HPV Vaccination Recommendations

HPV vaccine is routinely recommended at ages 11 or 12 years. Vaccination may begin as early as age 9 years if needed.

Everyone through age 26 years should receive HPV vaccination if they were not adequately vaccinated when younger.

The vaccine series consists of either two or three doses depending on the age at first vaccination.

Vaccination is not routinely recommended for adults older than 26 years. Adults aged 27 through 45 years may still receive HPV vaccine after discussing their personal risk factors and potential benefits with a clinician.

Vaccination in adults 27–45 years generally provides less benefit because many people in this age group have already been exposed to HPV.

HPV vaccination prevents new HPV infections. HPV vaccination does not treat existing HPV infections or diseases. The vaccine works most effectively when administered before any exposure to HPV.

Dosing Schedules

Two doses of HPV vaccine are recommended for individuals who start the vaccination series before their 15th birthday. The second dose should be given 6 to 12 months after the first dose.

If the two-dose series is administered less than 5 months apart, a third dose is required to complete the series.

Three doses are recommended for those starting the series at ages 15 through 26 years. Three doses are also recommended for immunocompromised individuals, including those with HIV infection, aged 9 through 26 years.

The recommended three-dose schedule is administered at 0, 1–2, and 6 months.

Contraindications and Precautions

A history of a severe allergic reaction such as anaphylaxis to a previous HPV vaccine dose or any vaccine component is a contraindication for further HPV vaccination.

The 9-valent HPV vaccine is produced using Saccharomyces cerevisiae (baker's yeast) and should not be given to individuals with immediate hypersensitivity to yeast.

Moderate or severe acute illness is a precaution, and vaccination should be postponed until the illness improves. Mild illness, including mild respiratory infections or diarrhea, with or without fever, is not a reason to delay HPV vaccination.

Pregnancy

HPV vaccine is not recommended for use during pregnancy. Women known to be pregnant should delay starting the HPV vaccination series until after the pregnancy ends.

Pregnancy testing is not required before HPV vaccination. If a woman is vaccinated and later learns she was pregnant at the time, no action is needed because no evidence shows harm from HPV vaccines during pregnancy.

The remaining doses should be delayed until after pregnancy. Women vaccinated during pregnancy may contact the manufacturer's registry for reporting and guidance.

Vaccine Safety

HPV vaccines have undergone extensive safety evaluations and are considered very safe. Scientific research consistently shows that the health benefits of HPV vaccination far outweigh potential risks.

All vaccines used in the United States, including HPV vaccines, undergo rigorous testing before being licensed by the FDA. The 9-valent HPV vaccine (Gardasil 9) was evaluated in clinical trials involving more than 15,000 males and females.

Clinical trial data demonstrated that the vaccine is safe and effective. Post-licensure monitoring continues to confirm the safety profile of HPV vaccines.

Adverse Reactions

The most common adverse reactions reported during HPV vaccine clinical trials were local reactions at the injection site. Pain, redness, or swelling at the injection site occurred in 20% to 90% of vaccine recipients.

A temperature of 100°F (38°C) within 15 days after vaccination was reported in 10% to 13% of recipients. The rate of fever was similar among vaccine and placebo groups.

Systemic symptoms such as nausea, dizziness, muscle aches, or general discomfort have been reported. These systemic symptoms occurred at similar rates in both vaccinated individuals and placebo recipients.

No serious adverse events have been associated with HPV vaccination. Continuous monitoring by CDC and FDA ensures ongoing safety oversight.

Fainting (syncope) can occur after any medical procedure, including vaccination. Adolescents should be seated or lying down during vaccination and remain in that position for 15 minutes afterward to prevent injuries from falls.