HPV is common—most sexually active people will have it at some point. But HPV vaccines can help prevent infection from both high-risk HPV types that can lead to cervical cancer and low-risk types that cause genital warts.
In the U.S., HPV infections are estimated to cause about 34,800 cases of cancer. HPV vaccination can prevent over 90% of these cancers from ever developing.
The HPV vaccine available in the U.S., Gardasil-9, has been approved for the prevention of cervical, anal, vulvar and vaginal cancers and pre-cancers. The vaccine protects against seven types of “high-risk” HPV that are associated with cancer. It also protects against two “low-risk” types associated with genital warts.
Vaccination is effective—rates of infection with strains of HPV covered by the vaccines have dropped significantly since the vaccine was introduced. According to the Centers for Disease Control and Prevention (CDC), HPV types that cause most HPV cancers and genital warts have dropped 86 percent among teen girls. But both boys and girls can benefit from the vaccine.
HPV vaccination is recommended for girls and boys ages 11-12. Why so young? For one, the vaccine produces a stronger immune response when taken during the preteen years, and fewer shots are required. Also, the vaccine is designed to prevent infection, so vaccination is recommended at a young age—before kids are exposed to the virus.
While the recommended age for HPV vaccine is 11-12, vaccination can start as early as age 9. Youth between ages 9 and 14 only need two doses of the HPV vaccine. The schedule calls for the second dose of the vaccine to be given 6-12 months following the first.
For older teens and adults who start the series later, starting at age 15, three doses are still required. In this case, the second shot should be given one to two months after the first, and the third shot should be given six months after the first. The goal is to get all three shots within six months.
In late 2018, the FDA approved use of the Gardasil-9 HPV vaccine in males and females ages 27-45, expanding the previous indication that covered from ages 9-26. Ideally, people should complete all doses of the vaccine before they become sexually active. However, adults over 27 now have the option of receiving the vaccine and should talk to their healthcare provider to make the decision about vaccination.
Over 120 million doses of the HPV vaccine have been distributed since the vaccine was licensed, and data has shown it to be safe and well tolerated. There have been some mild to moderate reactions reported from people who have received the vaccine, the most common of which is pain, redness, and swelling around where the shot was given. Other mild reactions reported include fever, headache, fatigue, nausea and vomiting. Some people have experienced fainting as well.
As with any vaccine or medication, there is always a possible of a serious problem, such allergic reaction. However, these reactions are rare. The HPV vaccine also continues to be monitored for any safety concerns.
Is the HPV vaccine mandatory for school enrollment?
Each state decides whether or not to require vaccinations for enrollment in childcare or school attendance. According to the National Conference for State Legislators (NCSL), at least five jurisdictions (Rhode Island, Virginia, Washington, D.C., Hawaii, and Puerto Rico) require HPV vaccination for school attendance.
Legislators in other states have introduced legislation to educate the public about the HPV vaccine and allow pharmacists to administer it.
See the NCSL website for up to date, state-specific information.
Does insurance pay for the vaccine?
The vast majority of health insurance plans report including most or all of the ACIP recommended vaccines in their benefits for children adolescents and adults.
For those that qualify, HPV vaccines are also available through the federal Vaccines for Children (VFC) program. The VFC program provides free vaccinations for children aged 18 and under who meet at least one of the following criteria: 1) Medicaid eligible; 2) uninsured; 3) underinsured; or 4) Native American or Alaska Native.
Do HPV vaccines to lead to increased sexual behavior?
No. While some parents have expressed a concern that vaccinating their children against HPV will lead to increased sexual behavior, several studies have shown this not to be the case. While many studies relied upon self-reported behavior about sexual activity, a 2012 study published in the journal Pediatrics instead looked at medical data, including pregnancy, sexually transmitted infection testing or diagnosis, and contraceptive counseling as evidence of sexually activity. The researchers found that HPV vaccination in the recommended ages was not associated with increased sexual activity.
Is cervical cancer screening still required?
Yes. HPV vaccines will not eliminate all HPV or cervical cancer. The vaccines prevent the HPV types that cause 70% of cervical cancer cases, but there are other types of HPV (not covered in the vaccine) that could cause disease.
Cisgender women and transgender men who still have a cervix who are 30 and over should be screened as recommended, with Pap and/or HPV tests.