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

HPV Vaccine Schedule Recommendations

Routine HPV vaccination should be initiated at age 11-12 years, though it can be started as early as age 9 years, with a 2-dose schedule for those beginning before age 15 and a 3-dose schedule for those starting at age 15 or older. 1

Age-Based Dosing Schedules

For Children and Young Adolescents (Starting Before Age 15)

• Administer 2 doses total when vaccination begins before the 15th birthday 1
• Give the second dose 6-12 months after the first dose 1, 2
• The critical factor is the age when the first dose was given, not when subsequent doses are administered 1
• If the first dose is given at age 14, only one more dose is needed at least 6 months later, regardless of when the second dose is actually given 1

For Older Adolescents and Adults (Starting at Age 15 or Older)

• Administer 3 doses total when vaccination begins at age 15 or older 1, 3
• Follow the schedule: 0,1-2, and 6 months 1, 3
• Minimum intervals: 4 weeks between doses 1 and 2, and 12 weeks between doses 2 and 3 1, 2
• Maintain at least 24 weeks between doses 1 and 3 3

Catch-Up Vaccination

• Vaccinate all persons through age 26 years who are not adequately vaccinated 1, 3
• For ages 27-45 years, use shared clinical decision-making considering individual risk factors, though effectiveness may be lower due to likely prior HPV exposure 3

Special Populations Requiring 3 Doses

Immunocompromised Individuals

• Always use a 3-dose schedule regardless of age at initiation for those with immunocompromising conditions 1, 3
• Be aware that immune response and vaccine efficacy may be reduced compared to immunocompetent individuals 3

Men Who Have Sex With Men

• Vaccinate through age 26 years if not previously vaccinated 1

Managing Interrupted Series

Never restart the vaccination series if interrupted 1, 3, 2. Instead:

• Continue from where you left off 1, 3
• Maintain minimum intervals: 4 weeks between doses 1-2, and 12 weeks between doses 2-3 1, 2
• Longer intervals between doses may actually produce stronger immune responses than shorter intervals 1

Pregnancy and Breastfeeding

• Do not vaccinate during pregnancy; postpone subsequent doses until after delivery 1, 3
• Breastfeeding women can safely receive the vaccine 1, 3

Administration Considerations

Syncope Prevention

• Have patients sit or lie down for 15 minutes after vaccination, as syncope can occur in adolescents following injections 1, 2

Co-Administration

• HPV vaccine can be given at the same visit as other age-appropriate vaccines (Tdap, MCV4) using separate syringes at different anatomic sites 1

Critical Clinical Pitfalls to Avoid

Do Not Delay Vaccination

• Do not wait for "optimal" timing once the patient is eligible 1, 3
• Approximately 24% of adolescents report sexual intercourse by 9th grade, and HPV infection incidence is nearly 60% within 2 years after sexual initiation in males 1, 2

Prior Sexual Activity Is Not a Contraindication

• Vaccinate sexually active individuals according to age-based recommendations 1, 3
• A history of genital warts, abnormal Pap test, or positive HPV DNA test does not mean the person has been infected with all vaccine HPV types 3
• The vaccine will still protect against other vaccine HPV types not yet acquired 1, 3

Screening Must Continue

• Cervical cancer screening recommendations have not changed for vaccinated individuals 1, 3
• The vaccine does not protect against all oncogenic HPV types 1, 3

Contraindications

• History of immediate hypersensitivity to yeast or any vaccine component 1
• Defer vaccination for moderate or severe acute illness 1

No Pre-Vaccination Testing Required

• Do not perform HPV testing before vaccination 1