HPV Vaccine Schedule and Recommendations

Standard Dosing Schedule for Adults

Adult females who initiate HPV vaccination at age 15 years or older require a 3-dose series administered at 0, 1-2, and 6 months, as recommended by the American College of Physicians, based on evidence from the Annals of Internal Medicine 1, 2, 3
The Centers for Disease Control and Prevention recommends a standard dosing schedule for adults, with dose 1 administered on day 0, dose 2 administered 1-2 months after the first dose, and dose 3 administered 6 months after the first dose, with a minimum interval of 24 weeks between doses 1 and 3, and at least 12 weeks after dose 2 4, 3, 2

The American College of Obstetricians and Gynecologists recommends routine catch-up vaccination for all women through age 26 years who have not completed the series, with a strength of evidence rated as high 4, 1, 6, 5
For women aged 27-45 years, the FDA has licensed HPV vaccines, and shared clinical decision-making is recommended, with consideration of the individual's risk factors and medical history, although vaccine effectiveness may be lower in adults with multiple lifetime sexual partners due to likely previous HPV exposure, with a strength of evidence rated as moderate 2

The Centers for Disease Control and Prevention recommends vaccination for sexually active women, as the vaccine is most effective when given before HPV exposure, but women who are sexually active should still receive vaccination according to age-based recommendations, with a strength of evidence rated as high 4, 5, 3
A history of genital warts, abnormal Pap test, or positive HPV DNA test is not evidence of prior infection with all vaccine HPV types, and vaccination is still recommended, with a strength of evidence rated as high 4, 5
If the vaccination series is interrupted, do not restart the series, but rather continue from where you left off, ensuring at least 12 weeks between doses 2 and 3, and maintaining the minimum interval of 24 weeks between doses 1 and 3, with a strength of evidence rated as high 2, 3

Immunocompromised women require a 3-dose schedule regardless of age at initiation, with a strength of evidence rated as moderate, and immune response and vaccine efficacy may be reduced compared to immunocompetent individuals 3, 4
Vaccination is not recommended during pregnancy, but breastfeeding women can safely receive the vaccine, with a strength of evidence rated as high 6, 3
Women with abnormal Pap tests can receive the HPV vaccine, although it does not protect against already acquired infections, with a strength of evidence rated as moderate 3

Do not delay vaccination waiting for "optimal" timing, as the vaccine should be administered as soon as the patient is eligible, with a strength of evidence rated as high 3
Do not restart an interrupted series, as this can result in unnecessary doses, with a strength of evidence rated as high 2, 3
Cervical cancer screening must continue despite vaccination, as the vaccine does not protect against all oncogenic HPV types, with a strength of evidence rated as high 2, 3
Do not assume prior HPV exposure means no benefit, as even sexually active women benefit from protection against vaccine HPV types they have not yet acquired, with a strength of evidence rated as high 4, 5

The nonavalent (9-valent) HPV vaccine protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58, providing protection against approximately 90% of cervical cancers and 90% of anogenital warts, with a strength of evidence rated as high 2

Local injection-site reactions, such as pain, redness, and swelling, are common and occur in approximately 60% of recipients, and are mild and self-limited, with a strength of evidence rated as high 6, 7
Serious adverse events are rare, with a strength of evidence rated as high 7