Ask the Experts: HPV (Human Papillomavirus): Vaccine Recommendations

Results (21)

Gardasil 9 (9vHPV, Merck) is the only HPV vaccine being distributed in the United States. Bivalent Cervarix (2vHPV, GSK) and quadrivalent Gardasil (4vHPV, Merck) are no longer available in the United States.

9vHPV is an inactivated 9-valent vaccine licensed by the FDA in 2014. It contains 7 oncogenic (cancer-causing) HPV types (16, 18, 31, 33, 45, 52, and 58) and two HPV types that cause most genital warts (6 and 11). The 9vHPV vaccine is licensed for people age 9 through 45 years.

Last reviewed: March 2, 2024

The ACIP recommends that routine HPV vaccination be initiated for all children at age 11 or 12 years. ACIP notes that vaccination may be started at age 9 years, if preferred, and should start at age 9 for any child that the provider at risk of exposure to HPV due to suspected abuse. There is no downside to beginning the series at age 9, and this option is often easier for families and clinics because it gives more time to complete the 2-dose series before the 13th birthday. Vaccination is also recommended for all people age 13 through 26 years who have not been vaccinated previously or who have not completed the vaccination series.

Last reviewed: March 2, 2024

No. In June 2019, the Advisory Committee on Immunization Practices (ACIP) voted to recommend routine catch-up HPV vaccination of all previously unvaccinated or incompletely vaccinated males age 22 through 26, matching the recommendation for females. HPV vaccination recommendations now differ by age group only, not by biological sex. There is a routine recommendation for vaccination of all people 9 through 26 years of age and a shared clinical decision-making recommendation based on risk and preference for people 27 through 45 years of age.

Current ACIP recommendations for HPV vaccine are listed at www.cdc.gov/vaccines/hcp/acip-recs/vacc-specific/hpv.html.

Last reviewed: March 2, 2024

Catch-up HPV vaccination is not recommended for adults older than 26 years of age. Instead, shared clinical decision-making regarding HPV vaccination is recommended for some adults aged 27 through 45 years who are not adequately vaccinated and want to be protected from ongoing risk of acquiring new HPV infection.

Ideally, HPV vaccine should be administered before potential exposure to HPV through sexual contact.

Last reviewed: March 2, 2024

Although new HPV infections are most commonly acquired in adolescence and young adulthood, having a new sex partner at any age is a risk factor for acquiring a new HPV infection. In addition, some people have specific behavioral or medical risk factors for HPV infection or disease, including men who have sex with men, transgender people, and people with immunocompromising conditions. HPV vaccine works to prevent infection among people who have not been exposed to vaccine-type HPV before vaccination. A discussion with your patient is the best way to decide together how much the patient may benefit from HPV vaccination to prevent new HPV infections.

Last reviewed: March 2, 2024

Because HPV acquisition generally occurs soon after first sexual activity, vaccine effectiveness will be lower in older age groups as a result of prior infections. In general, exposure to HPV also decreases among individuals in older age groups. Evidence suggests that although HPV vaccination is safe for adults 27 through 45 years, population benefit would be minimal; nevertheless, some adults who are unvaccinated or incompletely vaccinated might be at risk for new HPV infection and might benefit from vaccination in this age range.

Last reviewed: March 2, 2024

No. There is no screening laboratory test that can determine whether a person is already immune or still susceptible to any given HPV type. Most sexually active adults have been exposed to one or more HPV types, although not necessarily all of the HPV types targeted by vaccination. HPV vaccine works to prevent infection with vaccine types to which a person is still susceptible.

Last reviewed: March 2, 2024

Complete the series based on shared clinical decision-making involving the patient’s risk and desire for protection.

Last reviewed: March 2, 2024

ACIP recommends a routine 2-dose HPV vaccine schedule for adolescents who start the vaccination series before the 15th birthday. The two doses should be separated by 6 to 12 months. The minimum interval between doses is 5 calendar months.

A 3-dose schedule is recommended for all people who start the series on or after the 15th birthday and for people with certain immunocompromising conditions (such as cancer, HIV infection, or taking immunosuppressive drugs). The second dose should be given 1 to 2 months after the first dose, and the third dose should be given 6 months after the first dose. The minimum interval between the first and second doses of vaccine is 4 weeks. The minimum interval between the second and third doses of vaccine is 12 weeks. The minimum interval between the first and third dose is 5 calendar months.

If the vaccination series is interrupted, the series does not need to be restarted.

Last reviewed: March 2, 2024

Coverage levels for HPV vaccine are improving but are still inadequate. Results from CDC’s 2022 National Immunization Survey-Teen (NIS-Teen) indicate that for the first time since 2013, HPV vaccination initiation did not increase among adolescents age 13 through 17 years. HPV vaccination initiation actually fell among adolescents insured by Medicaid and remained lowest among the uninsured. The Vaccines for Children (VFC) program ensures access to HPV and other routine vaccines for adolescents who are uninsured or Medicaid-eligible at no cost. It is important that families are aware of this entitlement and the importance of HPV vaccination.

In 2022, 76% of adolescents had received at least 1 dose of HPV vaccine and 62.6% were up to date with HPV vaccination. A summary of the 2022 NIS-Teen survey and trends are available at www.cdc.gov/mmwr/volumes/72/wr/mm7234a3.htm.

Providers can improve uptake of this life-saving vaccine in several ways. First, studies show that missed opportunities are occurring. Some clinics address this by routinely starting the 2-dose vaccination series as early as possible, at age 9, giving them more chances to complete the series on time before age 13. A different strategy to improve uptake is by ‘bundling’ the recommendations for all adolescent vaccines at the first preteen visit. CDC recommends the following discussion starter: “Now that your child is 11, they need three vaccines to help protect against meningitis, HPV cancers, and whooping cough. We’ll give these shots during today’s visit. Do you have any questions about these vaccines?”

One of the main reasons parents give researchers for not vaccinating their adolescents is that the HPV vaccine was not recommended to them by their child’s healthcare provider. CDC urges healthcare providers to strongly and consistently recommend HPV vaccine, especially when patients are age 11 or 12 years. CDC’s “Talking to Parents about HPV Vaccine,” available at www.cdc.gov/hpv/hcp/for-hcp-tipsheet-hpv.pdf can help providers with these conversations.

For more detailed information about HPV vaccination strategies for providers, visit www.cdc.gov/hpv/hcp/boosting-vacc-rates.html and www.cdc.gov/vaccines/partners/routine-immunizations-lets-rise.html.

Last reviewed: March 2, 2024

Explain to the parent that vaccination starting at 11 or 12 years will provide the best protection possible long before the start of any kind of sexual activity. It is standard practice to vaccinate people before they are exposed to an infection, as is the case with measles and the other recommended childhood vaccines. Similarly, we want to vaccinate children before they get exposed to HPV. Studies of HPV vaccine indicate that younger adolescents respond better to the vaccine than older adolescents and young adults. Healthy children vaccinated at this age will need only 2 doses of vaccine rather than 3 doses if vaccinated at an older age. Finally, numerous research studies have shown that getting the HPV vaccine does not make kids more likely to be sexually active or start having sex at a younger age.

Last reviewed: March 2, 2024

There is no ACIP recommendation for additional doses of 9vHPV for people who started the series with 2vHPV or 4vHPV and completed the series with 9vHPV.

Last reviewed: March 2, 2024

ACIP and CDC do not recommend revaccination with 9vHPV of people who have completed a recommended series of another HPV vaccine given at appropriate dosing intervals.

Last reviewed: March 2, 2024

Yes.

Last reviewed: March 2, 2024

Yes. Vaccinated women still need to see their healthcare provider for periodic cervical cancer screening. The vaccine does not provide protection against all types of HPV that cause cervical cancer, so even vaccinated women will still be at a small risk for some cancers from HPV.

Last reviewed: March 2, 2024

Yes. HPV vaccine is recommended for all people through age 26 years, regardless of sexual orientation or gender identity.

Last reviewed: March 2, 2024

ACIP recommends vaccination with 3 doses of HPV vaccine for people age 9 through 26 years with primary or secondary immunocompromising conditions that might reduce cell-mediated or humoral immunity. Examples include B lymphocyte antibody deficiency, T lymphocyte complete or partial defects, HIV infection, malignant neoplasm, transplantation, autoimmune disease, or immunosuppressive therapy. In these circumstances, the 3-dose series is recommended even for those who initiate vaccination at age 9 through 14 years when the routine recommendation is for a 2-dose series.

Last reviewed: March 2, 2024

No. The recommendation for a 3-dose HPV schedule does not apply to people with asplenia and neither does it apply to children 9 through 14 years with asthma, chronic granulomatous disease, chronic liver disease, chronic renal disease, central nervous system, anatomic barrier defects (such as a cochlear implant), complement deficiency, diabetes, heart disease or sickle cell disease unless the person is receiving immunosuppressive therapy for the condition.

Last reviewed: March 2, 2024

Yes. HPV vaccine should be administered to people who are already sexually active if age appropriate. Routine catch-up vaccination of any person not vaccinated on schedule as a preteen is recommended through age 26 years, and vaccination may be considered with shared clinical decision-making between ages 27 and 45. Ideally, patients should be vaccinated before the onset of sexual activity; however, people who have already been infected with one or more HPV types will still be protected from other HPV types in the vaccine that have not been acquired.

Last reviewed: March 2, 2024

In clinical trials, HPV vaccines were shown to be highly effective (more than 95%) for prevention of HPV vaccine-type infection and disease among people without prior infection with the HPV types included in the vaccine. The most likely explanation for this situation is that the patient was exposed to at least HPV types 16 and 18 prior to vaccination. The HPV vaccine is not effective in preventing infection from HPV types a person has been exposed to prior to vaccination. The vaccine also cannot prevent progression of HPV infection or HPV-related disease. The 9vHPV vaccine protects against 9 different types of HPV.

Last reviewed: March 2, 2024

A history of genital warts or clinically evident genital warts indicates previous infection with HPV, most often type 6 or 11, which cause 90% of genital warts. However, people with this history might not have been infected with both HPV 6 and 11 or with the other HPV types included in HPV vaccine. Vaccination will provide protection against infection with HPV serotypes the patient has not already acquired. Providers should advise their patients/clients that the vaccine will not have a therapeutic effect on existing HPV infection or genital warts. It is important, however, that patients receive a full age-appropriate series of HPV vaccine to get full protection from genital warts, in addition to the cancer-causing HPV types in the vaccine.

Last reviewed: March 2, 2024

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