Vaccination Guidelines for Immunocompromised Individuals

Introduction to Vaccination Schedules

• Immunocompromised individuals, regardless of age, should receive a three-dose schedule of the HPV vaccine (0, 2, and 6 months) as recommended by the European Centre for Disease Prevention and Control and supported by the Infectious Diseases Society of America 1, 2
• Users of Pre-Exposure Prophylaxis (PrEP) for HIV between 15 and 45 years old should also follow the three-dose schedule, according to recommendations for high-risk populations 1

Vaccination Recommendations for Specific Groups

• Individuals with compromised immune systems, including those with HIV, transplant recipients, immunosuppressant users, and PrEP users, require the complete three-dose schedule to ensure adequate protection, as stated by the Infectious Diseases Society of America and the European Centre for Disease Prevention and Control 1, 2
• The Centers for Disease Control and Prevention (CDC) recommends HPV vaccination for all individuals, including immunocompromised populations, to prevent high-grade cervical lesions and anal intraepithelial neoplasia, with evidence showing high efficacy against cervical intraepithelial neoplasia (CIN) and anal intraepithelial neoplasia (AIN) 3
• HPV vaccination has demonstrated efficacy against persistent HPV infection, which is a precursor to cancer development, providing significant protection against HPV-related cancers, including 70% of cervical cancers (HPV types 16/18) and 90% of genital warts (HPV types 6/11), as supported by multiple studies 4, 5, 6, 7, 8, 9, 10

Special Considerations

• People with HIV have a higher risk of HPV-related cancers and may benefit from vaccination, although efficacy may be lower in immunocompromised populations, according to the European Centre for Disease Prevention and Control and the CDC 1, 4
• Vaccination is recommended for solid organ or hematopoietic stem cell transplant recipients, preferably before transplantation when possible, as advised by the European Centre for Disease Prevention and Control, but not in the first 6 months post-transplant 1
• The American Academy of Pediatrics recommends that vaccination be initiated at ages 9-10, with completion rates higher (97.5%) compared to ages 11-12 (78%), and requires only a 2-dose schedule if started before age 15, with a recommended schedule of 2 doses (0, 6-12 months) for ages 9-14 years, as supported by the CDC and the Morbidity and Mortality Weekly Report 11, 3, 5, 6, 7, 8
• The recommended vaccination schedule is as follows:

12, 13, 14, 8, 3, 15

Contraindications and Side Effects

• Severe allergic reaction to a previous dose of HPV vaccine, severe allergic reaction to yeast, and moderate or severe acute illness (temporary precaution) are contraindications to HPV vaccination, as noted by multiple studies 5, 6, 7, 3, 8
• Common side effects include injection site reactions, headache, and fever, with patients recommended to be observed for 15 minutes after administration due to risk of syncope, as reported by multiple studies 5, 6, 7, 8, 16

Screening and Testing

• HPV vaccination does not eliminate the need for cervical cancer screening, and vaccinated individuals should continue screening per guidelines, according to the CDC and ACOG 3, 8
• No prevaccination testing (e.g., HPV testing) is recommended, as stated by the CDC and the American College of Obstetricians and Gynecologists (ACOG) 3, 8
• No clinical antibody test can determine whether a person is already immune or still susceptible to any given HPV type, as stated by the CDC 3

Duration of Protection

• Protection from HPV vaccination has been demonstrated for at least 10-11 years without evidence of waning immunity, with long-term studies continuing to monitor duration of protection, and potential lifelong protection based on antibody response data, as supported by multiple studies 3, 4