Two doses of HPV vaccine are recommended for most persons starting the series before their 15 th birthday. Three doses of HPV vaccine are recommended for teens and young adults who start the series at ages 15 through 26 years, and for immunocompromised persons. A severe allergic reaction e. HPV vaccine is not recommended for use during pregnancy. Women known to be pregnant should delay initiation of the vaccination series until after the pregnancy.
However, pregnancy testing before vaccination is not needed. Although HPV vaccines have not been linked to causing adverse pregnancy outcomes or side effects adverse events to the developing fetus among pregnant women vaccinated inadvertently, HPV vaccines have not been studied in pregnant women in clinical trials. HPV vaccines are very safe. Various strains of HPV spread through sexual contact and are associated with most cases of cervical cancer. Gardasil 9 is an HPV vaccine approved by the U.
Food and Drug Administration and can be used for both girls and boys. This vaccine can prevent most cases of cervical cancer if the vaccine is given before girls or women are exposed to the virus. This vaccine can also prevent vaginal and vulvar cancer. In addition, the vaccine can prevent genital warts, anal cancers, and mouth, throat, head and neck cancers in women and men. In theory, vaccinating boys against the types of HPV associated with cervical cancer might also help protect girls from the virus by possibly decreasing transmission.
It can be given as early as age 9. It's ideal for girls and boys to receive the vaccine before they have sexual contact and are exposed to HPV. Research has shown that receiving the vaccine at a young age isn't linked to an earlier start of sexual activity.
Once someone is infected with HPV , the vaccine might not be as effective. Also, response to the vaccine is better at younger ages than it is at older ages.
Younger adolescents ages 9 and 10 and teens ages 13 and 14 also can receive vaccination on the two-dose schedule. Research has shown that the two-dose schedule is effective for children under Teens and young adults who begin the vaccine series later, at ages 15 through 26, should receive three doses of the vaccine. The U. Food and Drug Administration recently approved the use of Gardasil 9 for males and females ages 9 to If you're age 27 to 45, discuss with your doctor whether he or she recommends that you get the HPV vaccine.
The HPV vaccine isn't recommended for pregnant women or people who are moderately or severely ill. Tell your doctor if you have any severe allergies, including an allergy to yeast or latex. Also, if you've had a life-threatening allergic reaction to any component of the vaccine or to a previous dose of the vaccine, you shouldn't get the vaccine.
Even if you already have one strain of HPV , you could still benefit from the vaccine because it can protect you from other strains that you don't yet have. Will patients who have already had genital warts benefit from receiving HPV vaccine? Vaccination will provide protection against infection with HPV serotypes the patient has not already acquired.
It is important, however, that patients receive a full age-appropriate series of HPV vaccine to get full protection from genital warts. The minimum interval between doses is 5 calendar months.. A 3-dose schedule is recommended for people who start the series on or after the 15th birthday and for people with certain immunocompromising conditions such as cancer, HIV infection, or taking immunosuppressive drugs.
Has ACIP expressed a preference for the 2-dose over the 3-dose schedule for adolescents 9 through 14 years of age? ACIP recommends the 2-dose schedule for people starting the HPV vaccination series before the 15th birthday, as long as they are immunocompetent. If a dose of HPV vaccine is significantly delayed, do I need to start the series over? No, do not restart the series.
You should continue where the patient left off and complete the series. Can the 4-day "grace period" be applied to the minimum intervals for HPV vaccine? A 16 year old received the third dose of HPV vaccine 12 weeks after the second dose but only 4 months after the first dose.
Should the third dose be repeated? If an HPV vaccine dose is administered at less than the recommended minimum interval then the dose should be repeated. The repeat third dose should be repeated 5 months after the first dose or 12 weeks after the invalid third dose, whichever is later. Does the 2-dose HPV vaccine schedule need to be completed with the same vaccine, or can it include different vaccines such as bivalent or quadrivalent vaccine?
The 2-dose schedule can be completed with any combination of HPV vaccine brands as long as dose 1 was given before age 15 years.
If dose 1 of HPV vaccine was given before the 15th birthday and it has been more than a year since that dose was given, would the series be complete with just one additional dose? Adolescents and adults who started the HPV vaccine series prior to the 15th birthday and who are not immunocompromised are considered to be adequately vaccinated with just one additional dose of HPV vaccine. We have adolescents in our practice who have received the first 2 doses of the HPV series 1 or 2 months apart according to the 3-dose schedule.
Can we consider their HPV vaccine series to be complete or do we need to give these patients a third dose? Is the 2-dose recommendation retroactive for children and teens vaccinated prior to ? Any person who ever received 2 doses of any combination of HPV vaccines can be considered fully vaccinated if dose 1 was given before the 15th birthday and the 2 doses were separated by at least 5 months.
I work with university students and many of them miss coming in on time for their next dose of HPV vaccine. What's the longest interval allowed before we need to start the series over? No vaccine series needs to be restarted because of an interval that is longer than recommended with the exception of oral typhoid vaccine in certain circumstances. You should continue the series where it was interrupted. I have read that HPV vaccine should not be administered to pregnant women.
Do we need to perform a pregnancy test prior to administering this vaccine to our patients? Currently, we ask about pregnancy prior to providing the vaccine.
HPV vaccine is not recommended for use in pregnant women. HPV vaccines have not been associated causally with adverse outcomes of pregnancy or adverse events in the developing fetus. However, if a woman is found to be pregnant after initiating the vaccination series, the remainder of the series should be delayed until completion of pregnancy. Pregnancy testing is not needed before vaccination.
If a vaccine dose has been administered during pregnancy, no intervention is needed. We inadvertently gave HPV vaccine to a woman who didn't know she was pregnant at the time. How should we complete the schedule? You should withhold further HPV vaccine until she is no longer pregnant.
After the pregnancy is completed, administer the remaining doses of the series using the usual 2- or 3-dose schedule depending on the age at initiation of the series.
Can HPV vaccine be administered at the same time as other vaccines? Yes, administration of a different inactivated or live vaccine, either at the same visit or at any time before or after HPV vaccine, is acceptable because HPV is not a live vaccine.
If HPV vaccine is given subcutaneously instead of intramuscularly, does the dose need to be repeated? No data exist on the efficacy or safety of HPV vaccine given by the subcutaneous route.
All data on efficacy and duration of protection are based on a vaccine series administered by the intramuscular route. In the absence of data on subcutaneous administration, CDC and the manufacturer recommend that a dose of HPV vaccine given by any route other than intramuscular should be repeated.
There is no minimum interval between the invalid subcutaneous dose and the repeat dose. Contraindications are the following: HPV vaccine is contraindicated for persons with a history of immediate hypersensitivity to any vaccine component, including yeast. The precaution to HPV vaccine is a moderate or severe acute illness with or without fever. Vaccination should be deferred until the condition improves.
HPV vaccines are not recommended for use in pregnant women. If a woman is found to be pregnant after starting the vaccination series, the remainder of the 2 or 3-dose series depending on the age of first HPV vaccination should be delayed until completion of pregnancy. If a woman has had HPV infection, can she still be vaccinated? Women who have evidence of present or past HPV infection may be vaccinated. They should be advised that the vaccine will not have a therapeutic effect on existing HPV infection or cervical lesions.
Can a woman who is breastfeeding receive HPV vaccine? Is the history of an abnormal Pap test a contraindication to the HPV vaccine series? Even a woman found to be infected with a strain of HPV that is present in the vaccine could receive protection from the other strains in the vaccine. The rates and severity of adverse reactions following each dose of 9vHPV were similar between boys and girls.
We've heard stories in the media about severe reactions to the HPV vaccine. Is there any substance to these stories? Among all reports to the Vaccine Adverse Event Reporting System VAERS following HPV vaccines, the most frequently reported symptoms overall were dizziness; fainting; headache; nausea; fever; and pain, redness, and swelling in the arm where the shot was given.
Although deaths have been reported among vaccine recipients none has been conclusively shown to have been caused by the vaccine. You can find complete information on this and other vaccine safety issues at www. Do HPV vaccines cause fainting? Nearly all vaccines have been reported to be associated with fainting syncope. However, it is not known whether the vaccines are responsible for post-vaccination syncope or if the association with these vaccines simply reflects the fact that adolescents are generally more likely to experience syncope.
Syncope can cause serious injury. Falls that occur due to syncope after vaccination can be prevented by having the vaccinated person seated or lying down. The person should be observed for 15 minutes following vaccination. The vaccine must not be frozen. Protect the vaccine from light. Administer as soon as possible after being removed from refrigeration. The manufacturer package insert contains additional information and can be found at www. For complete information on vaccine storage and handling best practices and recommendations please refer to CDC's Vaccine Storage and Handling Toolkit at www.
Back to top This page was updated on October 22, According to the Vaccine Adverse Events Reporting System, more than million doses of HPV vaccine have been distributed worldwide since , and there are no data to suggest that there are any severe adverse effects or adverse reactions linked to vaccination The 9-valent and quadrivalent vaccines had similar safety profiles, except that the 9-valent HPV vaccine had a higher rate of injection site swelling and erythema than the quadrivalent HPV vaccine, and the rate increased after each successive dose of the 9-valent HPV vaccine Available data demonstrate no safety concerns in individuals who were vaccinated with the 9-valent HPV vaccine after having been vaccinated with the quadrivalent HPV vaccine 29 Anyone who has had a life-threatening allergic reaction to any component of the HPV vaccine, or to a previous dose of the HPV vaccine, should not get the vaccine.
Obstetrician—gynecologists and other health care professionals should assess patients for severe allergies, including but not limited to an allergy to yeast or prior HPV vaccine dose.
An individual with a moderate or severe febrile illness should wait until the illness improves before receiving a vaccine. Obstetrician—gynecologists and other health care professionals should counsel patients to expect mild local discomfort after the vaccination and that such discomfort is not a cause for concern. Syncope and site reactions are common after this vaccine, but serious adverse events are rare. Adolescents should be observed for at least 15 minutes after vaccination because of the risk of fainting.
The HPV vaccine significantly reduces the incidence of anogenital cancer and genital warts in women and in men 31 Additionally, HPV vaccination may decrease the incidence of oropharyngeal cancer. Additionally, a marked reduction in genital warts has occurred in countries with high HPV vaccine coverage This includes prevention of cervical, vaginal, vulvar, and anal disease caused by these HPV types.
The HPV vaccine is a prophylactive vaccine used to prevent disease. Studies are ongoing currently as to whether it may be helpful to prevent recurrent disease, but current data does not support its use as a therapeutic vaccine Current vaccination rates are unacceptably low.
Obstetrician—gynecologists play a critical role and should assess and vaccinate adolescent girls age 11—12 years and previously unvaccinated young women during the catch-up period ages 13—26 years. Health care professionals should use shared clinical decision making with previously unvaccinated women aged 27—45 years to assess the benefit of HPV vaccination. Copyright by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.
Human papillomavirus vaccination. American College of Obstetricians and Gynecologists. Obstet Gynecol ;e15— This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care.
It is not intended to substitute for the independent professional judgment of the treating clinician. Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology.
The American College of Obstetricians and Gynecologists reviews its publications regularly; however, its publications may not reflect the most recent evidence. Any updates to this document can be found on acog. ACOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither ACOG nor its officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.
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