HPV Vaccination After Incomplete Series
This patient should continue the vaccination series from where he left off without restarting, receiving doses 2 and 3 at the appropriate intervals, as interrupted HPV vaccine series do not need to be restarted regardless of the time elapsed. 1, 2
Rationale for Continuing (Not Restarting) the Series
The CDC explicitly states that if the HPV vaccine schedule is interrupted, the vaccine series does not need to be restarted. 1 When the series is interrupted after the first dose, the second dose should be administered as soon as possible, followed by the third dose with an interval of at least 12 weeks between doses 2 and 3. 1
For adults who initiated vaccination at age 15 years or older (which applies to this 56-year-old patient), a complete series consists of 3 doses total: 1
- Dose 2: administered as soon as possible (originally 1-2 months after dose 1)
- Dose 3: at least 12 weeks after dose 2, with a minimum of 24 weeks after dose 1 1
Age Considerations and Benefit in This Patient
While this patient is 56 years old and outside the routine vaccination age range, several factors support completing the series:
The FDA has licensed HPV vaccines for adults through age 45 years, with shared clinical decision-making recommended for ages 27-45. 1 Although this patient is beyond age 45, the presence of recurrent genital warts indicates ongoing HPV exposure and potential benefit from protection against other HPV types. 3, 4
Key benefits for this patient include:
- Protection against HPV types 16 and 18 (causing 70% of cervical and anal cancers) even if already infected with types 6 or 11 (which cause genital warts) 3
- Patients with genital warts can be infected simultaneously with multiple HPV types, making vaccination beneficial for protection against types not yet acquired 3
- The quadrivalent vaccine protects against HPV types 6,11,16, and 18 3
Important Counseling Points
The vaccine will NOT treat existing genital warts or prevent recurrence of current warts. 3 It only provides protection against future infections with vaccine-type HPV strains not yet acquired. 3, 4
Critical caveats for this patient:
- Genital warts commonly recur after treatment, especially in the first 3 months, and vaccination does not change this natural history 3
- The vaccine is most effective when administered before exposure to HPV through sexual activity, so benefit may be diminished in sexually active adults with multiple lifetime partners 1
- Vaccine effectiveness might be low among persons with risk factors for HPV infection, such as adults with multiple lifetime sex partners and likely previous infection with vaccine-type HPV 1
Practical Implementation
Administer dose 2 immediately, followed by dose 3 at least 12 weeks later. 1 The vaccine can be administered at the same visit as other age-appropriate vaccines using separate syringes at different anatomic sites. 1
The patient should be counseled that while the vaccine may provide some protection against HPV types not yet acquired, the primary benefit at this age with recurrent genital warts is likely limited compared to vaccination before sexual debut. 1, 5 However, completing the series remains reasonable given the already-initiated vaccination and potential protection against oncogenic HPV types 16 and 18. 3