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Human Papillomavirus (HPV) Vaccine


Margot L. Savoy

, MD, MPH, Lewis Katz School of Medicine at Temple University

Reviewed/Revised Jul 2023

Preparations of HPV Vaccine

Three vaccines protect against HPV:

Only the 9-valent vaccine is now available in the United States.

Recombinant DNA technology is used to prepare HPV vaccines from the major capsid (L1) protein of HPV. The L1 proteins self-assemble into noninfectious, nononcogenic virus-like particles (VLPs).

Preparations reference

Indications for HPV Vaccine

The HPV vaccine is a routine childhood vaccination (see CDC: Child and Adolescent Immunization Schedule by Age). The U.S. Food and Drug Administration (FDA)–approved indication for the 9-valent vaccine has recently been expanded to include adults age 27 through 45 years for prevention of certain HPV-related cancers and diseases; the current recommendations from the Advisory Committee on Immunization Practices are

  • For both males and females up to age 26 years: HPV vaccine is recommended at age 11 or 12 years (can start at age 9 years) and for previously unvaccinated or not adequately vaccinated patients up through age 26 years.

  • For adults 27 to 45 years: Clinicians should engage in a shared decision-making discussion with patients to determine whether they should be vaccinated.

Alternatively (for consideration outside the United States), the following may be used:

  • HPV4 or HPV2 for females

  • HPV4 for males, including those who have sex with men

Contraindications and Precautions for HPV Vaccine

Contraindications for HPV vaccine include

Although HPV vaccines are not recommended for pregnant women, pregnancy testing is not needed before vaccination. If pregnancy is diagnosed after the vaccination series has been started, no intervention is needed, but the remaining doses of the series should be delayed until pregnancy is completed.

The main precaution with HPV vaccine is

  • Moderate or severe acute illness with or without fever (vaccination is postponed until the illness resolves)

Dose and Administration of HPV Vaccine

The HPV vaccine dose is 0.5 mL IM, given in a 3-dose or 2-dose series depending on age at initial HPV vaccination.

  • Initial dose at age 9 to 14 years: A 2-dose series is given at 0 and 6 to 12 months. Minimum interval between doses is 5 months. If a dose is given too soon (in < 5 months), the dose should be repeated ≥ 12 weeks after the invalid dose and ≥ 5 months after the first dose.

  • Initial dose at age ≥ 15 years: A 3-dose series is given at 0, 1 to 2 months, and 6 months. Minimum intervals are 4 weeks between the first and second dose, 12 weeks between the second and third doses, and 5 months between the first and third doses. If the second or third dose is administered too soon it should be repeated.

  • Some adults aged 27 to 45 years: Based on a shared clinical decision-making discussion, adults in this age group may be given the 2- or 3-dose series as above.

  • People with immunocompromising conditions, including HIV infection: People with immunocompromise are given the 3-dose series as above, regardless of age at initial vaccination.

Adverse Effects of HPV Vaccine

No serious adverse effects have been reported.

Mild effects include pain, redness, swelling, and tenderness at the injection site.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

Drugs Mentioned In This Article

Drug Name Select Trade
Gardasil 9
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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