What is the recommended age schedule for the Human Papillomavirus (HPV) vaccine?

HPV Vaccine Age Schedule

Routine HPV vaccination should be initiated at age 11 or 12 years, though it can be started as early as age 9 years, with catch-up vaccination recommended for all persons through age 26 years. 1, 2

Routine Vaccination Schedule

Primary Age Recommendation

• Initiate HPV vaccination at age 11 or 12 years as the routine recommendation, bundled with other adolescent vaccines (Tdap and MCV4) 1, 2
• Vaccination can begin as early as age 9 years, which offers flexibility for providers and may improve completion rates before sexual debut 1, 2, 3

Dosing Schedule Based on Age at Initiation

For children starting before age 15:

• 2-dose schedule is sufficient 2, 4
• Administer doses at 0 and 6-12 months apart 2, 4
• The 12-month interval produces stronger immune responses than shorter intervals 2

For adolescents/adults starting at age 15 or older:

• 3-dose schedule is required 1, 2, 5
• Administer at 0,1-2, and 6 months 1, 2, 5
• Minimum intervals: 4 weeks between doses 1 and 2; 12 weeks between doses 2 and 3; 24 weeks between doses 1 and 3 2, 5

Critical point: The age at first dose determines the schedule—not when subsequent doses are given. A patient who starts at age 14 needs only 2 doses total, even if the second dose is delayed until after age 15 2

Catch-Up Vaccination

Ages 13-26 Years

• Catch-up vaccination is recommended for all persons through age 26 years who are not adequately vaccinated 1
• This represents a 2019 harmonization across genders, simplifying previous gender-specific recommendations 1
• Use the 3-dose schedule for anyone initiating at age 15 or older 1, 2, 5

Ages 27-45 Years

• Catch-up vaccination is NOT routinely recommended for all adults in this age group 1
• Instead, use shared clinical decision-making for select individuals who may benefit 1
• Consider vaccination for those at risk for new HPV infection (e.g., new sexual partners, not in long-term monogamous relationships) 1
• Vaccine effectiveness is substantially lower in this age group due to prior HPV exposure 1
• The number needed to vaccinate to prevent one case increases dramatically with age (from 120 at younger ages to 6,500 in older adults) 1

Special Populations

Immunocompromised Individuals

• Always use 3-dose schedule regardless of age at initiation 2, 5
• This includes persons with HIV infection and other immunocompromising conditions 1, 2

Men Who Have Sex with Men (MSM)

• Vaccination recommended through age 26 years 1

Pregnancy and Breastfeeding

• Do not initiate or continue vaccination during pregnancy—postpone remaining doses until after delivery 2, 5
• Breastfeeding women can safely receive the vaccine 2, 5

Administration Considerations

Co-administration

• HPV vaccine can be given at the same visit as other age-appropriate vaccines using separate syringes at different anatomic sites 2
• This approach increases likelihood of completing all recommended adolescent vaccinations on schedule 2

Interrupted Series

• Never restart the series—continue from where you left off 2, 5
• Maintain minimum intervals between remaining doses 2, 5

Pre-vaccination Testing

• No pre-vaccination testing is recommended (no Pap testing, no HPV testing) 1, 2
• Prior abnormal Pap test, positive HPV test, or history of genital warts does not preclude vaccination 2, 5

Critical Pitfalls to Avoid

1. Do not delay vaccination waiting for "optimal" timing—approximately 24% of adolescents report sexual intercourse by 9th grade, and HPV infection incidence is nearly 60% within 2 years of sexual initiation in males 2

2. Do not restart an interrupted series—this results in unnecessary doses and delays completion 2, 5

3. Do not assume sexually active individuals won't benefit—even those with prior HPV exposure benefit from protection against vaccine types not yet acquired 1, 2, 5

4. Do not discontinue cervical cancer screening in vaccinated women—vaccines do not protect against all oncogenic HPV types 2, 5

5. Patients should sit or lie down for 15 minutes after vaccination due to syncope risk in adolescents 2

Rationale for Early Vaccination

The emphasis on ages 11-12 (or even starting at age 9) is based on several key principles:

• Maximum effectiveness occurs before any HPV exposure, which typically happens soon after first sexual activity 1
• Younger adolescents mount stronger immune responses than older individuals—9-14 year-olds achieve higher antibody titers with 2 doses than 16-26 year-olds achieve with 3 doses 2
• Earlier initiation allows more time to complete the series before sexual debut 2, 6
• Starting at age 9-10 may reduce vaccine hesitancy by disentangling HPV recommendations from discussions of sexuality 3

Cancer Prevention Impact

HPV vaccination prevents approximately 28,500 cancers annually in the United States, including most cervical, vaginal, vulvar, anal, penile, and oropharyngeal cancers 1, 2