How many doses of human papillomavirus (HPV) vaccine can a woman receive?

HPV Vaccine Dosing for Women

Women receive either 2 or 3 doses of HPV vaccine depending on the age at which they start the vaccination series. 1

Age-Based Dosing Schedule

For Girls Starting Before Age 15

• A 2-dose schedule is recommended when vaccination begins at ages 9-14 years 2
• The second dose should be administered 6-12 months after the first dose 3
• This simplified schedule provides adequate protection due to stronger immune responses in younger individuals 4, 3

For Women Starting at Age 15 or Older

• A 3-dose schedule is required when vaccination begins at ages 15-26 years 3, 2
• The recommended timing is: first dose at elected date, second dose 1-2 months later, and third dose 6 months after the first dose 1, 3
• The minimum interval between first and second doses is 4 weeks 1
• The minimum interval between second and third doses is 12 weeks 1
• A minimum of 24 weeks must separate the first and last dose 5

Special Populations Requiring 3 Doses

• Immunocompromised women require 3 doses regardless of age at initiation 3, 2
• This includes women with HIV or other conditions affecting immune function 3

Routine Vaccination Recommendations

Optimal Timing

• Routine vaccination is recommended at ages 11-12 years 1, 6, 4
• Vaccination can begin as early as age 9 years 1, 6, 4
• Vaccination before sexual debut provides maximum protection against HPV-related cancers and genital warts 1, 4

Catch-Up Vaccination

• Catch-up vaccination is recommended for women through age 26 who have not been previously vaccinated or completed the series 1, 4
• Women aged 22-26 should be informed that vaccination at older ages may be less effective in lowering cancer risk 4, 3
• Even sexually active women benefit from vaccination, as they are unlikely to have been infected with all vaccine HPV types 1

Interrupted Schedules

• If the vaccination schedule is interrupted, it does not need to be restarted 1, 3
• Simply administer the next dose as soon as possible while maintaining minimum intervals 1
• If only the third dose is delayed, it should be given as soon as possible 1

Important Clinical Considerations

No Pre-Vaccination Testing Required

• Pap testing and screening for HPV DNA or HPV antibody are not needed before vaccination at any age 1, 4
• It is not possible for clinicians to assess the extent to which sexually active women would benefit from vaccination 1

Continued Screening Necessary

• Vaccination does not replace routine cervical cancer screening 1, 3
• All women should continue cervical cancer screening as recommended regardless of vaccination status 3

Administration Details

• Each dose is 0.5 mL administered intramuscularly, preferably in the deltoid muscle 1
• The vaccine should be shaken well before administration 1
• HPV vaccine can be co-administered with other age-appropriate vaccines such as Tdap and meningococcal vaccines 1, 6, 4

Common Pitfalls to Avoid

• Do not delay vaccination waiting for "ideal" timing - starting at ages 11-12 ensures completion before sexual debut and maximizes immune response 6, 4
• Do not restart the series if interrupted - simply continue with the next dose 1, 3
• Do not withhold vaccination from sexually active women - they still benefit from protection against HPV types to which they have not been exposed 1
• Strong provider recommendation is crucial - lack of provider recommendation is a major reason for non-receipt of HPV vaccine 6