Two-Dose Gardasil Schedule

For individuals aged 9 through 14 years, administer two 0.5-mL intramuscular doses of Gardasil 9 at 0 and 6–12 months. 1

Dosing Schedule by Age

Standard schedule: First dose at day 0, second dose at 6–12 months later 1
Each dose: 0.5 mL administered intramuscularly, preferably in the deltoid muscle 1
Critical timing rule: If the second dose is given earlier than 5 months after the first dose, a third dose must be administered at least 4 months after the second dose 1
This two-dose schedule provides noninferior immunogenicity compared to the three-dose regimen in older individuals, with antibody geometric mean titer ratios ranging from 1.36 to 5.36 times higher across all nine HPV types 2

Schedule: 0,2, and 6 months 1
Each dose: 0.5 mL intramuscularly 1
The three-dose schedule remains mandatory for this age group because immunogenicity data supporting two-dose schedules were only established in younger adolescents 1, 2

Shake the vial or syringe well immediately before use to maintain proper suspension 1
After agitation, the vaccine should appear as a white cloudy liquid 1
Inspect visually for particulate matter or discoloration; do not use if either is present 1
Administer in the deltoid muscle or anterolateral thigh 1

Observe all patients for 15 minutes after injection to monitor for syncope, which can occur with tonic-clonic movements 1
Have patients sit or lie down during observation; syncope typically responds to restoring cerebral perfusion by maintaining supine or Trendelenburg position 1

Between doses 1 and 2: Minimum 4 weeks (though 5 months is preferred for two-dose schedules) 3
Between doses 2 and 3 (if three doses required): Minimum 12 weeks 3

Do not restart the series—simply give the next dose as soon as possible 3, 4
If only the second dose is delayed in a two-dose schedule, administer it when feasible and ensure at least 5 months have elapsed since dose one (or add a third dose if given earlier) 1
If the third dose is delayed in a three-dose schedule, give it as soon as possible without restarting 3

All immunocompromised persons must receive three doses (0,1–2,6 months) regardless of age at initiation 4, 5
This includes individuals with sickle cell disease, HIV infection, or those receiving immunosuppressive therapy 4, 6
The two-dose schedule does not provide adequate protection in immunocompromised states 4, 5

Defer vaccination during pregnancy; complete remaining doses postpartum 7, 6
Pregnancy is not an absolute contraindication but vaccination should be postponed 6

Gardasil 9 can be administered simultaneously with other age-appropriate vaccines (Tdap, meningococcal conjugate) at the same visit 3, 6
Use separate syringes and different anatomic sites 3, 6
Do not dilute or mix Gardasil 9 with other vaccines 1
Simultaneous administration increases likelihood of completing all recommended vaccinations 3

Do not give only two doses to individuals who start vaccination at age 15 or older—they require three doses 1
Do not give the second dose earlier than 5 months after the first in a two-dose schedule, or you will need to add a third dose 1
Do not restart the series if interrupted—this wastes doses and delays protection 3
Do not assume two doses are adequate for immunocompromised patients—they always need three doses 4, 5
Do not skip the 15-minute post-injection observation period—syncope with injury is a real risk, especially in adolescents 1