What are the Human Papillomavirus (HPV) vaccine recommendations?

From the Guidelines

The HPV vaccine is recommended for all children at age 11-12 years, though it can be started as early as age 9, and catch-up vaccination is recommended for everyone through age 26 who hasn't been adequately vaccinated. The vaccine is given as a two-dose series if started before age 15, with the second dose administered 6-12 months after the first. For those who begin vaccination at age 15 or older, or who are immunocompromised, a three-dose series is recommended (0,1-2, and 6 months) 1.

Key Points

• The most commonly used HPV vaccine is Gardasil 9, which protects against nine HPV types that cause approximately 90% of cervical cancers and most genital warts 1.
• The vaccine works by stimulating the immune system to produce antibodies against HPV before exposure, preventing infection with these high-risk types.
• Side effects are generally mild and may include pain at the injection site, fever, headache, and fatigue.
• For adults aged 27-45, shared clinical decision-making is recommended, as the vaccine provides less benefit since many people have already been exposed to HPV 1.

Special Considerations

• The American Cancer Society recommends routine HPV vaccination between ages 9 and 12 years to achieve higher on-time vaccination rates, which will lead to increased numbers of cancers prevented 1.
• Providers should inform individuals aged 22 to 26 years who have not been previously vaccinated or who have not completed the series that vaccination at older ages is less effective in lowering cancer risk 1.
• The ACS does not endorse the 2019 Advisory Committee on Immunization Practices recommendation for shared clinical decision making for some adults aged 27 through 45 years who are not adequately vaccinated because of the low effectiveness and low cancer prevention potential of vaccination in this age group 1.

From the FDA Drug Label

GARDASIL 9 is indicated in girls and women 9 through 45 years of age for the prevention of the following diseases: Cervical, vulvar, vaginal, anal, oropharyngeal and other head and neck cancers caused by Human Papillomavirus (HPV) types 16,18,31,33,45,52, and 58. GARDASIL 9 is indicated in boys and men 9 through 45 years of age for the prevention of the following diseases: Anal, oropharyngeal and other head and neck cancers caused by HPV types 16,18,31,33,45,52, and 58.

The HPV vaccine recommendations are as follows:

• The vaccine is recommended for girls and women 9 through 45 years of age to prevent cervical, vulvar, vaginal, anal, oropharyngeal, and other head and neck cancers caused by HPV types 16,18,31,33,45,52, and 58.
• The vaccine is recommended for boys and men 9 through 45 years of age to prevent anal, oropharyngeal, and other head and neck cancers caused by HPV types 16,18,31,33,45,52, and 58.
• The vaccine is administered in a 2-dose or 3-dose schedule, depending on the age of the recipient 2.
• Key points to consider:
  • Vaccination with GARDASIL 9 does not eliminate the necessity for vaccine recipients to undergo screening for cervical, vulvar, vaginal, anal, oropharyngeal, and other head and neck cancers as recommended by a health care provider.
  • GARDASIL 9 has not been demonstrated to provide protection against disease caused by HPV types not covered by the vaccine or HPV types to which a person has previously been exposed through sexual activity.

From the Research

HPV Vaccine Recommendations

• The nonavalent HPV vaccine is effective in preventing the development of high-grade precancerous cervical lesions in noninfected patients 3.
• Vaccination is ideally administered at 11 or 12 years of age, irrespective of the patient's sex 3.
• A two-dose series is recommended if administered before 15 years of age; however, individuals who are immunocompromised require three doses 3.

Age-Specific Recommendations

• Strong recommendations for HPV vaccination varied by age: 65% strongly recommended for ages 9-10,94% for ages 11-12,96% for ages 13-18,82% for age 19-26, and 26% for ages 27-45 years 4.
• Approximately two-thirds of clinicians practicing in federally qualified health centers or safety net settings strongly recommend HPV vaccine series initiation at ages 9-10 4.
• Females were more likely than males to have initiated HPV vaccination by the age of 13 but not by younger ages 5.

Settings for Receiving HPV Vaccination

• A doctor's office was the most common place where HPV vaccination was received (79.2%), followed by clinics, health centers, or other medical facilities (13.5%), health department (4.1%), hospital or emergency room (2.3%), schools (.5%), and pharmacies or stores (.4%) 6.
• Overall, 99.1% of adolescents aged 13-17 years received HPV vaccination at medical settings and only 0.9% at nonmedical settings 6.

Predictors of Vaccine Initiation

• Strength of health provider recommendation regarding HPV vaccination was a particularly salient predictor of vaccine initiation 5.
• Approximately a third of children may be initiating the HPV vaccine series before or during the targeted age range for routine administration of the vaccine 5.