What is the recommended age range to receive the Human Papillomavirus (HPV) vaccine?

HPV Vaccine Age Recommendations

Routine HPV vaccination should be initiated at age 11-12 years, with the series able to start as early as age 9 years, and catch-up vaccination is recommended for all persons through age 26 years. 1, 2

Routine Vaccination Schedule

Primary Age Group

• Initiate vaccination at age 11-12 years for both males and females 1, 2
• The vaccination series can begin as early as age 9 years at the provider's discretion 1, 2
• This timing is designed to ensure vaccination occurs before potential HPV exposure through sexual activity 2

Dosing Based on Age at Initiation

• 2-dose schedule (0,6-12 months apart): For individuals who begin vaccination before age 15 years 2, 3
• 3-dose schedule: Required for those starting at age 15 years or older, and for all immunocompromised individuals regardless of age 2, 3

The rationale for early vaccination is compelling: antibody responses are highest in children aged 9-15 years compared to older adolescents and young adults, and approximately 24% of adolescents report sexual intercourse by 9th grade 2. The cumulative incidence of HPV infection approaches 40% within two years after first sexual intercourse 2.

Catch-Up Vaccination

All Persons Through Age 26

• ACIP updated recommendations in June 2019 to recommend catch-up vaccination for all persons through age 26 years who have not been previously vaccinated or completed the series 1
• This represents a change from previous gender-specific recommendations 1

Historical Context (Pre-2019)

Prior to 2019, catch-up recommendations were:

• Females: through age 26 years 1
• Males: through age 21 years (general population) 1
• Men who have sex with men and immunocompromised persons: through age 26 years 1

Ages 27-45 Years: Shared Clinical Decision-Making

ACIP does not recommend routine catch-up vaccination for adults aged 27-45 years, but recognizes that shared clinical decision-making may be appropriate for select individuals. 1

• The FDA expanded approval for 9-valent HPV vaccine (Gardasil 9) to ages 9-45 years in October 2018 1
• However, ACIP stopped short of recommending routine vaccination in this age group due to limited benefit, as most adults have already been exposed to HPV 1
• Some unvaccinated persons in this age range who are at risk for new HPV infection (e.g., those with new sexual partners) might benefit from vaccination 1

Critical Clinical Considerations

Effectiveness Decreases with Age

• Providers should inform individuals aged 22-26 years that vaccination at older ages is less effective in lowering cancer risk 1, 2
• The vaccine does not protect against HPV types already acquired at the time of vaccination 1
• However, even sexually active individuals can benefit from protection against vaccine HPV types they have not yet encountered 1, 2

Common Pitfalls to Avoid

• Do not delay vaccination until older adolescence—this reduces effectiveness as HPV exposure often occurs soon after sexual debut 2
• Do not require HPV testing or Pap testing before vaccination—these are not needed at any age 2
• Do not miss opportunities to co-administer HPV vaccine with other adolescent vaccines (Tdap, meningococcal) at the 11-12 year visit 2
• Provide strong, unambiguous recommendations—weak provider recommendations are a major barrier to vaccine acceptance 2

Special Populations

• Immunocompromised individuals: Require 3-dose schedule regardless of age at initiation 2, 3
• Men who have sex with men: Vaccination recommended through age 26 years 1, 2

Addressing Access Barriers

For adolescents with limited healthcare access, consider using alternative vaccination sites and non-comprehensive visits (minor illness visits, sports physicals) to improve coverage 2.