HPV vaccination of adults aged 27-45 years

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Should adults between the ages of 27 and 45 get the human papillomavirus (HPV) vaccine? The answer lies in shared clinical decision-making between you and your patient.

HPV is so common that almost all men and women will become infected at some point in their lives. Most sexually active adults have been exposed to HPV, although not necessarily all of the types of HPV that the vaccine is directed against. While most HPV infections go away or go undetectable, some don’t and can cause some precancerous and cancers, as well as anogenital warts.

Cervical cancer is the most common HPV-associated cancer in women, and oropharyngeal cancers (cancer of the throat including the base of the tongue and tonsils) are most common in men. HPV can also cause cancers of the anus, vulva, vagina, and penis, as well as anal, vaginal, cervical, and vulvar precancerous lesions. Although screening for cervical cancer does exist, routine screenings for other types of HPV-related cancer do not exist, so they are often not detected until they cause serious health problems. HPV vaccination can prevent more than 90% of cancers caused by HPV.

Here are five things you should know about the current HPV vaccination recommendations:

1. HPV vaccination is not routinely recommended for people over the age of 26.

CDC recommends collaborative clinical decision-making (SCDM) regarding potential HPV vaccination in adults aged 27 to 45 who have not yet been vaccinated. Some of these adults, aged 27 to 45, may choose to have a vaccine after consulting their doctor. Vaccinating adults in this age group with HPV is of less benefit compared to vaccinating younger people because more people have already been exposed to HPV.


CDC does not recommend vaccination for all adults aged 27 to 45 years, but recognizes that some people in this age group who are not adequately vaccinated are at risk for new HPV infection and could benefit from vaccination. Since there is no clinical antibody test that can determine whether a person is already immune or still susceptible to a particular type of HPV, it is not always easy to find out who could benefit from HPV vaccination. Some considerations are mentioned in the next section.

2. SCDM recommendations should be based on the characteristics, values, and preferences of the patient and the clinical judgment of the healthcare provider.

HPV vaccination does not need to be discussed with most adults over the age of 26. For adults 27 years or older, doctors may consider discussing HPV vaccination with people who are most likely to benefit from it.

The HPV vaccine is most effective in people who have never had sex. The effectiveness of the HPV vaccine may be less effective in people with higher risk factors for HPV, such as: B. Sex with more than one person or certain immune-compromising diseases. At any age, having a new sexual partner is a risk factor for a new HPV infection. However, this is only one possible consideration for SCDM.

Adults with more HPV risk factors (e.g., multiple previous sexual partners or certain immunosuppressive disorders) may have been infected with HPV in the past and may be less likely to get a new HPV infection in the future.

Adults with fewer HPV risk factors (e.g., few or no previous sexual partners) who may not have been infected with HPV in the past may have a higher risk of developing HPV infection from a new sexual partner. People who have been in a longstanding, mutually monogamous relationship are unlikely to get a new HPV infection.

Therefore, use your clinical assessment based on information the patient has given you to assess whether they could benefit from HPV vaccination at their current age.

3. The routine recommendations for HPV vaccination of adolescents remain unchanged.

HPV vaccination offers the greatest benefit when given before a person is exposed to HPV. For this reason, CDC recommends HPV vaccination at 11 or 12 years of age; The series can be started at the age of 9. For those who are not adequately vaccinated, HPV vaccination is also recommended up to the age of 26 years. The HPV vaccination is given as a series of either two or three doses, depending on the age at the initial vaccination.

4. HPV vaccination prevents new HPV infections but does not treat existing infections or diseases.

HPV vaccines are prophylactic (that is, they prevent new HPV infections). They do not prevent HPV infection from progressing into disease, reduce the time it takes to clear HPV infection, or treat HPV-related disease.

5. If adults between the ages of 27 and 45 are vaccinated, they will need three doses of HPV vaccine.

If you and your previously unvaccinated adult patient decide to have HPV vaccination, offer a HPV series of three doses at 0, 2 and 6 months. If your patient is pregnant, HPV vaccination can be given after the pregnancy. HPV vaccination is considered very safe unless a patient has had a severe allergic reaction after a previous dose or to a vaccine ingredient. Eligible patients should also receive recommended cervical cancer screening.

resources

Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Vaccination Practices | MMWR (cdc.gov)

ACIP HPV Vaccine Recommendations | CDC

Common ACIP Recommendations for Clinical Decision Making | CDC

HPV vaccine schedule and dosage | CDC

Adult vaccination schedule by vaccine and age group | CDC

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