HPV Vaccination Guidelines for Patients with Sickle Cell Disease

Recommendation Overview

• HPV vaccination is strongly recommended for individuals with sickle cell disease, following the same age‑based schedule as immunocompetent persons, but a three‑dose series should be used regardless of the age at initiation because of their immunocompromised status. 1, 2

Vaccination Schedule

Target Population

• All patients with sickle cell disease aged 9 – 26 years should receive HPV vaccine according to the standard ACIP age‑appropriate timing. 3, 2, 4

Dose Regimen Modification

• A three‑dose schedule (0, 1‑2, and 6 months) must be used for every patient with sickle cell disease, even when vaccination starts before age 15. 2

Dosing Intervals

• The recommended interval between doses is 0 months, 1‑2 months, and 6 months. 7, 1
• Minimum acceptable intervals are ≥4 weeks between dose 1 and dose 2, and ≥12 weeks between dose 2 and dose 3. 7, 1
• If the series is interrupted, do not restart the series; give the next dose as soon as possible. 7

Age‑Specific Recommendations

Routine Initiation (11‑12 years)

• Initiate HPV vaccination at the routine 11‑12 year well‑child visit, ideally before any sexual activity. 7, 1
• Vaccination may be started as early as age 9, which can improve series completion rates. 1

Catch‑Up (13‑26 years)

• Patients with sickle cell disease who have not completed the series by age 26 should receive catch‑up vaccination. 3, 2, 4
• Prior sexual activity does not preclude vaccination; most individuals remain unexposed to at least some vaccine‑covered HPV types. 1, 4

Shared Decision‑Making (27‑45 years)

• For adults aged 27‑45 years, vaccination should be offered based on shared clinical decision‑making that considers individual risk factors and likelihood of new HPV exposure. 4
• Population‑level benefit is limited in this age group due to prior exposure, but selected individuals may still benefit. 4

Safety, Immunogenicity, and Co‑Administration

• HPV vaccines are safe and immunogenic in immunocompromised populations, including those with sickle cell disease. 1
• The vaccine is non‑live and therefore cannot cause infection. 1, 3
• HPV vaccine may be administered simultaneously with other age‑appropriate vaccines (e.g., Tdap, meningococcal conjugate) using separate syringes at different anatomic sites. 7, 1
• Simultaneous administration increases the likelihood of completing all recommended vaccinations. 7

Contraindications and Precautions

• Absolute contraindication: Immediate hypersensitivity to yeast or any vaccine component. 1

• Precautions:

  • Defer vaccination in patients with moderate or severe acute illness until recovery. 1
  • Postpone vaccination during pregnancy; resume remaining doses after delivery. 1
  • Have patients sit or lie down for 15 minutes after injection to prevent syncope, which is common in adolescents. 1

• Not contraindications:

  • Breastfeeding. 1
  • Abnormal or equivocal Pap test results. 1
  • Immunosuppression from sickle cell disease (it is an indication for the modified three‑dose schedule). 1, 3, 2

Administration Details

• Dose: 0.5 mL administered intramuscularly, preferably in the deltoid muscle. 7
• Shake the vaccine vial well before administration. 7
• The 9‑valent HPV vaccine (9vHPV) is the only formulation currently available in the United States and provides the broadest protection against oncogenic HPV types. 5