What are the Human Papillomavirus (HPV) vaccine recommendations?

From the Guidelines

The HPV vaccine is recommended for all children at age 11-12 years, though it can be started as early as age 9, and catch-up vaccination is recommended for everyone through age 26 who hasn't been adequately vaccinated. The vaccine series consists of two doses given 6-12 months apart if started before age 15. For those starting at age 15 or older, or for immunocompromised individuals, three doses are recommended (0,1-2, and 6 months) 1.

Key Points

• The most common vaccine used is Gardasil 9, which protects against HPV types that cause approximately 90% of cervical cancers and most genital warts 1.
• The vaccine works by stimulating the immune system to produce antibodies against HPV before exposure, preventing infection with these high-risk types.
• Side effects are generally mild and include pain at the injection site, fever, and headache.
• For adults aged 27-45, shared clinical decision-making is recommended as the vaccine provides less benefit, according to the Advisory Committee on Immunization Practices (ACIP) 1.

Recommendations

• HPV vaccination is routinely recommended at age 11 or 12 years; vaccination can be given starting at age 9 years 1.
• Vaccination is recommended for all persons through age 26 years who are not adequately vaccinated.
• The American Cancer Society (ACS) does not endorse the recommendation for shared clinical decision making for adults aged 27-45 years because of the low effectiveness and low cancer prevention potential of vaccination in this age group 1.

Considerations

• The ACS recommends routine HPV vaccination between ages 9 and 12 years to achieve higher on-time vaccination rates, which will lead to increased numbers of cancers prevented 1.
• Providers should inform individuals aged 22-26 years who have not been previously vaccinated or who have not completed the series that vaccination at older ages is less effective in lowering cancer risk 1.

From the FDA Drug Label

GARDASIL 9 is indicated in girls and women 9 through 45 years of age for the prevention of the following diseases: Cervical, vulvar, vaginal, anal, oropharyngeal and other head and neck cancers caused by Human Papillomavirus (HPV) types 16,18,31,33,45,52, and 58. GARDASIL 9 is indicated in boys and men 9 through 45 years of age for the prevention of the following diseases: Anal, oropharyngeal and other head and neck cancers caused by HPV types 16,18,31,33,45,52, and 58.

The HPV vaccine recommendations are as follows:

• Age 9-14 years: 2-dose or 3-dose regimen
• Age 15-45 years: 3-dose regimen The vaccine is administered intramuscularly, with a dose of 0.5-mL, and the schedule is as follows:
• 2-dose regimen: 0,6 to 12 months
• 3-dose regimen: 0,2,6 months 2

From the Research

HPV Vaccine Recommendations

• The primary goal of human papillomavirus (HPV) vaccination is to reduce morbidity and mortality from HPV-associated disease, especially cervical cancer 3.
• Studies have shown that HPV vaccine effectiveness against cervical cancer at the population level is high among girls vaccinated younger than age 20 years 3.
• The lack of immediate effect in women vaccinated at age 20-30 years points to the importance of early age at vaccination 3.
• Dissemination of the HPV vaccine is critical in reducing the risk of the disease, and various intervention techniques can help to boost vaccine uptake, particularly in underresourced communities 4.
• The best strategy to reduce the incidence of cervical cancer is through the administration of HPV vaccines along with routine cervical screening 5.
• Financial issues are the main barrier to HPV vaccination, and the framework for behavioural and social drivers of vaccination can be used to uncover important aspects linked with HPV vaccination 5.
• Currently, three types of prophylactic vaccines, quadrivalent HPV vaccine, bivalent HPV vaccine, and a new nonavalent HPV vaccine, are commercially available, although they provide limited benefits to eliminate pre-existing infections 6.
• Interventions that leverage social networks and norms, increase confidence in the vaccine's safety, and work to improve access to HPV vaccination services, may increase coverage of the HPV vaccine 7.

Key Factors Associated with Vaccine Uptake

• Greater HPV vaccine hesitancy is associated with having an unvaccinated daughter 7.
• Higher odds of being vaccinated are found among daughters of respondents with greater knowledge about the HPV vaccine and who know someone who has cervical cancer 7.
• Speaking with more people about cervical cancer/HPV vaccination, and perceiving that other parents are vaccinating their daughters against HPV, are strongly associated with daughters' HPV vaccination status 7.

Vaccine Effectiveness and Safety

• HPV vaccines are effective in protecting against 90% of HPV infection, but they provide limited benefits to eliminate pre-existing infections 6.
• More than half of parents/guardians are concerned about the HPV vaccine's safety, and interventions that increase confidence in the vaccine's safety may increase coverage of the HPV vaccine 7.