GARDASIL Vaccine Age Recommendations
GARDASIL is routinely recommended for all persons aged 11-12 years (can start at age 9), with catch-up vaccination recommended through age 26 years for anyone not adequately vaccinated previously. 1
Routine Vaccination Ages
- Primary target: 11-12 years old - This is the optimal age for routine HPV vaccination, though administration can begin as early as age 9 years 1
- Catch-up vaccination: Through age 26 years - All persons through age 26 who were not adequately vaccinated previously should receive catch-up vaccination 1
- The vaccine is licensed by the FDA for use in females and males aged 9-45 years 1
Ages 27-45 Years: Shared Clinical Decision-Making
For adults aged 27-45 years, ACIP does not recommend routine catch-up vaccination but instead recommends shared clinical decision-making based on individual risk factors 1. This approach recognizes that:
- Most sexually active adults have already been exposed to HPV, reducing vaccine effectiveness 2
- Approximately 50% of females over age 19 have had 4 or more sexual partners, increasing likelihood of prior HPV exposure 2
- Vaccine effectiveness decreases with increasing number of lifetime sexual partners 2
Decision Algorithm for Ages 27-45
When considering vaccination in this age group, assess the following 2:
- No prior sexual activity: Full benefit expected - strongly consider vaccination 2
- Limited sexual partners (<4): Moderate benefit possible - vaccination may be beneficial 2
- Multiple sexual partners (≥4): Reduced but still possible benefit - discuss individual risk factors 2
- Immunocompromised patients: Conditionally recommended even in ages 27-45 due to increased risk of cervical dysplasia and cancer 2
Special Populations
- Immunocompromised individuals: Should receive a 3-dose series regardless of age, with particular consideration for vaccination through age 45 2, 3
- Men who have sex with men: Vaccination recommended through age 26 years 1
- HIV-infected individuals: Vaccination recommended through age 26 years 1
Important Clinical Caveats
- HPV testing before vaccination is not recommended - Current testing only reflects current viral shedding and does not measure past exposure 2, 4
- Prior HPV exposure does not contraindicate vaccination - The vaccine is safe for individuals with prior HPV exposure, though it does not treat existing infection 2
- Cervical cancer screening must continue regardless of vaccination status, as the vaccine does not protect against all oncogenic HPV types 4
- Pregnancy: Vaccination should be postponed if pregnant, though no safety concerns have been identified with inadvertent vaccination during pregnancy 4