HPV Vaccine and Adolescent Immunisation
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Direct answer
HPV vaccine protects against infection with high-risk human papillomavirus types, which cause most cervical cancers and some anogenital cancers and warts. It is given in early adolescence, before sexual exposure, and two doses are enough when the first dose is started before 15 years. Three doses are needed when the course starts later or the child is immunocompromised.
What you must remember
- Quadrivalent: Gardasil, covering HPV types 6, 11, 16 and 18.
- Nonavalent and bivalent: Gardasil 9 adds types 31, 33, 45, 52 and 58 to the quadrivalent set, while Cervarix covers types 16 and 18 only.
- Indian product: Cervavac, an indigenous quadrivalent HPV vaccine developed in India.
- Two-dose schedule: doses at 0 and about 6 months, for children starting before 15 years.
- Three-dose schedule: doses at 0, 1 to 2 and 6 months, for those starting at 15 or older and for immunocompromised people.
- Nature of the vaccine: a non-live recombinant vaccine, so immunocompromised people are not excluded from it.
- India programme: the national HPV drive launched in February 2026 offers a single dose of the quadrivalent vaccine to 14-year-old girls, following WHO single-dose guidance; two doses remain the classic textbook schedule.
- Pregnancy: HPV vaccine is not recommended in pregnancy, and an inadvertent dose is not a reason for termination.
Matching the number of doses to the age at first dose
An 11-year-old girl and her mother ask how many doses are needed, since the answer depends on the age at the first dose. The table sets out the schedule by situation.
| Situation | Schedule |
|---|---|
| Starts before 15 years, immunocompetent | Two doses at 0 and about 6 months |
| Starts at 15 years or older | Three doses at 0, 1 to 2 and 6 months |
| Immunocompromised at any age | Three doses at 0, 1 to 2 and 6 months |
Starting before 15 produces a strong antibody response that allows two doses, which is why the age cut-off is examined closely. Once the first dose is given at 15 or later, three doses are needed, and immunocompromised children also receive three.
The adolescent visit is also the chance to review the tetanus-diphtheria booster (Td, given at 10 and 16 years under the UIP), and to check the completeness of the childhood schedule. Non-live vaccines given at this stage can be combined with other adolescent doses, according to national guidance.
Where the exam tries to catch you
HPV questions usually turn on dose counts, pregnancy and the limits of protection.
- Trap: counting three doses for a 12-year-old Correct: starting before 15 needs only two doses, unless the child is immunocompromised.
- Trap: deciding that vaccinated women no longer need cervical screening Correct: the vaccine covers only some high-risk types, so screening continues at recommended intervals.
- Trap: giving the vaccine in pregnancy because it is non-live Correct: HPV vaccine is not recommended in pregnancy, and no vaccine course is started during it.
Frequently asked questions
How many doses of HPV vaccine does a 12-year-old need?
A 12-year-old needs two doses of HPV vaccine, given about six months apart, because the first dose is started before 15 years. Three doses are needed if the first dose is given at 15 or older, or if the child is immunocompromised.
Which HPV vaccine covers the most HPV types?
Gardasil 9 is the nonavalent HPV vaccine, covering types 6, 11, 16, 18, 31, 33, 45, 52 and 58. It covers more types than the quadrivalent Gardasil or the bivalent Cervarix.
Is HPV vaccine given during pregnancy?
HPV vaccine is not recommended during pregnancy, so a course should be deferred until after delivery. An accidental dose given in pregnancy is not a reason to terminate the pregnancy.
Why does HPV vaccination not replace cervical screening?
HPV vaccination protects only against the HPV types it contains, so some high-risk types remain uncovered. Vaccinated women therefore still need cervical screening at the recommended intervals.
Which other vaccine is commonly given in adolescence?
Td (tetanus-diphtheria) is given at 10 and 16 years under India's Universal Immunisation Programme, replacing TT. The adolescent visit is a good opportunity to review it alongside HPV vaccination.