Primary prevention
Data suggest that the human papillomavirus (HPV) vaccine is helpful in preventing HPV infection. The quadrivalent HPV vaccine reduces the rate of anal intraepithelial neoplasia (AIN) in men who have sex with men, and may therefore help to reduce the risk of anal cancer in this population.[18]
A nine-valent HPV vaccine is approved in the US for people ages 9-45 years. The Centers for Disease Control and Prevention (CDC) recommends routine vaccination against HPV for girls and boys ages 11 or 12 years, but early vaccination from the age of 9 years onwards may be considered.[26] The American Academy of Pediatrics recommends routine HPV vaccination between the ages of 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series.[27] The CDC recommends catch-up vaccination for unvaccinated people ages ≤26 years; catch-up vaccination may be considered following shared decision making for those ages 27-45 years.[28][29][26][30] Vaccination is not recommended during pregnancy.[29]
Further details on current vaccination schedules and special patient populations can be found in the latest ACIP vaccination schedules for children and adults.[26][30]
The table that follows summarizes recommendations on HPV vaccination from the CDC.[26][30]
Note that an individual patient may fall into more than one group, and so interventions might be additive; please review all population and subpopulation groups to assess all that apply.
Ages 9-12 years; not yet vaccinated against HPV
Without immunocompromise
Intervention
HPV vaccination; 2-dose series
HPV vaccination is routinely recommended at ages 11-12 years, but can start at age 9 years.
HPV vaccination is recommended to start at the age of 9 years for those with a history of sexual abuse or assault.
A 2-dose series (given at 0 months and 6-12 months) is recommended.
Goal
Prevention of HPV and HPV-associated disease, including anal cancer
The HPV vaccination series is complete, with no additional dose needed, for those ages 9–14 years at initial vaccination who have received 2 doses at least 5 months apart.
No additional dose is recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.
With immunocompromise
Intervention
HPV vaccination; 3-dose series
HPV vaccination is routinely recommended at ages 11-12 years, but can start at age 9 years.
HPV vaccination is recommended to start at the age of 9 years for those with a history of sexual abuse or assault.
For those with immunocompromising conditions, including HIV infection, a 3-dose series (given at 0 months, 1-2 months, and 6 months) is recommended.
Goal
Prevention of HPV and HPV-associated disease, including anal cancer
The HPV vaccination series is complete, with no additional dose needed, for those with immunocompromise of any age who have received 3 doses given at 0, 1-2, and 6 months.
The following minimum intervals apply:
Dose 1 to dose 2: 4 weeks
Dose 2 to dose 3: 12 weeks
Dose 1 to dose 3: 5 months
No additional dose is recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.
Pregnant
Intervention
Delay HPV vaccination until after pregnancy
HPV vaccination is not recommended during pregnancy (although routine pregnancy testing is not recommended before vaccination). No intervention is needed if vaccination is given inadvertently during pregnancy.
Goal
Defer vaccination due to lack of evidence regarding HPV vaccination safety in pregnancy
Ages 12-14 years; not yet vaccinated against HPV, or not adequately vaccinated
Without immunocompromise
Intervention
Catch-up HPV vaccination; 2-dose series
A 2-dose series (given at 0 months and 6-12 months) is recommended.
A minimum interval of 5 months is required between doses; give the second dose if this has not yet been given, or repeat the second dose if this was administered too soon.
Goal
Prevention of HPV and HPV-associated disease, including anal cancer
The HPV vaccination series is complete, with no additional dose needed, for those ages 9–14 years at initial vaccination who have received 2 doses at least 5 months apart.
No additional dose is recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.
With immunocompromise
Intervention
Catch-up HPV vaccination; 3-dose series
For those with immunocompromising conditions, including HIV infection, a 3-dose series (given at 0 months, 1-2 months, and 6 months) is recommended.
Goal
Prevention of HPV and HPV-associated disease, including anal cancer
The HPV vaccination series is complete, with no additional dose needed, for those with immunocompromise of any age who have received 3 doses given at 0, 1-2, and 6 months.
The following minimum intervals apply:
Dose 1 to dose 2: 4 weeks
Dose 2 to dose 3: 12 weeks
Dose 1 to dose 3: 5 months
No additional dose is recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.
Pregnant
Intervention
Delay HPV vaccination until after pregnancy
HPV vaccination is not recommended during pregnancy (although routine pregnancy testing is not recommended before vaccination). No intervention is needed if vaccination is given inadvertently during pregnancy.
Goal
Defer vaccination due to lack of evidence regarding HPV vaccination safety in pregnancy
Ages 15-26 years; not yet vaccinated against HPV, or incompletely vaccinated
No doses of HPV vaccine received
Intervention
Catch-up HPV vaccination; 3-dose series
For those vaccinated against HPV at ages 15 years or older at initial vaccination, a 3-dose series (given at 0 month, 1-2 months, and 6 months) is recommended.
Goal
Prevention of HPV and HPV-associated disease, including anal cancer
The HPV vaccination series is complete, with no additional dose needed, for those ages ≥ 15 years who have received 3 doses given at 0, 1-2, and 6 months.
The following minimum intervals apply:
Dose 1 to dose 2: 4 weeks
Dose 2 to dose 3: 12 weeks
Dose 1 to dose 3: 5 months
No additional dose is recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.
Incompletely vaccinated; ages 9-14 years at initial vaccination
Intervention
Catch-up HPV vaccination; give one additional dose
Those who were ages 9–14 years at initial vaccination and received 1 dose or 2 doses less than 5 months apart require 1 additional dose of HPV vaccine.
Goal
Prevention of HPV and HPV-associated disease, including anal cancer
The HPV vaccination series is complete, with no additional dose needed, for those ages 9–14 years at initial vaccination who have received 2 doses at least 5 months apart.
No additional dose is recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.
Incompletely vaccinated; ages ≥ 15 years at initial vaccination
Intervention
Catch-up HPV vaccination; give one or two additional doses
Those who began HPV vaccination at ages ≥ 15 years are considered to be incompletely vaccinated if they have received less than 3 doses, or if subsequent doses were administered too soon.
For those ages 15 years or older at initial vaccination, a 3-dose series (given at 0 months, 1-2 months, and 6 months) is recommended.
Goal
Prevention of HPV and HPV-associated disease, including anal cancer
The HPV vaccination series is complete, with no additional dose needed, for those ages ≥ 15 years who have received 3 doses given at 0, 1-2, and 6 months.
The following minimum intervals apply:
Dose 1 to dose 2: 4 weeks
Dose 2 to dose 3: 12 weeks
Dose 1 to dose 3: 5 months
No additional dose is recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.
Pregnant
Intervention
Delay HPV vaccination until after pregnancy
HPV vaccination is not recommended during pregnancy (although routine pregnancy testing is not recommended before vaccination). No intervention is needed if vaccination is given inadvertently during pregnancy.
Goal
Defer vaccination due to lack of evidence regarding HPV vaccination safety in pregnancy
Ages 27-45 years; not yet vaccinated against HPV, or incompletely vaccinated
No doses of HPV vaccine received
Intervention
Consider catchup HPV vaccination; 3-dose series
Use shared clinical decision making in discussion with the patient, taking into account individual patient characteristics and preferences and healthcare provider discretion.
For those vaccinated against HPV at ages 15 years or older at initial vaccination, a 3-dose series is recommended.
A 3-dose series (given at 0 months, 1-2 months, and 6 months) is recommended.
Goal
Prevention of HPV and HPV-associated disease, including anal cancer
The HPV vaccination series is complete, with no additional dose needed, for those ages ≥ 15 years who have received 3 doses given at 0, 1-2, and 6 months.
The following minimum intervals apply:
Dose 1 to dose 2: 4 weeks
Dose 2 to dose 3: 12 weeks
Dose 1 to dose 3: 5 months
No additional dose is recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.
Incompletely vaccinated; ages 9-14 years at initial vaccination
Intervention
Consider catch-up HPV vaccination with administration of one additional dose
Use shared clinical decision making in discussion with the patient, taking into account individual patient characteristics and preferences and healthcare provider discretion.
One additional dose of HPV vaccine may be considered for those ages 9-14 years at initial vaccination who received only 1 dose, or 2 doses less than 5 months apart.
Goal
Prevention of HPV and HPV-associated disease, including anal cancer
The HPV vaccination series is complete, with no additional dose needed, for those ages 9-14 years at initial vaccination who have received 2 doses at least 5 months apart.
No additional dose is recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals
Incompletely vaccinated; ages ≥ 15 years at initial vaccination
Intervention
Consider catch-up HPV vaccination with one or two additional doses
Use shared clinical decision making in discussion with the patient, taking into account individual patient characteristics and preferences and healthcare provider discretion.
Those who began HPV vaccination at ages ≥ 15 years are considered to be incompletely vaccinated if they have received less than 3 doses, or if subsequent doses were administered too soon. In this scenario, consider catchup vaccination using shared decision making.
A 3-dose series (given at 0 months, 1-2 months, and 6 months) is recommended.
Goal
Prevention of HPV and HPV-associated disease, including anal cancer
The HPV vaccination series is complete, with no additional dose needed, for those ages ≥ 15 years who have received 3 doses given at 0, 1-2, and 6 months.
The following minimum intervals apply:
Dose 1 to dose 2: 4 weeks
Dose 2 to dose 3: 12 weeks
Dose 1 to dose 3: 5 months
No additional dose is recommended when any HPV vaccine series of any valency has been completed using the recommended dosing intervals.
Pregnant
Intervention
Consider HPV vaccination after pregnancy
HPV vaccination is not recommended during pregnancy (although routine pregnancy testing is not recommended before vaccination). No intervention is needed if vaccination is given inadvertently during pregnancy.
Following pregnancy, decisions about HPV vaccination should be made using shared clinical decision making following discussion with the patient, taking into account individual patient characteristics and preferences and healthcare provider discretion.
Goal
Defer vaccination due to lack of evidence regarding HPV vaccination safety in pregnancy
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