At what age should the Human Papillomavirus (HPV) vaccine be administered?

HPV Vaccine Timing Recommendations

The HPV vaccine should be routinely administered at age 11-12 years, though vaccination can begin as early as age 9 years, with catch-up vaccination recommended through age 26 for females and age 21 for males (through age 26 for men who have sex with men and immunocompromised individuals). 1

Routine Vaccination Timing

• The Advisory Committee on Immunization Practices (ACIP) and American Cancer Society recommend routine HPV vaccination at age 11-12 years for both males and females 1
• Vaccination series can be started as early as age 9 years at the provider's discretion 1
• The American Academy of Pediatrics (AAP) has recently recommended initiating the HPV vaccine between ages 9-12 years, offering more flexibility than the ACIP recommendation 2

Rationale for Early Vaccination

• Vaccination before potential exposure to HPV through sexual activity provides the greatest protection 1
• Approximately 24% of adolescents report having sexual intercourse by 9th grade and 58.1% by 12th grade, supporting early vaccination 1
• Antibody responses are highest in children aged 9-15 years compared to those 16-26 years 1
• Early vaccination helps disentangle HPV recommendations from discussions about sexuality 2

Dosing Schedule

• For individuals who begin vaccination before age 15: a 2-dose schedule is recommended (0,6-12 months) 1
• For individuals who begin vaccination at age 15 or older: a 3-dose schedule is recommended (0,1-2,6 months) 3
• Immunocompromised individuals should receive 3 doses regardless of age at initiation 3

Catch-Up Vaccination

• Catch-up vaccination is recommended for females through age 26 who have not been vaccinated previously or who have not completed the series 1
• For males, catch-up vaccination is recommended through age 21 years 1
• For men who have sex with men and immunocompromised individuals (including those with HIV), vaccination is recommended through age 26 1

Special Considerations

• Providers should inform individuals aged 22-26 years that vaccination at older ages is less effective in lowering cancer risk 1
• HPV vaccination is not currently recommended for individuals over age 26 1
• Even if someone has been sexually active, they should still receive the vaccine as they may not have been exposed to all vaccine HPV types 1
• Pap testing and screening for HPV DNA or HPV antibody are not needed before vaccination at any age 1

Clinical Pitfalls to Avoid

• Delaying vaccination until older adolescence reduces effectiveness, as exposure to HPV often occurs soon after sexual debut 1
• The cumulative incidence of HPV infection approaches 40% within two years after first sexual intercourse among college women 1
• Missing opportunities to co-administer HPV vaccine with other adolescent vaccines (Tdap, MCV4) at the 11-12 year visit 1
• Providing weak or ambiguous recommendations to parents—strong healthcare provider recommendations are crucial for vaccine acceptance 1

Addressing Health Disparities

• Starting HPV vaccination at age 9 instead of 11-12 may help reduce health disparities in both vaccination coverage and HPV-associated cancers 4
• Alternative vaccination sites and use of non-comprehensive visits (e.g., minor illness visits, sports physicals) should be considered for adolescents with limited access to healthcare 1