Technically Speaking: Updated ACIP Recommendations on HPV Vaccine

When should the series be two doses versus three doses?

Since 2007, when the first recommendations for use of human papillomavirus (HPV) vaccine were published, CDC’s Advisory Committee on Immunization Practices (ACIP) has recommended a series of three doses, regardless of the age or health status of the recipient. In December 2016, ACIP changed the HPV vaccine recommendations to a two-dose schedule for routine vaccination of 11- and 12-year-olds, as well as for many others, as detailed below.

What has changed?

ACIP now recommends that healthy adolescents who begin the HPV vaccine series at 11 to 12 years of age, or at any time before the 15th birthday, receive a two-dose series (rather than three doses, as previously recommended).

• The two doses should be separated by six to 12 months, with a minimum interval between doses of five months.
• If only the first dose is administered before the 15th birthday, a second dose will be needed after that birthday to complete the series. 

People who begin the HPV vaccine series on or after the 15th birthday, as well as people who are younger than age 15 who have immunocompromising conditions (such as HIV infection, B-lymphocyte antibody deficiency, or immunosuppressive therapy), should continue to receive a three-dose HPV vaccine series.

Updated recommendations are not affected by the HPV vaccine product previously used

The 9-valent HPV vaccine (9vHPV, Gardasil® 9, Merck) is now the only HPV vaccine being distributed in the U.S.

• People who initiated the HPV vaccine series before the 15th birthday with a single dose of 9vHPV or any HPV vaccine that was previously available in the U.S. can complete the two-dose series with one additional dose of 9vHPV.
  Example: A 12-year-old who received a single dose of 4-valent HPV vaccine (Gardasil, Merck) and is now age 16, can complete the two-dose series with one dose of 9vHPV.
• Two doses of any HPV vaccine previously available in the U.S. can be counted as a valid two-dose series as long as the first dose was administered before the 15th birthday, and the two doses were separated by at least five months.
  Example: A 17-year-old who received two doses of 2-valent HPV (Cervarix®, GSK) at age 11 years can be considered fully vaccinated if the two doses were separated by at least five months. If the two doses were separated by less than five months, the person should receive a third dose of 9vHPV to complete the series.

Resources

Centers for Disease Control and Prevention

• Use of a 2-Dose Schedule for Human Papillomavirus Vaccination — Recommendations of ACIP
• Human Papillomavirus Vaccination Information for Clinicians

Immunization Action Coalition

• Ask the Experts: Human Papillomavirus
• HPV Educational Materials for Healthcare Professionals and Patients
• HPV Diseases and Vaccines Web Page

Vaccine Education Center

• Human Papillomavirus: What you should know, Volume 5, Winter 2016
  • English
  • Spanish
• www.Prevent-HPV.org — a dedicated webpage answering questions about HPV disease and vaccination
• Talking about Vaccines with Dr. Paul Offit: HPV
• A Look at Each Vaccine: HPV

Editor’s note: The November issue of Vaccine Update also addressed this topic in the News and Views section and includes information about vaccinating those who already completed HPV2 or HPV4 as does the VEC HPV Q&A and the winter 2016 webinar.