HPV Vaccination Protocol
Routine HPV vaccination should be initiated at age 11-12 years for all individuals, with a 2-dose schedule for those starting before age 15, and a 3-dose schedule for those starting at age 15 or older. 1, 2, 3
Routine Vaccination Schedule by Age
Ages 9-14 Years: 2-Dose Schedule
- Initiate vaccination at age 11-12 years (can start as early as age 9 years) 1, 3
- Two doses administered 6-12 months apart 3, 4
- This 2-dose schedule provides equivalent protection to the 3-dose schedule when given before age 15 3, 5
- Complete the series by the 13th birthday for greatest effectiveness 1
Ages 15-26 Years: 3-Dose Schedule
- Three doses required for individuals initiating vaccination at age 15 or older 2, 3
- Dosing intervals: First dose at elected date, second dose 1-2 months later, third dose 6 months after first dose 2
- Minimum intervals: 4 weeks between doses 1 and 2; 12 weeks between doses 2 and 3 2
- If the series is interrupted, do not restart—simply continue where left off 2
Age-Specific Recommendations
Catch-Up Vaccination
- Females aged 13-26 years: Vaccination recommended if not previously vaccinated or series incomplete 1
- Males aged 13-21 years: Vaccination recommended if not previously vaccinated or series incomplete 1
- Males aged 22-26 years: May be vaccinated (individual clinical decision) 1
- Important caveat: Providers should inform individuals aged 22-26 years that vaccination at older ages is less effective in lowering cancer risk due to likely prior HPV exposure 1, 2, 6
Special Populations Requiring Extended Coverage
- Men who have sex with men: Vaccination recommended through age 26 years regardless of prior vaccination status 1, 2
- Immunocompromised individuals (including HIV-positive): Vaccination recommended through age 26 years; always use 3-dose schedule regardless of age at initiation 1, 2, 3
Vaccine Selection
Current Available Vaccine
- 9-valent HPV vaccine (9vHPV, Gardasil-9) is the only HPV vaccine available in the United States as of January 2017 2
- Protects against HPV types 6,11,16,18,31,33,45,52, and 58 2
- HPV types 16 and 18 cause approximately 70% of HPV-related cancers 2
Historical Options (if still available)
- Females: Can receive bivalent (2vHPV), quadrivalent (4vHPV), or 9vHPV 1
- Males: Can receive quadrivalent (4vHPV) or 9vHPV 1
Clinical Implementation Pearls
Timing Considerations
- Vaccination is most effective when given before sexual debut and HPV exposure 2, 7
- Immune response is age-dependent, with stronger responses in younger individuals—this is why fewer doses are needed before age 15 2
- Bundle with other routine adolescent vaccines (Tdap and MCV4) at age 11-12 to improve uptake 1
Common Pitfalls to Avoid
- Do not perform prevaccination HPV testing—it is not recommended and does not determine appropriateness of vaccination 2
- Do not withhold vaccination based on sexual history—even sexually active individuals benefit from vaccination against HPV types to which they have not been exposed 6
- Do not restart an interrupted series—simply continue with the next dose 2
- Do not assume vaccinated women do not need cervical cancer screening—all women should continue screening per guidelines regardless of vaccination status 1, 2, 6