As a family‑nurse practitioner, can I prescribe the human papillomavirus (HPV) vaccine for a 37‑year‑old woman?

HPV Vaccination for a 37-Year-Old Woman by FNP

Yes, as a Family Nurse Practitioner you can prescribe the HPV vaccine for a 37-year-old woman, as the vaccine is FDA-licensed through age 45 years, though the decision requires shared clinical decision-making since routine catch-up vaccination is only recommended through age 26 years. 1, 2

Prescriptive Authority

• FNPs have prescriptive authority for vaccines within their scope of practice, and the 9-valent HPV vaccine (Gardasil 9) is FDA-licensed for use in women aged 9-45 years. 3, 2
• The vaccine is legally available for this age group, making prescription appropriate within your scope. 1

Current Guideline Framework for Ages 27-45 Years

Catch-up vaccination is routinely recommended only through age 26 years. 1, 3

For adults aged 27-45 years (including your 37-year-old patient):

• The Advisory Committee on Immunization Practices (ACIP) does not recommend universal catch-up vaccination for all adults in this age range. 1
• Instead, ACIP recommends shared clinical decision-making to determine if vaccination is appropriate based on individual risk factors and potential benefit. 1, 2

Shared Clinical Decision-Making Approach

Assess the following factors to determine if your patient would benefit:

Patients Most Likely to Benefit:

• Those not adequately vaccinated previously who may be at risk for new HPV infection through new or multiple sexual partners. 1
• Women who have not been exposed to all vaccine HPV types (most 37-year-olds are unlikely to have been infected with all nine vaccine types). 4
• Those with limited prior sexual partners or recent changes in relationship status. 1

Key Counseling Points:

• Efficacy decreases with age because most sexually active adults have already been exposed to one or more vaccine HPV types. 1, 5
• The vaccine does not treat existing HPV infections or cervical lesions—it only prevents new infections. 1, 3
• Even with prior HPV exposure or abnormal Pap tests, vaccination can still provide protection against vaccine types not yet acquired. 1, 4
• Cervical cancer screening must continue regardless of vaccination status, as the vaccine does not protect against all oncogenic HPV types. 4, 3

Administration Details

If you decide to vaccinate:

• Administer as a 3-dose series at 0,2, and 6 months (0.5 mL intramuscularly, preferably in the deltoid). 1, 4
• No pre-vaccination testing (Pap test, HPV DNA test, or HPV antibody test) is recommended or necessary. 4, 6
• The vaccine can be given even with abnormal Pap results, while breastfeeding, or when immunocompromised. 4
• Postpone if pregnant, though no safety concerns exist with inadvertent vaccination during pregnancy. 4

Common Pitfalls to Avoid

• Do not assume prior sexual activity is a contraindication—most women have not been exposed to all nine vaccine types. 4, 5
• Do not order pre-vaccination HPV testing—current tests only reflect current viral shedding and do not measure past exposure to all vaccine types. 4
• Do not discontinue cervical cancer screening after vaccination—screening guidelines remain unchanged. 1, 3
• Do not present vaccination as universally recommended for this age—be clear that it requires individualized assessment of benefit. 1