From the Guidelines
The patient under 25 who has only had 2 doses of Gardasil does not need to restart the immunization series, but rather should complete the series with a third dose, as the current recommendation is a 3-dose series for those who initiated the vaccine series at 15 years of age or older 1.
HPV Vaccination Schedule
The recommended schedule for Gardasil is 3 doses, with the second dose given 1-2 months after the first dose, and the third dose given 6 months after the first dose. However, for individuals who initiated the vaccine series between 9-14 years of age, a 2-dose series is recommended, with the second dose given 6-12 months after the first dose 1.
Completing the Series
If the patient has fallen behind schedule, they do not need to restart the series but should receive the remaining dose as soon as possible. There is no maximum interval between doses, so even if it has been years since the previous dose, the series can still be completed with just the remaining dose. This approach is based on immunological principles showing that previously administered doses remain effective and the immune system will respond appropriately to complete the vaccination series 1.
Special Considerations
For patients who started the series before age 15, only 2 doses may be sufficient if given at least 5 months apart, but the standard recommendation for those who started at age 15 or older is to complete all 3 doses. It's also important to note that a series begun with 4vHPV can be completed with 9vHPV, and health care provider recommendation and physician attitude play a major role in the decision to vaccinate against HPV 1.
Key Points
- The patient does not need to restart the series, but rather complete it with a third dose.
- The recommended schedule is 3 doses for those who initiated the vaccine series at 15 years of age or older.
- There is no maximum interval between doses, and the series can still be completed even if it has been years since the previous dose.
- Health care provider recommendation and physician attitude are crucial in the decision to vaccinate against HPV.
From the FDA Drug Label
For persons who are 9 through 14 years old 2-shots *Dose 1: first shot *Dose 2: second shot given between 6 and 12 months after the first shot or 3-shots *Dose 1: first shot *Dose 2: second shot given 2 months after the first shot *Dose 3: third shot given 6 months after the first shot
The patient under 25 who only had 2 doses of Gardasil should not restart immunization, as the recommended schedule for individuals 9 through 14 years old is 2 or 3 shots, depending on the specific circumstances. Since the patient has already received 2 doses, they should consult their healthcare professional to determine if an additional dose is needed. 2
From the Research
HPV Vaccination Schedule
- The Advisory Committee on Immunization Practices (ACIP) recommends a 2-dose schedule for girls and boys who initiate the vaccination series at ages 9 through 14 years 3.
- For persons who initiate the vaccination series at ages 15 through 26 years, three doses are recommended 3.
- If a patient under 25 has only had 2 doses of Gardasil, it is likely that they will need to complete the full 3-dose series, as the 2-dose schedule is only recommended for those who initiate vaccination at ages 9-14 3.
Vaccine Efficacy and Safety
- HPV vaccines have been shown to be highly effective in preventing HPV-related diseases, including cervical precancer and cancer 4, 5, 6.
- The vaccines have been found to be safe, with no increased risk of serious adverse effects 6.
- However, there is moderate-certainty evidence that HPV vaccines may reduce the risk of CIN2+ in older women who are HPV16/18 negative, but not when they are unselected by HPV DNA status 6.
Restarting Immunization
- There is no clear guidance on restarting immunization for a patient who has already received 2 doses of Gardasil, but it is likely that they will need to complete the full 3-dose series 3.
- It is recommended to consult with a healthcare professional to determine the best course of action for completing the vaccination series.