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Updated HPV Vaccine Recommendations Include 2 Doses for Some, 3 for Others


It is now easier to meet human papillomavirus (HPV) vaccine recommendations for all patients, according to a report from the Advisory Committee on Immunization Practices (ACIP). 
Although three doses of HPV vaccine are still advised for females and males who have their first dose between the ages of 15 and 26, as well as for those who are immunocompromised, girls and boys who start the HPV vaccine series between the ages of 9 and 14 need only two doses, lead report author Elissa Meites, MD, MPH, a medical epidemiologist at the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues wrote in the journal, American Journal of Transplantation, online February 27, 2017.
"Through 10 years of follow-up from clinical trials, no evidence of waning protection after a 3-dose series of HPV vaccine has been found. Because antibody kinetics are similar with 2-dose and 3-dose series, duration of protection is also expected to be long-lasting after a 2-dose series," the authors wrote.
"HPV infection causes cervical, vaginal, and vulvar cancers in women; penile cancers in men; and oropharyngeal and anal cancers as well as genital warts in both men and women…HPV vaccines are highly effective and safe, and a powerful prevention tool for reducing HPV infections and HPV-associated cancers. Based on the available immunogenicity evidence, a 2-dose schedule (at 0, and 6–12 months following) will have efficacy equivalent to a 3-dose schedule (at 0, 1–2, and 6 months) if the HPV vaccination series is initiated before the 15th birthday," the authors recommend. 
As of late 2016, only the 9-valent HPV (9vHPV) vaccine (licensed by Merck and Co, Inc., Whitehouse Station, New Jersey) is being distributed in the United States.
The authors conducted a systematic review of studies that reported primary data on important or critical health outcomes related to HPV vaccination after two doses in 9- through 14-year-old girls and boys.
In the 9vHPV clinical trial that led to FDA approval of a 2-dose series, 9- through 14-year-old girls and boys who received two vaccine doses were compared with 16- through 26-year-old females who received three doses. By 4 weeks after the last dose, 97.9% or more of the 1377 study participants seroconverted to all nine vaccine-preventable HPV types. Also, geometric mean titers (GMTs) were significantly higher for all 9vHPV types in the younger group. Six other studies found similar results for the 4vHPV and 2vHPV vaccines.
The ACIP Work Group reviewed the evidence and the voting ACIP members unanimously approved the updated recommendations in October 2016.
ACIP now recommends that children receive their first HPV vaccination when they are 11 or 12 years of age, but they may begin at the age of 9. ACIP also advises vaccination for females through age 26 and for males through age 21 if they were not adequately vaccinated previously, adding that males ages 22 through 26 may be vaccinated.
For individuals receiving their first shot before their 15th birthday, the schedule is two doses, with the second dose given 6 to 12 months after the first.
For those receiving their first shot on or after their 15th birthday, the schedule is three doses, with the second dose given 1 to 2 months after the first dose, and the third dose given 6 months after the first.

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