Human Papillomavirus Vaccine - Gardasil/Cervarix/Gardasil 9


Quadrivalent Gardasil is WHA's preferred agent as it covers more strains.

Recommendations for use of HPV vaccine for Females:

  • Routine vaccination with three doses of HPV vaccine is recommended for females 11-12 years of age
  • The vaccination series can be started in females as young as 9 years of age
  • Quadrivalent HPV vaccine (Gardasil) is licensed for use in females and males aged 9 through 26 years
  • Bivalent HPV vaccine (Cervarix) is licensed for use in females aged 9 through 25 years
  • Catch-up vaccination is recommended for females 13-26 years of age who have not been vaccinated previously or who have not completed the full vaccine series 
  • Ideally, vaccine should be administered before potential exposure to HPV through sexual contact

The first dose must be administered before the patient’s 27th birthday

  • At present, cervical cancer screening recommendations have not changed for females who receive HPV vaccine
  • Pre-vaccination assessments (e.g., Pap testing or screening for high-risk HPV DNA, type-specific HPV DNA tests, or HPV antibody tests) to establish the appropriateness of HPV vaccination are not recommended

Recommendations for Males

  • The 3-dose series of quadrivalent HPV vaccine may be given to males aged 9 through 26 years to reduce their likelihood of acquiring genital warts
  • Ideally, vaccine should be administered before potential exposure to HPV through sexual contact


  • Each dose of HPV vaccine is 0.5 mL, administered intramuscularly
  • HPV vaccine is administered in a three dose schedule
  • The second and third doses should be administered 2 and 6 months after the first dose (Gardasil) and at 1 and 6 months (Cervarix)
  • HPV vaccine can be administered at the same visit when other age appropriate vaccines are provided, such as Tdap, Td and MCV4
  • Each vaccine should be administered by using a separate syringe at a different anatomic site
  • Whenever possible, the same HPV vaccine product should be used for all doses in the series

Special situations

  • HPV vaccine can be given to females who have an equivocal or abnormal Pap test, a positive Hybrid Capture II® high risk test, or genital warts
  • Vaccine recipients should be advised that data from clinical trials do not indicate the vaccine will have any therapeutic effect on existing Pap test abnormalities, HPV infection or genital warts
  • Vaccination of these females would provide protection against infection with vaccine HPV types not already acquired
  • Lactating women can receive HPV vaccine
  • Patients who are immunocompromised either from disease or medication can receive HPV vaccine. However the immune response to vaccination and vaccine effectiveness might be less than in females who are immunocompetent. ACIP recommends routine vaccination at age 11 or 12 years with HPV2 or HPV4 for females and with HPV4 for males
  • Pregnancy:
    • HPV vaccine is not recommended for use in pregnancy
    • The vaccine has not been associated causally with adverse outcomes of pregnancy or adverse events to the developing fetus. However, data on vaccination during pregnancy are limited. Any exposure to vaccine during pregnancy should be reported to the vaccine pregnancy registry (1-800-986- 8999)

Contraindications to use of vaccine:

  • HPV vaccine is contraindicated for people with a history of immediate hypersensitivity to yeast or to any vaccine component
  • HPV2 should not be used in persons with anaphylactic allergy to latex


  • HPV vaccine can be administered to patients with minor acute illnesses (e.g., diarrhea or mild upper respiratory tract infections, with or without fever)
  • Vaccination of people with moderate or severe acute illnesses should be deferred until after the illness improves

Per CDC Morbidity and Mortality Weekly Report (March 27, 2015)

Recommendations for Use of HPV Vaccines:

  • ACIP recommends that routine HPV vaccination be initiated at age 11 or 12 years.  The vaccination series can be started beginning at age 9 years.  Vaccination is also recommended for females age 13 through 26 years and for males age 13 through 21 years who have not been vaccinated previously or who have not completed the 3-dose series (1).  Males aged 22 through 26 years may be vaccinated.  Vaccination of females is recommended with 2vHPV, 4vHPV (as long as this formulation is available), or 9vHPV.  Vaccination of males is recommended with 4vHPV (as long as this formulation is available) or 9vHPV
  • 2vHPV, 4vHPV, and 9vHPV all protect against HPV 16 and 18, types that cause about 66% of cervical cancers and the majority of other HPV-attributable cancers in the United States (1, 12).  9vHPV targets five additional cancer causing types, which account for about 15% of cervical cancers (12).  4vHPV and 9vHPV also protect against HPV 6 and 11, types that cause anogenital warts


Last review date: July 21, 2016

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