What are the guidelines for Human Papillomavirus (HPV) vaccination, including recommended age, dosage, and catch-up vaccination?

HPV Vaccination Guidelines

Routine Vaccination: Start at Age 11-12 Years (Can Begin at Age 9)

HPV vaccination should be routinely initiated at age 11-12 years for all individuals, though vaccination can begin as early as age 9 years, with the dosing schedule determined by the age at initiation. 1, 2, 3

Age-Based Dosing Schedule

For children starting before age 15:

• 2-dose schedule is recommended 2, 3, 4
• Second dose given 6-12 months after the first dose 2, 3
• Series should ideally be completed before the 13th birthday for maximum effectiveness 2, 3

For individuals starting at age 15 or older:

• 3-dose schedule is required 1, 2, 4
• Second dose: 1-2 months after first dose 2, 4
• Third dose: 6 months after first dose 2, 4
• Minimum intervals: 4 weeks between doses 1 and 2; 12 weeks between doses 2 and 3 4

The rationale for three doses after age 15 is that immune response to HPV vaccination is age-dependent, with stronger responses in younger individuals. 4

Catch-Up Vaccination Through Age 26

Catch-up HPV vaccination is recommended for all persons through age 26 years who are not adequately vaccinated. 1, 3

This includes:

• Females aged 13-26 years not previously vaccinated or with incomplete series 2
• Males aged 13-21 years not previously vaccinated or with incomplete series 2
• Males aged 22-26 years may be vaccinated, though providers should inform them that vaccination at older ages is less effective due to likely prior HPV exposure 2, 4

Special Populations Requiring 3-Dose Schedule Regardless of Age

The following groups should receive a 3-dose schedule even if starting before age 15: 2, 3, 4

• Men who have sex with men (through age 26 years) 2, 3, 4
• Immunocompromised individuals, including HIV-positive persons (through age 26 years) 2, 3, 4

Adults Aged 27-45 Years: Shared Clinical Decision-Making

Catch-up HPV vaccination is NOT routinely recommended for all adults over age 26 years. 1 Instead, shared clinical decision-making is recommended for some adults aged 27-45 years who are not adequately vaccinated. 1

Key Considerations for Ages 27-45:

• Most sexually active adults have already been exposed to HPV 1
• Vaccine effectiveness is lower due to prior infections 1
• Adults in long-term, mutually monogamous relationships are unlikely to acquire new HPV infections 1
• Having a new sex partner is a risk factor for acquiring new HPV infection 1
• HPV vaccines are prophylactic only—they do not treat existing infections or prevent progression of current infections to disease 1
• Population benefit is minimal in this age group, though some individuals may benefit 1

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

Current Vaccine Available

The 9-valent HPV vaccine (9vHPV, Gardasil-9) is the only HPV vaccine distributed in the United States as of late 2016/January 2017. 2, 3, 4

It protects against HPV types 6,11,16,18,31,33,45,52, and 58. 2, 3 HPV types 16 and 18 cause approximately 70% of HPV-related cancers. 2, 3, 4

Important Clinical Considerations

No prevaccination testing is required:

• No Pap smear or HPV testing needed before vaccination 1, 3, 4
• No clinical antibody test can determine immunity or susceptibility to specific HPV types 1, 3

Timing considerations:

• Vaccination is most effective when given before exposure to HPV through sexual activity 1, 3, 4
• Vaccination should be deferred until after pregnancy is completed, but can be given to breastfeeding mothers 3
• If the vaccination schedule is interrupted, it does not need to be restarted 4

Cervical cancer screening:

• All women should continue to follow cervical cancer screening guidelines regardless of vaccination status 1, 4

Cancer Prevention Impact

HPV vaccination can prevent approximately 28,500 cancers annually in the United States, including most cervical, vulvar, vaginal, anal, oropharyngeal, and penile cancers. 2, 3