What is the recommended immunization schedule for Human Papillomavirus (HPV) vaccination?

HPV Vaccination Schedule Recommendations

The recommended HPV vaccination schedule includes routine vaccination at age 11-12 years (can start as early as age 9), with a 2-dose schedule for those starting before age 15 (doses at 0 and 6-12 months) and a 3-dose schedule for those starting at age 15 or older (doses at 0,1-2, and 6 months). 1

Age-Based Recommendations

• Routine HPV vaccination is recommended at age 11 or 12 years, but can be started as early as age 9 years 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
• 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, 2
• 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 (ages 9-14 years):

  • First dose: at elected date
  • Second dose: 6-12 months after the first dose 1

• For the 3-dose schedule (ages 15+ years):

  • First dose: at elected date
  • Second dose: 1-2 months after the first dose
  • Third dose: 6 months after the first dose 2
  • Minimum intervals: 4 weeks between first and second doses, and 12 weeks between second and third doses 2

Special Populations

• Immunocompromised individuals should receive a 3-dose schedule regardless of age at initiation 1, 2
• Men who have sex with men should receive HPV vaccination through age 26 if not previously vaccinated 2
• Individuals with a history of genital warts, abnormal Pap test, or positive HPV DNA test should still be vaccinated, as they may not have been infected with all vaccine HPV types 3

Important Clinical Considerations

• No prevaccination testing is recommended before vaccination 1
• Vaccination is most effective when given before exposure to HPV through sexual activity 1, 3
• HPV vaccine can be administered at the same visit as other age-appropriate vaccines, using a separate syringe at a different anatomic site 1
• If the vaccination schedule is interrupted, it does not need to be restarted 2
• The vaccine should be stored at 2°C-8°C (36°F-46°F) and should not be frozen 3

Contraindications and Precautions

• The vaccine should not be given to people with a history of immediate hypersensitivity to yeast or any vaccine component 1
• Vaccination should be deferred for people with moderate or severe acute illness 1
• Vaccination is not recommended during pregnancy; if a woman becomes pregnant during the vaccination series, subsequent doses should be postponed until after delivery 1

Efficacy and Protection

• HPV vaccination is highly effective in preventing persistent HPV infection, cervical cancer precursor lesions, and genital warts caused by HPV types covered by the vaccine 3, 4
• The 9-valent HPV vaccine (Gardasil-9) is currently the only HPV vaccine available in the United States, protecting against HPV types 6,11,16,18,31,33,45,52, and 58 2
• HPV types 16 and 18 are responsible for approximately 70% of HPV-related cancers 2
• The additional five HPV types in the 9-valent vaccine (31,33,45,52, and 58) can prevent up to an additional 14% of anogenital cancers and up to 30% of high-risk precancerous cervical lesions 5

Post-Vaccination Considerations

• Cervical cancer screening recommendations have not changed for vaccinated individuals 1
• All women, regardless of vaccination status, should continue to follow cervical cancer screening guidelines 2