When should the series be two
doses versus three doses?
Since 2007, when the first recommendations for use of human
papillomavirus (HPV) vaccine were published, CDC’s Advisory
Committee on Immunization Practices (ACIP) has recommended a
series of three doses, regardless of the age or health status of
the recipient. In December 2016, ACIP changed the HPV vaccine
recommendations to a two-dose schedule for routine vaccination of
11- and 12-year-olds, as well as for many others, as detailed
What has changed?
ACIP now recommends that healthy adolescents who
begin the HPV vaccine series at 11 to 12 years of age, or at any
time before the 15th birthday, receive a two-dose series (rather
than three doses, as previously recommended).
- The two doses should be separated by six to 12
months, with a minimum interval between doses of five months.
- If only the first dose is administered before the
15th birthday, a second dose will be needed after that birthday
to complete the series.
People who begin the HPV vaccine series on or after the 15th
birthday, as well as people who are younger than age 15 who have
immunocompromising conditions (such as HIV infection, B-lymphocyte
antibody deficiency, or immunosuppressive therapy), should
continue to receive a three-dose HPV vaccine series.
Updated recommendations are not affected by the HPV vaccine
product previously used
The 9-valent HPV vaccine (9vHPV, Gardasil® 9, Merck)
is now the only HPV vaccine being distributed in the U.S.
- People who initiated the HPV vaccine series before
the 15th birthday with a single dose of 9vHPV or any HPV vaccine
that was previously available in the U.S. can complete the
two-dose series with one additional dose of 9vHPV. Example: A
12-year-old who received a single dose of 4-valent HPV vaccine
(Gardasil, Merck) and is now age 16, can complete the two-dose
series with one dose of 9vHPV.
- Two doses of any HPV vaccine previously available
in the U.S. can be counted as a valid two-dose series as long as
the first dose was administered before the 15th birthday, and
the two doses were separated by at least five months. Example: A
17-year-old who received two doses of 2-valent HPV (Cervarix®,
GSK) at age 11 years can be considered fully vaccinated if the
two doses were separated by at least five months. If the two
doses were separated by less than five months, the person should
receive a third dose of 9vHPV to complete the series.
Vaccine Education Center resources
Editor’s note: The November issue of Vaccine Update also
addressed this topic in the
News and Views section and includes information about
vaccinating those who already completed HPV2 or HPV4 as does the
VEC HPV Q&A and the winter 2016 webinar.