What is the recommended age range for Human Papillomavirus (HPV) vaccination and screening?

HPV Vaccination and Screening Age Recommendations

Routine HPV vaccination should be administered at age 11-12 years, with catch-up vaccination recommended for all persons through age 26 years. 1

Routine Vaccination Schedule

Start vaccination at age 11-12 years for maximum cancer prevention benefit. 1, 2

• Vaccination can begin as early as age 9 years if clinically appropriate 1, 2
• This timing provides protection before sexual debut, when vaccine effectiveness is highest 2
• Antibody responses are strongest in children aged 9-15 years compared to older adolescents and young adults 2

Dosing Schedule by Age

For individuals starting vaccination before age 15 years: 2-dose series at 0 and 6-12 months 3, 2

For individuals starting vaccination at age 15 years or older: 3-dose series at 0,1-2, and 6 months 1, 3

For immunocompromised individuals: 3-dose series regardless of age at initiation 3, 2

Catch-Up Vaccination (Ages 13-26 Years)

All persons through age 26 years who are not adequately vaccinated should receive catch-up HPV vaccination. 1

• This recommendation applies equally to males and females 1
• Vaccination remains beneficial even for sexually active individuals, as they are unlikely to have been exposed to all vaccine-type HPV strains 3, 4
• No pre-vaccination testing (Pap test, HPV DNA test, or antibody testing) is required or recommended 1, 2
• Prior history of genital warts, abnormal Pap tests, or positive HPV tests is NOT a contraindication to vaccination 3

Adults Aged 27-45 Years

Catch-up HPV vaccination is NOT routinely recommended for all adults aged 27-45 years. 1

Shared clinical decision-making may be considered for select individuals aged 27-45 years, though the American Cancer Society explicitly does not endorse this approach due to minimal benefit. 1, 3

Key Considerations Against Routine Vaccination in This Age Group:

• Vaccination of adults through age 45 would prevent only an additional 0.5% of cancer cases compared to vaccination through age 26 3
• Most sexually active adults have already been exposed to HPV 1, 3
• Vaccine effectiveness decreases dramatically by age 18 years with minimal benefit by age 20-21 years 3
• The number needed to vaccinate to prevent one cancer case is 6,500 for ages 27-45 versus 202 for the routine program 3

Factors That May Favor Vaccination (Ages 27-45):

• New sex partners or anticipating new partners in the future 1, 3
• Men who have sex with men 3
• Immunocompromised status 3
• Persons in long-term monogamous relationships are unlikely to benefit 1, 3

HPV vaccines are not licensed for use in adults over age 45 years. 1, 3

Special Populations

Pregnancy: Delay vaccination until after pregnancy; however, pregnancy testing before vaccination is not required 1

Breastfeeding/lactating persons: Can receive HPV vaccine 1, 4

Immunocompromised individuals: Require 3-dose schedule regardless of age; vaccine effectiveness may be lower but vaccination is still recommended through age 26 3

Critical Pitfalls to Avoid

• Do not delay vaccination to older adolescence - effectiveness decreases significantly after age 15, as HPV exposure often occurs soon after sexual debut 2
• Do not perform pre-vaccination testing - Pap tests, HPV DNA tests, or antibody tests are not indicated and should not delay vaccination 1, 2
• Do not withhold vaccination based on sexual history - even sexually active individuals benefit from protection against vaccine types they have not yet encountered 3, 4
• Do not confuse prophylaxis with treatment - HPV vaccines prevent new infections but do not treat existing infections, clear current warts, or eliminate established HPV-related disease 3

Cervical Cancer Screening

HPV vaccination does not change cervical cancer screening recommendations - continue routine screening per established guidelines. 1, 3

Real-World Impact

Recent surveillance data demonstrate substantial vaccine impact: among females aged 14-19 years, vaccine-type HPV prevalence decreased by 88% from the pre-vaccine era to 2015-2018, with significant declines even among unvaccinated females suggesting herd protection 5