HPV Vaccine

Pregnancy: Not recommended — defer until after delivery.

HPV vaccination (Gardasil 9) is not recommended during pregnancy as a precautionary measure due to limited data.

• If pregnancy is discovered after initiating the vaccine series, defer remaining doses until after delivery.

• No teratogenicity has been demonstrated in clinical trials or post-marketing surveillance (pregnancy registry data for quadrivalent Gardasil).

• Inadvertent vaccination during pregnancy is NOT an indication for termination.

• No special monitoring needed if vaccinated inadvertently.

Breastfeeding: Safe.

HPV vaccine (Gardasil 9) is safe during breastfeeding. It is a recombinant, non-infectious vaccine. Breastfeeding women can be vaccinated without restriction. No modification to breastfeeding schedule required.

Pediatric use:

• Routine vaccination: 9–14 years of age (gender-neutral, WHO recommendation).

• Schedule by age:

  • 9–14 years: 2 doses at 0 and 6–12 months.
  • ≥15 years: 3 doses at 0, 2, 6 months.
  • WHO SAGE (2022): single-dose regimen for girls 9–20 years is equally effective.

• Minimum interval between doses: 5 months (2-dose schedule), 4 weeks/12 weeks/5 months (3-dose schedule).

• Syncope: observe adolescents for 15 minutes post-vaccination (common in this age group).

• Immunocompromised children (including HIV-positive): 3-dose schedule recommended regardless of age.

Geriatric use:

• Catch-up vaccination is available up to 45 years (FDA-approved) through shared clinical decision-making for 27–45 years.

• Efficacy in adults >26 years is lower than in younger age groups (fewer HPV-naïve individuals).

• Not routinely recommended for adults ≥46 years.

• Older adults who are HPV-naïve may still benefit from vaccination if at risk.