Human papilloma virus vaccine dose and schedule
The HPV vaccine is given as a 2-dose or 3-dose series depending on age at first dose. For ages 9-14, two doses are given 6-12 months apart. For ages 15 and older, or immunocompromised individuals, three doses are required (0, 1-2, and 6 months). The recommended age for routine vaccination is 11-12 years, but catch-up vaccination is recommended through age 26, and shared decision-making applies for ages 27-45.
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HPV vaccine dose schedule 2025 ACIP recommendations
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HPV Vaccine - Dose and Schedule
Available Vaccines
Only one HPV vaccine is currently marketed in the United States:
- Gardasil 9 (9vHPV) - 9-valent, covers HPV types 6, 11, 16, 18, 31, 33, 45, 52, 58
- Previously available: Gardasil (4vHPV) and Cervarix (2vHPV) - no longer marketed in the US
Current U.S. CDC Schedule (as of January 2026)
Important update: In January 2026, the CDC - following a directive from HHS - revised the childhood immunization schedule to recommend a single dose of HPV vaccine for all children at ages 11-12 years. This change was made outside the usual ACIP evidence-review process and was based on data from the ESCUDDO trial (NEJM, 2025), which demonstrated non-inferiority of one dose vs. two doses. Professional societies including ASCCP have noted this change while raising concerns about its process.
| Population | Doses | Timing |
|---|---|---|
| Routine (children, all) | 1 dose | At age 11-12 years |
| Can start as early as | 1 dose | Age 9 years |
Prior Schedule (Still Relevant for High-Risk Groups / Catch-Up / Adults)
The previous standard schedule (still used as a reference for immunocompromised patients, older adolescents, and adults) was:
2-Dose Schedule
- Who: Persons starting vaccination before age 15
- Timing: Dose 1, then Dose 2 at 6-12 months after Dose 1 (minimum interval: 5 months)
3-Dose Schedule
- Who: Persons starting vaccination at age 15 or older, or immunocompromised individuals (including HIV infection, regardless of CD4 count)
- Timing:
- Dose 1: Month 0
- Dose 2: 1-2 months after Dose 1
- Dose 3: 6 months after Dose 1
Age Recommendations
| Age Group | Recommendation |
|---|---|
| 9-12 years | Routine vaccination (all children) |
| 13-26 years | Catch-up vaccination if not previously vaccinated |
| 27-45 years | Shared clinical decision-making (benefits may be limited) |
| >45 years | Not recommended |
Key Points
- Dose: 0.5 mL intramuscular (IM), preferably in the deltoid muscle
- Vaccines are most effective before exposure to HPV - ideally before sexual debut
- HPV vaccines do not have therapeutic effect on existing HPV infection or disease
- Antibody titers are higher when given at ages 9-15 compared to 16-26 years
- Protection has been demonstrated for up to 8-10 years with no evidence of waning
WHO / International Schedule
The WHO (2022) recommends:
- 1 or 2 doses for ages 9-20 years
- 2 doses for ages 9+ with 6-month interval (standard)
- Single dose option for ages 9-20 (67 countries have now adopted single-dose schedules)
Recent Evidence Supporting Single-Dose
A 2024 meta-analysis (PMID 38180991) of 902,368 vaccinated women found that one-dose HPV vaccination had high clinical effectiveness. The key ESCUDDO RCT (Kreimer et al., NEJM 2025, PMID 41337735) demonstrated non-inferiority of one dose vs. two doses of HPV vaccine. A 2025 systematic review (PMID 40610947) further supported comparable effectiveness and immunogenicity of single-dose regimens.
Note: The January 2026 single-dose revision applies to the routine "all children" schedule. For adults 27-45, immunocompromised persons, and catch-up scenarios, providers should consult the latest guidelines as specific recommendations are still evolving.
- Red Book 2021, p. 717-718
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