Implementing interventions to start HPV vaccination at age 9: Using the evidence we have

Sep 24, 2026

Uploaded by Patrick

Human papillomavirus (HPV) vaccination is routinely recommended for adolescents aged 11 or 12 years but can begin at age 9. On-time vaccination by the thirteenth birthday effectively prevents HPV cancer and pre-cancer, yet HPV coverage remains lower than for other adolescent vaccines. Starting at age 9 is endorsed by major pediatric and cancer organizations and may improve completion timing, vaccine scheduling, and cancer-prevention messaging. Implementation science can guide adaptation and dissemination of evidence-based interventions for this approach.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Abstract

HPV vaccination background and coverage gaps

Benefits of starting HPV vaccination at age 9

Evidence-based interventions and implementation science approach

Endorsements and immunization policy changes

COMMENTARY Implementing interventions to start HPV vaccination at age 9: Using the evidence we have Heather M. Brandta, Alison Footmana, Prajakta Adsulb, Shoba Ramanadhanc, and Deanna Kepkad aHPV Cancer Prevention Program, St. Jude Children’s Research Hospital, Memphis, TN, USA; bDepartment of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, NM, USA; cDepartment of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; dHuntsman Cancer Institute and College of Nursing, University of Utah, Salt Lake City, UT, USA ABSTRACT Human papillomavirus (HPV) vaccination is routinely recommended for adolescents aged 11 or 12 years but can begin at age 9. On-time HPV vaccination by the thirteenth birthday has proven to be effective in preventing HPV cancer and pre-cancer. However, HPV coverage rates continue to lag behind other routinely recommended vaccinations for adolescents. A promising approach to improving coverage is to start HPV vaccination at age 9. This approach has been endorsed by the American Academy of Pediatrics and the American Cancer Society. Benefits of this approach include increased time to complete vaccination series by the thirteenth birthday, additional spacing of recommended vaccines, and a more concentrated focus on cancer prevention messaging. While promising, little is known about how and if existing evidence-based interventions and approaches can be used to promote starting HPV vaccination at age 9. Implementation science frameworks offer scientific direction in how to adapt current and develop new interventions to promote starting HPV vaccination at age 9 and accelerate dissemination and prevent HPV cancers. ARTICLE HISTORY Received 28 November 2022 Revised 27 January 2023 Accepted 10 February 2023 KEYWORDS Vaccination; papillomavirus vaccines; HPV vaccine; HPV vaccination; implementation science; interventions Human papillomavirus (HPV) vaccination prevents diseases caused by HPV, including six types of cancer (oral, cervical, anal, vaginal, vulvar, and penile), cervical precancer, genital warts, and recurrent respiratory papillomatosis. HPV vaccination is routinely recommended at age 11 or 12 years and can begin at age 9 up through age 26 in the United States (US) . Recently, vaccinations have been recommended for some adults aged 27 to 45 years who were not vaccinated when they were younger, following a discussion with their healthcare provider. 1–3 In the US, HPV vaccination coverage has reached nearly 77% of 13- to-17-year-old adolescents with one or more doses and nearly 62% completing the vaccination series.4 However, when compared to other routinely recommended vaccinations for adolescents, HPV vaccination continues to lag behind. Coverage for two other routinely recommended adolescent vaccines are more than 30% higher. Coverage rates for the quadrivalent meningococcal conjugate (MenACWY) vaccine is 89% and 90% for tetanus, diphtheria, and acellular pertussis (Tdap) vaccinenationally.4 Disparities in HPV vaccination coverage based on geographic region, rurality, and poverty persist.4,5 Since the vaccine was first introduced in the US in 2006, HPV infections and cervical precancers have dropped significantly despite relatively slow uptake.5 However, the vaccine’s cancer prevention potential has not been realized due to a range of factors, including limited awareness and knowledge, lack of a strong health-care provider recommendation, and concerns related to safety and effectiveness. Recent studies6–13 continue to validate the effectiveness of HPV vaccination for disease prevention, particularly on-time HPV vaccination by the thirteenth birthday. 14, 15 Effective, scalable approaches that are widely implemented are urgently needed to improve on-time HPV vaccination to prevent related cancers and other HPV diseases. A promising approach to improving coverage is starting HPV vaccination at age 9 as discussed in sever

FAQs

Why start HPV vaccination at age 9 instead of the usual 11–12 age range?

Starting at age 9 increases time to complete the vaccination series by the thirteenth birthday and supports on-time initiation and completion. It also enables more focused cancer-prevention messaging before first HPV exposure.

What benefits are highlighted for age-9 initiation?

The article notes benefits such as additional spacing opportunities with other recommended adolescent vaccines, a stronger cancer-prevention focus prior to HPV exposure, reduced emphasis on sexual activity, and less reliance on school “required” vaccination messaging.

What problem remains despite evidence that HPV vaccination prevents cancer?

HPV coverage still lags behind other routinely recommended adolescent vaccines. The article attributes this to factors such as limited awareness and knowledge, insufficient provider recommendations, and concerns about safety and effectiveness.

Sep 24, 2026

Uploaded by Patrick