What is the recommended human papillomavirus (HPV) vaccination schedule for a 14‑year‑old who has not yet received any HPV vaccine?

HPV Vaccination Schedule for a 14-Year-Old

A 14-year-old who has not yet received any HPV vaccine should receive a 2-dose schedule with the second dose administered 6–12 months after the first dose. 1

Age-Based Dosing Determination

The critical factor is the age at the first dose, not when subsequent doses are given. 1 Since this patient is 14 years old:

• Two doses are required because vaccination is initiated before the 15th birthday 1
• The second dose should be given 6–12 months after the first dose 1
• The minimum acceptable interval between doses is 12 weeks (approximately 3 months), though longer intervals closer to 12 months produce stronger immune responses 1

Rationale for the 2-Dose Schedule

• Younger adolescents (9–14 years) mount significantly higher antibody responses than older individuals receiving 3 doses, which is why the 2-dose schedule is sufficient 1
• Geometric mean antibody titers are markedly higher in 9–14 year-olds compared to 16–26 year-olds 1
• The 2-dose schedule in this age group is based on robust immunogenicity data showing non-inferior immune responses compared to a 3-dose schedule in older individuals 1, 2

Urgency of Vaccination

Vaccination should be completed promptly because:

• Approximately 24% of adolescents report sexual intercourse by 9th grade and 58% by 12th grade 1
• HPV infection incidence is nearly 60% within 2 years after sexual initiation in males 1
• Vaccination is most effective when given before exposure to HPV through sexual activity 1

Current Vaccine Product

• Gardasil 9 (9-valent HPV vaccine) is the only HPV vaccine available in the United States as of January 2017 1
• It protects against HPV types 6,11,16,18,31,33,45,52, and 58 1
• The vaccine prevents approximately 90% of anal cancers, 72% of oropharyngeal cancers, and 90% of genital warts 1

Important Clinical Considerations

• No pre-vaccination testing is required (no HPV DNA test, antibody test, or Pap smear needed) 1
• The vaccine can be co-administered with other age-appropriate vaccines (such as Tdap and meningococcal vaccine) using separate syringes at different anatomic sites 1
• Patients should sit or lie down for 15 minutes after vaccination due to the risk of syncope in adolescents 1
• The vaccine is administered as a 0.5 mL intramuscular injection into the deltoid muscle 1

If the Schedule Is Interrupted

• Do not restart the series if interrupted after the first dose 1
• Simply administer the second dose as soon as possible 1
• There is no maximum time interval between doses—the vaccine does not "expire" or lose effectiveness if delayed 1
• The determining factor remains the age when the first dose was given (14 years), so this patient qualifies for the 2-dose schedule regardless of any extended interval 1

Common Pitfalls to Avoid

• Do not delay vaccination waiting for "optimal" timing—the priority is completing the series before potential HPV exposure 1
• Do not give a third dose unless the patient has an immunocompromising condition 1
• Do not withhold vaccination if the patient is already sexually active—they are unlikely to have been infected with all vaccine HPV types 1

Special Populations Requiring 3 Doses

A 3-dose schedule is required regardless of age for individuals with immunocompromising conditions, including:

• HIV infection 1
• Solid organ transplant recipients 1
• Other immunosuppressive conditions or medications 1

Cancer Screening Reminder

Cervical cancer screening recommendations have not changed for vaccinated individuals—screening remains essential because the vaccine does not protect against all oncogenic HPV types. 1