Primary prevention

Human papillomavirus (HPV) vaccination can prevent HPV infections and HPV-associated diseases.[53][54][55][56][57][58][59][60] [ Cochrane Clinical Answers logo ] ​​ Studies in countries with established HPV vaccination programmes report a substantially reduced incidence of cervical cancer.[16][17][18][19]​​ The studies highlight the importance of early vaccination in reducing risk. Vaccinating boys in the same schedule may contribute to indirect protection for unvaccinated women and increase immunity in the population overall.[21]

The majority of HPV-associated cancers are caused by HPV types 16 or 18 (approximately 70%), both of which are targeted by HPV vaccines.[26][61]​​ HPV vaccines are characterised by valency:[62]

  • Bivalent (protects against HPV types 16 and 18)

  • Quadrivalent (protects against HPV types 6, 11, 16, and 18)

  • 9-valent (protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58).

HPV vaccines are licensed for use in two- or three-dose schedules; however, evidence from long-term studies suggests that a single dose offers protection comparable to two doses.[63][64][65]​​ The World Health Organization recommends a one- or two-dose schedule for girls aged 9 to 20 years and a two-dose schedule for women over 21 years.[66]

​UK vaccination schedule

In the UK, HPV vaccination is recommended for all adolescents (boys and girls) aged 12-13 years.[67]​ A single dose of the 9-valent vaccine is recommended.[68]​​ UKHSA: routine childhood immunisations Opens in new window​ 

Those eligible in the UK national programme can be vaccinated up to age 25 years, including those coming to the UK from overseas who have not been vaccinated.

A 3-dose schedule with doses at 0, 1, and 4-6 months should be offered to people with HIV and those known to be immunocompromised at the time of immunisation.[68]​​

US vaccination schedule

In the US, HPV vaccination with the 9-valent vaccine is routinely recommended at age 11-12 years (but can start at age 9 years).[69][70]​​​

The recommended schedule is:​[70]

  • Two intramuscular injections at 0 and 6-12 months where vaccination is initiated before age 15 years, or

  • Three intramuscular injections at 0, 1-2, and 6 months where vaccination is initiated at age 15 years or older.

People with HIV or other immunocompromising conditions should receive three doses of HPV vaccine, even if vaccination is initiated between ages 9 and 14 years, because their response to vaccination may be attenuated.[71] Children with a history of sexual abuse or assault should be given the HPV vaccine as early as possible (starting at age 9 years).[72]

Catch-up vaccination is recommended for people through age 26 years (and may be considered with shared decision-making for those ages 27 years and over) who were not adequately vaccinated when younger.[70]

HPV vaccination is not recommended during pregnancy (although no intervention is needed if vaccination is given inadvertently during pregnancy).​[69][72][73] The American College of Obstetricians and Gynecologists (ACOG) recommends HPV vaccination in breastfeeding women ages 26 years and younger who have not previously been vaccinated.[72]

Further details of current US vaccination schedules, including catch-up vaccinations and special patient populations can be found in the latest ACIP vaccination schedules for children and adults.[70][73]

Barrier contraception and intrauterine devices

HPV is spread by skin-to-skin sexual contact; therefore, safe sexual health and effective barrier contraception may play a role in primary prevention.[74] However, the issue is complex.[75][76]

Use of an intrauterine device may reduce the risk of cervical cancer.[77][78][79]

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