Human Papillomavirus Vaccination

Abstract

A 24-year-old woman is being seen for routine health care. She has not received any vaccinations against human papillomavirus (HPV). The patient initiated sexual activity at 18 years of age and has had three male sex partners. What would you recommend regarding HPV vaccination?

Figure 1.. Natural History of Human Papillomavirus (HPV) Infection and Progression to Cervical Cancer.

Shown are the uterine cervix and histologic changes in the cervix from infection, precancer, and cancer. HPV infection occurs most often through sexual contact, and peak prevalence is around the age of first sexual encounters. HPV infects the basal epithelial cells, most often at the endocervical–ectocervical junction, where epithelial disruption allows access. Most HPV infections clear or become undetectable within 1 to 2 years, but a small percentage persist and progress to precancers over periods of months to years. Most precancers regress, but a small percentage of persistent lesions progress to invasive cancer, most commonly over a period of more than a decade. The delay between precancer and cancer allows screening to be effective in detection of early lesions. The treatment of precancers detected by means of screening can prevent invasive cancer. HPV vaccination prevents infection and therefore also precancers and cancers.

Figure 2.. Estimated Coverage of HPV Vaccine among Adolescents 13 to 17 Years of Age, According to Sex and Survey Year, from the National Immunization Survey–Teen, 2007–2021.

Data are from the National Immunization Survey–Teen. The Advisory Committee on Immunization Practices (ACIP) revised the recommended HPV vaccination schedule in late 2016. The schedule changed from a three-dose series to a two-dose series, with appropriate spacing between receipt of the first and second doses, for immunocompetent adolescents initiating the series before their 15th birthday. Three doses are still recommended for adolescents initiating the series at 15 years of age or older. Because of the change in the schedule, the figure includes estimates for the receipt of at least three doses of HPV vaccine during the 2006–2015 period and for up-to-date status of HPV vaccination for the 2016–2021 period. The ACIP recommendation for routine HPV vaccination was made for female adolescents in 2006 and for male adolescents in 2011; up-to-date status for HPV vaccination was defined as the receipt of at least three doses and also as the receipt of two doses when the first HPV vaccine dose was administered before 15 years of age with an interval of at least 5 months between the first and second doses.

Figure 3.. Prevalence of Quadrivalent Vaccine–Type Infection among Girls and Women, According to Age Group and Survey Period, from the National Health and Nutrition Examination Surveys, 2003–2018.

Adapted from Markowitz et al., Oliver et al., and Rosenblum et al. Quadrivalent vaccine–type HPV infection includes types HPV6, HPV11, HPV16, and HPV18. The decreases in the prevalence that are shown for persons 14 to 19 years of age and 20 to 24 years of age are for the 2015–2018 survey period as compared with the prevaccine era and are based on adjusted prevalence ratios. I bars indicate 95% confidence intervals.