More than 15 years of data show that HPV vaccination provides safe, effective, and long-lasting protection against cancers caused by HPV infections. Research shows that healthcare professionals are parents’ most trusted source of information about the HPV vaccine. CDC encourages healthcare professionals to recommend HPV vaccination in the same way and on the same day that they recommend other vaccines for adolescents. This post summarizes CDC’s current HPV vaccine recommendations. Access the official, full text below:

Routine recommendations

• HPV vaccine is recommended for routine vaccination at 11 or 12 years old. Vaccination can be started at age 9.
• ACIP also recommends vaccination for everyone through age 26 years if not adequately vaccinated when younger. HPV vaccination is given as a series of either two or three doses, depending on age at initial vaccination.
• Vaccination is not recommended for everyone older than 26 years. Some adults aged 27 through 45 years might decide to get the HPV vaccine based on a discussion with their clinician, if they did not get adequately vaccinated when they were younger. HPV vaccination of people in this age range provides less benefit, for several reasons, including that more people in this age range have already been exposed to HPV.
• For adults aged 27 through 45 years, clinicians can consider discussing HPV vaccination with people who are most likely to benefit. HPV vaccination does not need to be discussed with most adults over the age of 26 years. See ACIP’s shared clinical decision-making FAQs.

Most sexually active adults have already been exposed to HPV, although not necessarily all of the HPV types targeted by vaccination. At any age, having a new sex partner is a risk factor for getting a new HPV infection. People who are in a long-term, mutually monogamous relationship are not likely to get a new HPV infection.

Dosing schedule

Two doses of HPV vaccine are recommended for most people starting the series before their 15th birthday.

• The second dose of HPV vaccine should be given 6 to 12 months after the first dose.
• Adolescents who receive two doses less than 5 months apart will require a third dose of HPV vaccine.

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.

• The recommended three-dose schedule is 0, 1–2 months, and 6 months.
• Three doses are recommended for immunocompromised persons (including those with HIV infection) aged 9 through 26 years.

Vaccine safety

HPV vaccines are very safe. Scientific research shows the benefits of HPV vaccination far outweigh the potential risks. Like all medical interventions, vaccines can have some side effects.

All vaccines used in the United States, including HPV vaccines, go through extensive safety testing before the U.S. Food and Drug Administration (FDA) licenses them. During clinical trials before the licensure, the 9-valent HPV vaccine Gardasil 9 was studied in more than 15,000 males and females and was found to be safe and effective.

Possible adverse reactions

No serious adverse events have been associated with any HPV vaccine. Ongoing monitoring is conducted by CDC and the Food and Drug Administration.

Syncope (fainting) 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 after vaccination. This is to prevent any injuries that could occur from a fall during a syncopal event.

The most common adverse reactions reported during clinical trials of HPV vaccines were local reactions at the site of injection. In prelicensure clinical trials, local reactions such as pain, redness, or swelling were reported by 20% to 90% of recipients.

A temperature of 100°F during the 15 days after vaccination was reported in 10% to 13% of HPV vaccine recipients. A similar proportion of placebo recipients reported an elevated temperature. Local reactions generally increased in frequency with increasing doses. However, reports of fever did not increase significantly with increasing doses.

A variety of systemic adverse reactions have been reported by vaccine recipients, including nausea, dizziness, myalgia, and malaise. However, these symptoms occurred with equal frequency among both HPV vaccine and placebo recipients.

Contraindications and precautions

Contraindications and precautions to vaccination generally dictate circumstances when vaccines will not be given.

HPV vaccine contraindications

• A severe allergic reaction (e.g., anaphylaxis) to a vaccine component or following a prior dose of HPV vaccine is a contraindication to receipt of HPV vaccine.
• A moderate or severe acute illness is a precaution to vaccination, and vaccination should be deferred until symptoms of the acute illness improve.
• 9-valent HPV vaccine is produced in Saccharomyces cerevisiae (baker’s yeast) and is contraindicated for persons with a history of immediate hypersensitivity to yeast.

A minor acute illness (e.g., diarrhea or mild upper respiratory tract infection, with or without fever) is not a reason to defer vaccination.

Vaccination during pregnancy

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.

• If a woman is found to be pregnant after starting the HPV vaccine series, second and/or third doses should be delayed until they are no longer pregnant.
• If a woman receives HPV vaccine and later learns that she is pregnant, there is no reason to be alarmed. Anyone who knows they are pregnant and has received an HPV vaccine can contact the manufacturer at 1-877-888-4231.
• Any suspected adverse events following HPV vaccination during pregnancy should be reported to VAERS.

Resources

• HPV Vaccine Safety
• HPV Vaccine Information Statement
• Vaccines Web-based Training Course
• Immunization schedules (Child and adolescent | Adult)
• Vaccines For Children Program Information for Providers
• Ask the Experts: HPV | Immunize.org

Clinical information

• HPV | Vaccine Preventable Diseases Surveillance Manual
• Pink Book: HPV
• Clinical Overview of HPV

References

HPV Vaccine

• Markowitz LE, Gee J, Chesson H, Stokley S. Ten years of human papillomavirus vaccination in the United States. Acad Pediatr. 2018;18:S3-10.
• Markowitz LE, Schiller JT. Human Papillomavirus Vaccines. J Infect Dis. 2021;224(Supplement_4):S367-S378.
• Laprise JF, Chesson HW, Markowitz LE, et al. Effectiveness and Cost-Effectiveness of Human Papillomavirus Vaccination Through Age 45 Years in the United States. Ann Intern Med. 2020;172(1):22-29.

HPV Vaccine Impact

• Rosenblum HG, Lewis RM, Gargano JW, et al. Declines in Prevalence of Human Papillomavirus Vaccine-Type Infection Among Females after Introduction of Vaccine – United States, 2003-2018. MMWR. 2021;70:415-20.

• Meites E, Stone L, Amiling R, et al. Significant Declines in Juvenile Onset Recurrent Respiratory Papillomatosis following HPV Vaccine Introduction in the United States. Clin Infect Dis. 2021;3(5):885-890.

• McClung NM, Gargano JW, Park IU, et al; HPV-IMPACT Working Group. Estimated number of cases of high-grade cervical lesions diagnosed among women – United States, 2008 and 2016. MMWR. 2019;68(15):337-343.
• McClung NM, Lewis RM, Gargano JW, et al. Declines in Vaccine-Type Human Papillomavirus Prevalence in Females Across Racial/Ethnic Groups: Data From a National Survey. J Adolesc Health. 2019;65:715-722.
• McClung NM, Gargano JW, Bennett NM, et al, HPV-IMPACT Working Group. Trends in Human Papillomavirus Types 16 and 18 in Cervical Precancers, 2008-2014. Cancer Epidemiol Biomarkers Prev. 2019;28(3):602-609.
• Gargano J, Park IU, Griffin MR et al. Trends in High-grade Cervical Lesions and Cervical Cancer Screening in Five States, 2008–2015. Clin Infect Dis. 2019;68(8):1282-91.
• Drolet M, Benard E, Perez N, Brisson M, on behalf of the HPV Vaccination Impact Study Group. Population-level impact and herd effects following human papillomavirus vaccination programs: updated systematic review and meta-analysis. The Lancet. 2019;394:497-509.
• Flagg EW, Torrone EA. Declines in Anogenital Warts Among Age Groups Most Likely to Be Impacted by Human Papillomavirus Vaccination, United States, 2006-2014. Am J Public Health. 2018;108(1):112-119.
• Oliver SE, Unger ER, Lewis R, et al. Prevalence of Human Papillomavirus Among Females After Vaccine Introduction-National Health and Nutrition Examination Survey, United States, 2003-2014. J Infect Dis. 2017;216:594-603.
• Benard VB, Castle PE, Jenison SA, et al. Population-based incidence rates of cervical intraepithelial neoplasia in the human papillomavirus vaccine era. JAMA Oncol. 2017;3(6):833-837.
• Flagg EW, Torrone EA, Weinstock H. Ecological association of human papillomavirus vaccination with cervical dysplasia prevalence in the United States, 2007–2014. Am J Public Health. 2016;106(12):2211–2218.

HPV Vaccine and Sexual Behavior

• Madhivanan P, Pierre-Victor D, Mukherjee S, et al. Human papillomavirus vaccination and sexual Disinhibition in females: a systematic review. Am J Prev Med. 2016;51(3):373–83.
• Hansen BT, Kjaer SK, Arnheim-Dahlstrom L, et al. Human papillomavirus (HPV) vaccination and subsequent sexual behaviour: evidence from a large survey of Nordic women. Vaccine. 2014;32:4945-53.
• Bednarczyk RA, Davis R, Ault K, et al. Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. Pediatrics. 2012;130(5):798-805.
• Forster AS, Marlow LA, Stephenson J, et al. Human papillomavirus vaccination and sexual behaviour: cross-sectional and longitudinal surveys conducted in England. Vaccine. 2012;30(33):4939-44.

HPV Vaccination Coverage Issues

• Pingali C, Yankey D, Chen M, et al.National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years – United States, 2023. MMWR. 2024;73:708–714.
• Special issue: Raising HPV Vaccination Coverage Rates in Academic Pediatrics,
• Brewer NT, Hall ME, Malo TL, et al. Announcements versus conversations to improve HPV vaccination coverage: a randomized trial. Pediatrics. 2017;139(1):e20161764.
• Smulian EA, Mitchell KR, Stokley S. Interventions to increase HPV vaccination coverage: A systematic review. Hum Vaccin Immunother. 2016;12:1566-88.
• Perkins RB, Clark JA, Apte G, et al. Missed Opportunities for HPV Vaccination in Adolescent Girls: A Qualitative Study. Pediatrics. 2014;134(3):e666-74.