Human Papillomavirus (HPV) Vaccine

Three vaccines protect against HPV:

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• A human papillomavirus quadrivalent vaccine (HPV4) that protects against types 6, 11, 16, and 18

• A human papillomavirus bivalent vaccine (HPV2) that protects against types 16 and 18

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).

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.

See also CDC: Adult Immunization Schedule by Age.

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 for HPV vaccine include

• A severe allergic reaction (eg, anaphylaxis) after previous dose or to a vaccine component

• Pregnancy

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)

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), one additional dose should be given.

• 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 complete the 2-dose series (if initiated at age 9 to 14 years) or 3-dose series (if initiated at ≥ 15 years) (see CDC: Shared Clinical Decision-Making: HPV Vaccination for Adults Aged 27-45 Years).

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

Common adverse reactions include fever, nausea, dizziness, and injection site reactions such as pain, swelling, erythema, pruritis, and bruising.

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

1. Advisory Committee on Immunization Practices (ACIP): Human Papillomavirus (HPV) ACIP Vaccine Recommendations

2. Centers for Disease Control and Prevention (CDC): Human Papillomavirus (HPV) Vaccination Information for Clinicians

3. European Centre for Disease Prevention and Control (ECDC): Human Papillomavirus Infection: Recommended vaccinations