What are the recommendations for administering the Human Papillomavirus (HPV) vaccine, specifically Gardasil 9 (9-valent HPV vaccine), to boys?

HPV Vaccination Recommendations for Boys

Boys should receive routine HPV vaccination (Gardasil 9) at age 11-12 years, but vaccination can start as early as age 9 years. 1

Vaccination Schedule

• For boys starting vaccination before age 15:

  • 2-dose schedule is recommended 2
  • First dose at the selected date
  • Second dose 6-12 months after the first dose (12-month interval produces more robust immune response) 1, 2

• For boys starting vaccination at age 15 or older:

  • 3-dose schedule is recommended 2, 3
  • First dose at selected date
  • Second dose 1-2 months after first dose
  • Third dose 6 months after first dose 3

Benefits of HPV Vaccination in Boys

• Prevents HPV-related cancers in males, including: 1

  • Anal cancer (89% associated with HPV) 1
  • Penile cancer (63% associated with HPV) 1
  • Oropharyngeal cancer (72% associated with HPV in males) 1, 4

• Additional benefits include:

  • Prevention of genital warts (90% caused by HPV types 6 and 11) 1, 5
  • Contribution to herd immunity, providing additional protection to females 1

Rationale for Early Vaccination

• Vaccination is most effective when administered before potential exposure to HPV through sexual activity 2, 3
• High incidence of HPV infection occurs shortly after sexual initiation (nearly 40% within first 2 years) 1
• Approximately 24% of adolescents report having sexual intercourse by 9th grade 1
• Stronger immune responses are observed in younger individuals (9-14 years) compared to older age groups 1, 2

Special Considerations

• For men who have sex with men (MSM):

  • Recommended through age 26 years due to higher burden of HPV infection and HPV-related cancers 1, 3
  • Particularly effective for preventing anal cancer and precancers 1, 5

• For immunocompromised individuals (including those with HIV):

  • Recommended through age 26 years 1, 3
  • Should receive 3-dose schedule regardless of age at initiation 3

Practical Implementation

• HPV vaccine can be administered at the same visit as other age-appropriate vaccines using separate syringes at different anatomic sites 2
• If the vaccination schedule is interrupted, it does not need to be restarted 2, 3
• Observation for 15 minutes post-vaccination is recommended due to risk of syncope 6

Important Caveats

• Vaccination at older ages (22-26 years) is less effective in lowering cancer risk 1, 3
• No prevaccination testing is necessary before administering the vaccine 3
• As of January 2017, the 9-valent HPV vaccine (Gardasil-9) is the only HPV vaccine available in the United States 1, 3
• The vaccine is safe with predominantly non-serious side effects 1, 6