What is the recommended age and dosing regimen for the Human Papillomavirus (HPV) vaccine, including Gardasil (Recombinant Human Papillomavirus vaccine) and Cervarix (Human Papillomavirus bivalent vaccine)?

HPV Vaccination Recommendations: Age and Dosing Regimen

HPV vaccination is routinely recommended at age 11 or 12 years, but can be started as early as age 9 years, with a 2-dose schedule for those starting before age 15 and a 3-dose schedule for those starting at age 15 or older. 1

Age Recommendations

• Routine HPV vaccination should be initiated at age 11 or 12 years, though vaccination series can be started as early as age 9 years 2, 1
• Recent evidence suggests that starting vaccination at age 9 may help reduce health disparities in HPV vaccination coverage and HPV-associated cancers 3
• Vaccination is recommended for all persons through age 26 years who have not been adequately vaccinated 2
• For adults aged 27-45 years, HPV vaccination is not routinely recommended but may be considered through shared clinical decision making 2
• HPV vaccines are not licensed for use in adults older than 45 years 2

Dosing Schedule Based on Age

For Individuals Starting Before Age 15

• A 2-dose schedule is recommended 1, 4
• First dose at elected date, second dose 6-12 months after the first dose 1
• The minimum interval between the two doses is 5 months 1

For Individuals Starting at Age 15 or Older

• A 3-dose schedule is recommended 1, 5, 4
• Doses administered at 0,1-2, and 6 months 1, 5
• Minimum intervals: 4 weeks between first and second doses, 12 weeks between second and third doses 1, 5

Special Populations

• A 3-dose schedule is recommended for immunocompromised individuals regardless of age at initiation 1, 5
• Vaccination is recommended through age 26 years for men who have sex with men and for immunocompromised persons (including those with HIV infection) if not vaccinated previously 2
• Providers should inform individuals aged 22-26 years who have not been previously vaccinated that vaccination at older ages is less effective in lowering cancer risk 2, 5

Available Vaccines

• As of 2016, the 9-valent HPV vaccine (9vHPV, Gardasil-9) is the only HPV vaccine formulation distributed in the United States 2, 5
• Previously available formulations included:
  • Bivalent vaccine (2vHPV, Cervarix) - protected against HPV types 16 and 18 2, 6, 7
  • Quadrivalent vaccine (4vHPV, Gardasil) - protected against HPV types 6,11,16, and 18 2, 6, 7
• The 9-valent vaccine protects against HPV types 6,11,16,18,31,33,45,52, and 58 5, 6

Important Clinical Considerations

• No prevaccination testing (e.g., Pap or HPV testing) is recommended before vaccination 2, 1
• HPV vaccination is most effective when given before exposure to HPV through sexual activity 1, 8
• If the vaccination schedule is interrupted, it does not need to be restarted 5
• HPV vaccination does not replace the need for cervical cancer screening; regular screening should continue according to guidelines 2, 1
• HPV vaccine can be administered at the same visit as other age-appropriate vaccines, using a separate syringe at a different anatomic site 1

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
• For persons who are pregnant, HPV vaccination should be delayed until after pregnancy; however, pregnancy testing is not needed before vaccination 2
• Persons who are breastfeeding or lactating can receive HPV vaccine 2