licensed for use in adults aged >45 years 1, 2

Rationale for Age-Based Recommendations

Effectiveness Decreases with Age

• HPV vaccination is most effective when administered to adolescents, especially those aged 9-14 years, who demonstrate robust antibody responses with vaccine effectiveness ranging from 74-93% 1
• Immunogenicity generally declines with age, although studies show antibody responses across different age groups 1
• 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 2

Evidence for Women Over 45 Years

• Clinical trials have primarily focused on women up to age 45 years, with limited data available for women over this age 1
• The American Cancer Society does not endorse vaccination for adults aged 27-45 years due to low effectiveness and minimal cancer prevention potential in this age group 1
• Compared to vaccination through age 26 years, vaccination of adults through age 45 years was estimated to prevent only an additional 0.5% of cancer cases over the next 100 years 1

Risk Factors and Considerations

• Most HPV infections are acquired in adolescence and young adulthood, though some adults remain at risk for new HPV infections 1, 2
• Having a new sexual partner at any age is a risk factor for acquiring new HPV infections 1, 2
• Persons in long-term, mutually monogamous relationships are not likely to acquire new HPV infections 1, 2
• Most sexually active adults have already been exposed to some HPV types, though not necessarily all types targeted by vaccination 1, 2

Important Clinical Considerations

• HPV vaccines are prophylactic only and do not treat existing HPV infections or HPV-related diseases 1, 2
• No clinical antibody test can determine whether a person is already immune or still susceptible to any given HPV type 1, 2
• Vaccine efficacy is high among persons who have not been exposed to vaccine-type HPV before vaccination, but effectiveness might be low among persons with risk factors for prior HPV exposure 1, 2
• HPV vaccination does not change cervical cancer screening recommendations, which should continue to be followed 1, 2

Common Pitfalls and Caveats

• Assuming vaccination will treat existing HPV infections or HPV-related diseases - HPV vaccines are purely preventive 1, 2
• Overestimating the benefit of vaccination in older women who have likely already been exposed to multiple HPV types 1, 2
• Focusing on HPV vaccination as protection against only cervical cancer, when it also protects against other HPV-related cancers including oropharyngeal, anal, vulvar, vaginal, and penile cancers 1, 3
• Neglecting to continue recommended cervical cancer screening regardless of vaccination status 1, 2