HPV Vaccination Effectiveness and Recommendations

Current Recommendations for HPV Vaccination Dosing

• The Centers for Disease Control and Prevention recommends a 2-dose schedule for individuals initiating vaccination before their 15th birthday, and a 3-dose schedule for those initiating vaccination on or after their 15th birthday, or for persons with certain immunocompromising conditions 1
• The American Cancer Society recommends HPV vaccination routinely at age 11 or 12 years, but it can be started as early as age 9 years 2, 3

Efficacy Considerations by Dosing Schedule

Multi-Dose Efficacy

• A 12-month interval between 2 doses results in a more robust immune response than a 6-month interval 4
• Geometric mean antibody titers against all HPV types in the 9-valent HPV vaccine are higher in the 9- through 14-year-old age groups than in the 16- through 26-year-old women 4

Important Considerations for Vaccination

Age at Vaccination

• Administering the HPV vaccine routinely at the 11- through 12-year-old visit provides the greatest protection by giving the vaccine before the adolescent becomes sexually active 4
• There is a high incidence of HPV infection after sexual initiation, with a cumulative incidence of nearly 40% within the first 2 years after first having sexual intercourse among college women 4

Special Populations

Adults Over Age 26

• The FDA has licensed HPV vaccines for adults up to age 45, and the Advisory Committee on Immunization Practices recommends shared clinical decision-making for adults aged 27 through 45 years 1
• Vaccine effectiveness might be low among persons with risk factors for HPV infection or disease, such as adults with multiple lifetime sex partners and likely previous infection with vaccine-type HPV 1

Practical Implementation

• If the HPV vaccine schedule is interrupted, the vaccine series does not need to be restarted, and if the series is interrupted after the first dose, the second dose should be administered as soon as possible, with an interval of at least 12 weeks between the second and third doses 5, 6
• HPV vaccine can be administered at the same visit as other age-appropriate vaccines using separate syringes at different anatomic sites 5, 6

HPV Vaccination Completion Guidelines

Standard Dosing Schedule

• The American College of Physicians recommends a complete HPV vaccine series consisting of 3 doses total for adults who initiate vaccination at age 15 years or older, with dose 2 administered 1-2 months after dose 1 and dose 3 administered 6 months after dose 1 7, 8, 9
• The Centers for Disease Control and Prevention suggests that dose 2 should be given 1-2 months after dose 1, and dose 3 should be given 6 months after dose 1, with a minimum of 24 weeks after the first dose 8, 10

Age Considerations

• The American Academy of Family Physicians recommends routine catch-up vaccination through age 26 years for all males, with shared clinical decision-making recommended for ages 27-45 years 10, 8

Special Considerations

• The American College of Physicians suggests that men who have sex with men (MSM) may especially benefit from protection against condyloma and anal cancer, supporting completion of the vaccine series 10, 8
• The Infectious Diseases Society of America recommends considering completion of the vaccine series for individuals who are immunocompromised, as they may benefit from protection against HPV-related diseases 10, 8

Protection Against HPV-Related Diseases

• The National Cancer Institute suggests that completing the 3-dose series provides protection against HPV-related cancers, including anal, penile, and oropharyngeal cancers 7