HPV Vaccine Schedule for Adult Females
Adult females who initiate HPV vaccination at age 15 years or older require a 3-dose series administered at 0,1-2, and 6 months. 1, 2, 3
Standard Dosing Schedule for Adults
For women through age 26 years who have not completed the vaccine series, the recommended schedule is:
- Dose 1: Day 0 (initial visit)
- Dose 2: 1-2 months after the first dose (minimum interval of 4 weeks)
- Dose 3: 6 months after the first dose (minimum interval of 24 weeks from dose 1, and at least 12 weeks after dose 2)
Age-Specific Recommendations
Women through age 26 years: Routine catch-up vaccination is recommended for all women in this age group who have not completed the series. 1
Women aged 27-45 years: The FDA has licensed HPV vaccines for adults up to age 45, and shared clinical decision-making is recommended for this age group. 2 However, vaccine effectiveness may be lower in adults with multiple lifetime sexual partners due to likely previous HPV exposure. 2
Important Clinical Considerations
Prior Sexual Activity
- Vaccination is still recommended for sexually active women. 1 While the vaccine is most effective when given before HPV exposure, women who are sexually active should still receive vaccination according to age-based recommendations. 3
- History of genital warts, abnormal Pap test, or positive HPV DNA test is not evidence of prior infection with all vaccine HPV types, and vaccination is still recommended. 1
Interrupted Vaccine Series
If the vaccination series is interrupted, do not restart the series. 2, 3 Simply continue from where you left off:
- If interrupted after dose 1, administer dose 2 as soon as possible
- Ensure at least 12 weeks between doses 2 and 3
- Maintain the minimum interval of 24 weeks between doses 1 and 3
Special Populations
Immunocompromised women: A 3-dose schedule is required regardless of age at initiation. 3 Immune response and vaccine efficacy may be reduced compared to immunocompetent individuals. 1
Pregnancy: Vaccination is not recommended during pregnancy. 1, 3 If a woman becomes pregnant during the series, postpone subsequent doses until after delivery. 3 Breastfeeding women can safely receive the vaccine. 3
Women with abnormal Pap tests: HPV vaccine can be administered, though it does not protect against already acquired infections—only against other vaccine HPV types not yet acquired. 3
Critical Pitfalls to Avoid
Do not delay vaccination waiting for "optimal" timing. The vaccine should be administered as soon as the patient is eligible. 3
Do not restart an interrupted series. This is a common error that results in unnecessary doses. 2, 3
Cervical cancer screening must continue despite vaccination. The vaccine does not protect against all oncogenic HPV types, and screening recommendations do not change for vaccinated women. 2, 3
Do not assume prior HPV exposure means no benefit. Even sexually active women benefit from protection against vaccine HPV types they have not yet acquired. 1
Vaccine Types Available
The nonavalent (9-valent) HPV vaccine protects against HPV types 6,11,16,18,31,33,45,52, and 58, providing protection against approximately 90% of cervical cancers and 90% of anogenital warts. 2, 4
Expected Adverse Events
Local injection-site reactions (pain, redness, swelling) are common and occur in approximately 60% of recipients. 1 These are mild and self-limited. 5 Serious adverse events are rare. 5