Is a Human Papillomavirus (HPV) booster dose recommended for individuals who have completed the original HPV vaccine series?

HPV Booster Vaccination After Completing Original Series

No booster dose of HPV vaccine is recommended for individuals who have already completed the original HPV vaccine series. 1, 2

Current Guideline Recommendations

The most recent guidelines explicitly address this question:

• No additional doses should be administered to individuals who have completed either the 2vHPV (bivalent), 4vHPV (quadrivalent), or 9vHPV (nonavalent) vaccine series 1
• This is a weak recommendation based on low-quality evidence, but represents the current consensus 1

Rationale for No Booster

Long-term protection without waning: The original vaccine series provides durable immunity without evidence of clinically significant antibody decline requiring booster doses 3, 4

Lack of supporting evidence: No studies have demonstrated clinical benefit from administering booster doses to individuals who completed their primary series 1

Special Consideration: Switching to 9vHPV After 4vHPV

While booster doses are not recommended, there is one nuanced scenario worth understanding:

• Individuals who completed 4vHPV or 2vHPV series should NOT receive additional 9vHPV doses to gain protection against the five additional HPV types (31,33,45,52,58) 1
• Although one study showed that 98% of individuals who received three additional 9vHPV doses after completing 4vHPV became seropositive for the additional types, no guidelines recommend this practice 1
• Cost-effectiveness analyses suggest that administering a full 9vHPV series after completing 4vHPV is not an efficient vaccination strategy 1

Exception: Completing an Interrupted Series

The only scenario where additional doses are appropriate is completing an incomplete series, not boosting a completed one:

• If someone started but did not complete their original series, they should continue (not restart) the series with any available HPV vaccine 1, 2
• The 9vHPV vaccine may be used to continue or complete a series initiated with 4vHPV or 2vHPV 1
• The series does not need to be restarted if interrupted 2

Important Clinical Pitfall

Do not confuse catch-up vaccination with booster vaccination:

• Catch-up vaccination refers to initiating and completing a primary series in individuals up to age 26 (or 45 in some cases) who were never vaccinated 1, 2, 5
• This is fundamentally different from giving booster doses to those who already completed their series 2

Ongoing Screening Requirements

Completing HPV vaccination does not eliminate the need for cervical cancer screening:

• Vaccinated individuals must continue age-appropriate cancer screening per guidelines 2, 3
• Vaccines do not protect against all oncogenic HPV types, and screening remains essential 2
• Vaccines do not treat existing HPV infections acquired before vaccination 2, 3