Will the Human Papillomavirus (HPV) vaccine benefit me at 28 years old?

HPV Vaccination at Age 28: Benefits and Considerations

HPV vaccination at age 28 is not routinely recommended, but may benefit you based on your individual risk factors and sexual history through a shared clinical decision-making process with your healthcare provider.

Current Recommendations for Adults Aged 27-45

• The Advisory Committee on Immunization Practices (ACIP) recommends shared clinical decision-making regarding HPV vaccination for adults aged 27 through 45 years who are not adequately vaccinated 1
• HPV vaccination is not universally recommended for all adults over age 26, as the benefit is significantly reduced compared to vaccination at younger ages 1
• The American Cancer Society (ACS) previously did not recommend HPV vaccination for women over age 26 years due to insufficient evidence of benefit 1

Factors Affecting Potential Benefit at Age 28

• Prior HPV exposure: The potential benefit of vaccination decreases with increasing number of lifetime sexual partners and likelihood of previous HPV exposure 1
• Sexual history: If you have had multiple lifetime sexual partners, your likelihood of prior HPV exposure to at least one of the high-risk vaccine types is substantial 1
• Future risk: Having new sexual partners at any age is a risk factor for acquiring new HPV infections 1
• Vaccine efficacy: HPV vaccines are prophylactic (prevent new infections) but do not treat existing infections or HPV-related disease 1

Evidence on Effectiveness in Adults Over 26

• Vaccine effectiveness decreases with age at vaccination:
  • In a Swedish nationwide study, vaccine effectiveness against CIN2 or greater was 75% for individuals vaccinated before age 17,46% for those vaccinated at ages 17-19, and only 22% for those vaccinated at age 20 or older 1
  • When restricted to women in organized cervical screening programs (ages 23-29), there was strong protection for women vaccinated before age 20 but much smaller, non-statistically significant protection for those vaccinated at age 20 or older 1

Considerations for Your Decision

• No immunity testing: No clinical antibody test can determine whether you are already immune or still susceptible to any given HPV type 1
• Sexual activity patterns: If you are in a long-term, mutually monogamous relationship, you are less likely to acquire a new HPV infection 1
• Vaccine effectiveness: Effectiveness might be low among persons with risk factors for HPV infection (e.g., multiple lifetime sex partners) 1
• Cancer prevention: While vaccination may provide some benefit, regular cervical cancer screening should continue according to guidelines regardless of vaccination status 1

Conclusion

• The HPV vaccine may still benefit you at age 28 if you have not been previously exposed to all vaccine HPV types and are at risk for new HPV infections 1, 2
• The decision should be based on an informed discussion with your healthcare provider about your personal sexual history, risk of previous HPV exposure, and potential benefit from vaccination 1
• Even with vaccination at age 28, regular cervical cancer screening remains essential for cancer prevention 1