HPV Vaccination Recommendations and Schedule
The HPV vaccine is routinely recommended at age 11 or 12 years, but vaccination can start as early as age 9 years, with catch-up vaccination recommended for all persons through age 26 years who are not adequately vaccinated. 1, 2
Age-Based Recommendations and Dosing Schedule
- For individuals initiating vaccination before their 15th birthday, a 2-dose schedule is recommended with doses administered at 0 and 6-12 months 2, 3
- 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 2, 3
- 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 3
- Catch-up vaccination is recommended for all persons through age 26 years who are not adequately vaccinated 1, 4
- Shared clinical decision-making regarding HPV vaccination is recommended for adults aged 27-45 years who are not adequately vaccinated 1, 4
- HPV vaccines are not licensed for use in adults aged >45 years 1, 4
Special Populations
- Immunocompromised individuals should receive a 3-dose schedule regardless of age at initiation 2, 4
- HPV vaccination should be delayed until after pregnancy, though pregnancy testing is not needed before vaccination 1, 4
- Persons who are breastfeeding or lactating can receive HPV vaccine 1, 4
- No prevaccination testing (e.g., Pap or HPV testing) is recommended to establish the appropriateness of HPV vaccination 1, 2
Vaccine Effectiveness and Clinical Considerations
- HPV vaccination is most effective when given before exposure to HPV through sexual activity 1, 5
- The 9-valent HPV vaccine (Gardasil-9) is the only HPV vaccine currently available in the United States, protecting against HPV types 6,11,16,18,31,33,45,52, and 58 3
- HPV types 16 and 18 are responsible for approximately 70% of HPV-related cancers 3
- Despite vaccination, cervical cancer screening recommendations remain unchanged for vaccinated individuals 1, 2
Important Clinical Considerations
- The duration of immunity following a complete vaccination schedule has not been fully established, though studies show high seropositivity rates at 24 months 6
- Interrupted vaccination schedules do not need to be restarted; additional doses should be administered as soon as possible 3
- HPV vaccines are prophylactic only and do not treat existing HPV infections or HPV-related diseases 4, 5
- Vaccine effectiveness might be lower among persons with certain immunocompromising conditions 4
Considerations for Shared Decision-Making (Ages 27-45)
- New sex partners at any age increase risk for acquiring new HPV infections 4
- HPV vaccine efficacy is high among persons who have not been exposed to vaccine-type HPV before vaccination 4, 5
- Most sexually active adults have already been exposed to some HPV types 4
- Persons in long-term, mutually monogamous relationships are not likely to acquire new HPV infections 4
- No clinical antibody test can determine whether a person is already immune or still susceptible to any given HPV type 4
Emerging Recommendations
- Recent evidence suggests that starting HPV vaccination at age 9 instead of ages 11-12 may help improve vaccination rates and reduce health disparities in HPV-associated cancers 7
- Early vaccination is particularly important for populations with limited healthcare access who may not receive regular preventive care during early adolescence 7
HPV vaccination remains one of the most effective strategies for preventing HPV-related cancers, with the greatest benefit achieved when administered before potential exposure to the virus through sexual activity.