HPV Vaccination Recommendations
The recommended HPV vaccination regimen is a 2-dose schedule for individuals who initiate vaccination before age 15, with doses administered at 0 and 6-12 months, and a 3-dose schedule (at 0,1-2, and 6 months) for those who initiate vaccination 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, 1
- For individuals initiating vaccination before their 15th birthday, a 2-dose schedule is recommended with doses administered at 0 and 6-12 months 1, 3
- For those 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, 4, 3
- Catch-up vaccination is recommended for all persons through age 26 years who are not adequately vaccinated 1
Dosing Intervals
- For the 2-dose schedule (individuals <15 years): the second dose should be administered 6-12 months after the first dose 1
- For the 3-dose schedule (individuals ≥15 years): the minimum interval between the first and second doses is 4 weeks, and the minimum interval between the second and third doses is 12 weeks 4
- If a vaccination schedule is interrupted, it does not need to be restarted 4
Special Populations
- A 3-dose schedule is recommended for immunocompromised individuals, including those with HIV infection, regardless of age at initiation 1, 4
- Vaccination is recommended through age 26 years for men who have sex with men 2, 4
- For adults aged 22-26 years who have not been previously vaccinated, providers should inform them that vaccination at older ages may be less effective in lowering cancer risk 2, 4
Vaccine Types
- As of 2017, the 9-valent HPV vaccine (9vHPV, Gardasil-9) is the only HPV vaccine available in the United States, protecting against HPV types 6,11,16,18,31,33,45,52, and 58 4
- HPV types 16 and 18 are responsible for approximately 70% of HPV-related cancers 4, 5
Effectiveness Considerations
- HPV vaccination is most effective when administered before potential exposure to HPV through sexual contact 1, 4
- Studies show that individuals who start vaccination after age 15 require three doses to achieve adequate protection against HPV infection 4, 6
- Two-dose HPV vaccine schedules have shown no difference in seroconversion compared to three-dose schedules when administered to younger individuals 5, 6
Important Clinical Considerations
- No prevaccination testing is recommended before vaccination 1, 4
- All women, regardless of vaccination status, should continue to follow cervical cancer screening guidelines 1, 4
- HPV vaccine can be administered at the same visit as other age-appropriate vaccines, using a separate syringe at a different anatomic site 1
Common Pitfalls to Avoid
- Delaying vaccination until older ages reduces effectiveness - prioritize vaccination at the recommended age of 11-12 years 1, 5
- Failing to complete the series with proper intervals between doses may reduce protection - adhere to recommended intervals 4, 6
- Not recognizing that immunocompromised individuals require a 3-dose schedule regardless of age 1, 4
- Assuming that vaccination eliminates the need for cervical cancer screening - screening recommendations remain unchanged for vaccinated individuals 1, 4