ACS Updates HPV Vaccination Guidelines

The guidelines are based on recommendations from the Advisory Committee on Immunization Practices.

The American Cancer Society (ACS) has updated its guideline on the human papillomavirus (HPV) vaccination, including recommendations for the use in males, the use of the most recently available 9-valent (9vHPV) vaccine, and late vaccination for 22–26 year olds.

The updates are the first since the 2007 HPV vaccine guideline. They are based on recommendations from the Advisory Committee on Immunization Practices (ACIP), which were evaluated by an ACS established Guideline Development Group (GDG) via an endorsement process.

The ACIP HPV vaccine recommendations include:

  • HPV vaccination to begin for girls and boys at age 11 or 12, but children as young as age 9 can start receiving the three-dose vaccine series
  • Young women between 13 and 26 years and young men between 13 and 21 who have never been vaccinated against HPV or have not had all three doses should become fully vaccinated
  • Males aged 22–26 may be vaccinated; providers should inform individuals who have not been previously vaccinated or who have not completed the series that vaccination at older ages is less effective in lowering cancer risk
  • Vaccination recommended through age 26 years for men who have sex with men and for immunocompromised persons (including HIV infection) if not previously vaccinated

The GDG found that the evidence for these ACIPs recommendations is strong enough for them to endorse the use of the HPV vaccination for males. The ACS guideline states that evidence published since their last HPV vaccine guideline has shown that the vaccine is effective, immunogenic and safe for males. 

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The authors of the new guideline endorsement state that, on the basis of data on immunogenicity and efficacy, “it is possible to conclude that vaccination will be effective against cancer outcomes in the general male population.”

The use of most recent HPV vaccination available, the 9vHPV, was also endorsed by the ACS. Trials have shown the vaccine’s safety to be comparable to that of the 4vHPV vaccine. The ACS estimates that a total of 28,500 annual cases of cancer in the U.S. could be prevented by the 9vHPV vaccine.

Despite there being limited data on age distinctions, the ACS endorsed the recommendation for late vaccinations for males and females aged 22–26 years once providers convey to those who have not been previously vaccinated or who have not completed the series, that late vaccination reduces the effect of lowering cancer risks. This recommendation to provide the vaccine for individuals aged >21 years was based on:

  • Evidence of greater benefit for females vaccinated at ages 18–20 years compared with 21–26 years
  • Opportunities for young women and men to get vaccinated at college
  • Opportunities for young women and men to access vaccination without parental consent
  • Consistency with the ACIP recommendation for males

The ACS has made prevention of HPV-associated cancers through vaccination an organization priority. The guideline endorsement concludes, “It is critical that cancer prevention, immunization, health care provider, and other stakeholder organizations at the national, state, and local levels continue to prioritize HPV vaccination.”

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