Is the Human Papillomavirus (HPV) vaccine effective for individuals at 33 years old?

HPV Vaccination at Age 33

At age 33, HPV vaccination is not routinely recommended, but may be considered through shared clinical decision-making if you are at risk for new HPV infections, though effectiveness is substantially lower than vaccination at younger ages. 1

Official Guideline Recommendations

Catch-Up Vaccination Cutoff

• The Advisory Committee on Immunization Practices (ACIP) recommends catch-up HPV vaccination for all persons through age 26 years only 1
• ACIP explicitly does not recommend routine catch-up vaccination for all adults aged 27-45 years (which includes age 33) 1, 2

Shared Clinical Decision-Making for Ages 27-45

• For adults aged 27-45 years who are not adequately vaccinated, ACIP recommends shared clinical decision-making rather than routine vaccination 1
• This means discussing with your healthcare provider whether vaccination makes sense for your individual situation 1
• The American Cancer Society does not endorse even this shared decision-making approach due to low effectiveness and minimal cancer prevention potential 2

Why Effectiveness Decreases After Age 26

HPV Exposure Patterns

• Most new HPV infections occur in adolescents and young adults, generally soon after first sexual activity 1, 2
• Most sexually active adults have already been exposed to HPV by their late 20s and early 30s 1, 2, 3
• HPV vaccines are prophylactic only—they prevent new infections but do not treat existing infections or clear current HPV-related diseases 2, 1

Age-Specific Effectiveness Data

• Vaccine effectiveness against cervical precancers was 75% when vaccinated before age 17, but only 22% when vaccinated at age 20 or older 1
• In the pivotal trial for adults aged 24-45 years, per-protocol efficacy was 88.7%, but intention-to-treat efficacy (reflecting real-world effectiveness) was only 47.2% 1
• Vaccination of adults through age 45 was estimated to prevent only an additional 0.5% of cancer cases over the next 100 years compared to vaccination through age 26 2

When Vaccination at Age 33 Might Be Considered

Risk Factors Favoring Vaccination

• Having new sex partners or anticipating new partners in the future 2
• Being a man who has sex with men (MSM) 2
• Being immunocompromised or HIV-positive 2
• Having had limited lifetime sexual partners and therefore potentially less prior HPV exposure 3

Important Limitations to Understand

• No clinical test exists to determine whether you are already immune or still susceptible to specific HPV types 2
• The vaccine will not help with any HPV infections you already have 2, 1
• Persons in long-term, mutually monogamous relationships are not likely to acquire new HPV infections and would benefit less 2
• The number needed to vaccinate to prevent one cancer case is 6,500 at age 45 compared to 202 for the current adolescent program 2

Vaccine Details if You Proceed

Available Vaccine

• The 9-valent HPV vaccine (Gardasil 9) is the only HPV vaccine currently distributed in the United States 2, 1
• It protects against HPV types 6,11,16,18,31,33,45,52, and 58 2, 1

Dosing Schedule

• 3-dose schedule is required for adults: doses at 0,1-2 months, and 6 months 2
• The vaccine is FDA-approved for use through age 45 1

Safety Profile

• Few serious adverse events and no vaccine-related deaths were reported in clinical trials of adults aged 27-45 years 1
• The vaccine is safe and immunogenic in adults up to age 55 years 3

Critical Caveats

• HPV vaccination does not change cervical cancer screening recommendations—you still need regular screening regardless of vaccination status 2
• Vaccination should be delayed until after pregnancy if you are pregnant, though it can be given while breastfeeding 2
• Prior HPV infection, abnormal Pap tests, or history of genital warts are not contraindications to vaccination 2
• The vaccine's benefit decreases dramatically with each year of age after 18, with minimal benefit noted by age 20-21 2