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 vaccine (Gardasil 9) protects against HPV types that cause approximately 90% of cervical, anal, and other HPV-related cancers, as well as most genital warts 2.
• The vaccine works by stimulating the body to produce antibodies against HPV, preventing infection when exposed to the virus.
• Side effects are generally mild and may include pain at the injection site, fever, headache, and fatigue.
• The vaccine is most effective when given before potential exposure to HPV through sexual activity, which is why early vaccination is emphasized.
• 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 3.

Special Considerations

• Vaccination is recommended for all persons through age 26 years who are not adequately vaccinated, regardless of behavioral or medical risk factors for HPV infection or disease 1.
• For persons who are pregnant, HPV vaccination should be delayed until after pregnancy; however, pregnancy testing is not needed before vaccination 1.
• Persons who are breastfeeding or lactating can receive HPV vaccine 1.

Administration

• Dosing schedules, intervals, and definitions of persons considered adequately vaccinated have not changed 1.
• No prevaccination testing (eg, Pap or HPV testing) is recommended to establish the appropriateness of HPV vaccination 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.
• The vaccine is recommended for boys and men 9 through 45 years of age.
• The recommended dosage and administration is: + 2-dose schedule for 9 through 14 years of age: 0, 6 to 12 months + 3-dose schedule for 15 through 45 years of age: 0, 2, 6 months + 3-dose schedule for 9 through 14 years of age if the second dose is administered earlier than 5 months after the first dose: 0, 2, 6 months 4

From the Research

HPV Vaccine Recommendations

• The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) vaccination at 11-12 years, but the series can begin at age 9 5.
• A survey of clinicians in federally qualified health centers found that 65% strongly recommended HPV vaccination 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 6.
• Initiating vaccination at age 9 is feasible, but questions remain regarding the benefit of this approach to increase coverage 5.

Effectiveness of HPV Vaccination

• The real-world effectiveness of HPV vaccination against cervical cancer is high among girls vaccinated younger than age 20 years 7.
• For women vaccinated at ages 16 years and younger or 17-19 years, the incidence rate ratios of cervical cancer were 0.14 and 0.32, respectively, compared with unvaccinated women 7.
• HPV vaccine effectiveness against cervical cancer at the population level is lower in women vaccinated at age 20-30 years 7.

Screening for Cervical Cancer

• Current US cervical cancer screening guidelines do not differentiate recommendations based on a woman's HPV vaccination status 8.
• Optimal screening strategies for women vaccinated with the bivalent or quadrivalent vaccine involve either cytology or HPV testing alone every five years starting at age 25 or 30 years 8.
• In women vaccinated with the nonavalent vaccine, only primary HPV testing is efficient, involving decreased frequency (ie, every 10 years) starting at either age 35 years or age 30 years 8.
• Screening with HPV testing is the most effective method of detecting precancers and cancers between ages 25 and 65 9.