Three HPV vaccines are available: a quadrivalent HPV vaccine, Gardasil, that includes capsid proteins against four HPV types (6, 11, 16, and 18); a bivalent vaccine, Cervarix (includes capsid proteins against HPV types 16 and 18); and a nine-valent vaccine, Gardasil 9 (includes capsid proteins against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58). In the United States, only the 9 valent vaccine, Gardasil 9, is currently available. HPV vaccination is routinely recommended for all children ages 11 or 12 years. For those who do not receive vaccination at this age, all persons through age 26 years should receive HPV vaccine. Routine vaccination is not recommended for adults over age 26 but shared decision making may help identify individuals aged 27–45 years who would benefit from HPV vaccination, such as those with no or few previous sexual partners. Published studies show a high degree of efficacy in prevention of vaccine-associated genital warts, persistent HPV infections, and cervical intraepithelial neoplasia. Protection has not been shown against strains that are absent from the vaccine administered or against strains that had already infected an individual before vaccination.
While HPV vaccination has been shown to decrease the risk of invasive cervical cancer among vaccinated women, receipt of a vaccine should not change cervical cancer screening intervals in women. For those who start the vaccine series before the age of 15 years, two doses are recommended, whereas for those who start the series between age 15 and 26 years, a three-dose vaccine series is recommended.
Hepatitis B vaccine is routinely administered to children and adolescents aged 0–18 years. For adults who have not previously been vaccinated, individuals who are at risk for sexual or blood-borne transmission of hepatitis B should be vaccinated. The Advisory Committee on Immunization Practices of the CDC also recommends vaccinating any adult who requests vaccination, regardless of the presence of an identified risk factor. Rates of hepatitis B are higher in individuals with diabetes mellitus and outbreaks of hepatitis B have been associated with blood glucose monitoring. Hepatitis B vaccination is therefore also recommended for individuals with diabetes mellitus.
Hepatitis A can also be sexually transmitted. Hepatitis A vaccination is currently recommended for all children aged 12 months or older and for all adults requesting protection against hepatitis A (eg, travelers, health care workers). Individuals who use injection or non-injection illicit drugs and those with high-risk sexual behaviors will receive greater benefit.