HPV Vaccination and Screening
Who to vaccinate, at what age, in how many doses, and the screening that stays · v1.3- Enter the age, the biological sex, whether the patient is immunocompromised, and how many HPV doses have already been given.
- Get the immune status right before you read the dose count, because it changes the number of doses at every age.
- You get eligibility, the doses still due with their schedule, and the cervical screening due alongside.
- Doses follow the IAP ACVIP recommendation and the national programme, with the WHO position printed beside them wherever the two differ.
- An abnormal Pap or VIA result, cervical intraepithelial neoplasia, and surveillance after treatment. It gives the screening interval and stops there.
- Screening of any kind in a man. The screening section runs for women, and anal and oropharyngeal screening is not in it.
- The choice between the bivalent, quadrivalent and nonavalent preparations, which are compared in Evidence and Pearls.
- Any dose for a child below 9 years or an adult above 45, for whom it prints none.
Vaccination does not replace screening, and a vaccinated woman is screened on the same schedule as anyone else. Current vaccines cover the types responsible for the large majority of cervical cancers but not all of them, and a woman vaccinated after exposure gains less. For screening intervals, an abnormal Pap or VIA result, CIN management or post-treatment surveillance, use the Cervical Screening and Abnormal Pap Management pathway.
Patient Demographics & History
Immunological Status
Get this one right before you read the dose count. Immune compromise changes the number of doses, and it changes it at every age.
1. Why the Dose Count Falls with Age, and Why It Is Now One
The response to the HPV virus-like particles is strongly age-dependent. In early adolescence, 9 to 14 years, a naive immune system generates a strong B cell memory response, and the immunobridging trials showed that two doses in a 10 year old produce significantly higher antibody titres than three doses in a 20 year old. That finding set the reduced schedule.
- The Indian cohort followed by IARC took it further. At ten years a single dose gave 95.4 per cent efficacy against persistent HPV 16 and 18 infection, against 93.1 per cent for two doses and 93.3 per cent for three.
- IAP ACVIP now recommends a single dose for immunocompetent girls from 9 up to 15 years, and the national programme launched on 28 February 2026 gives one dose.
- The two-dose schedule remains licensed, and it is what boys of the same age receive.
- From 15 years, or at any age in a patient who is immunocompromised, the response no longer supports the reduced schedule and the course is three doses at 0, 2 and 6 months.
2. Withholding the Vaccine Because She Is Already Sexually Active
Practice Advisory: A major barrier in India is withholding the vaccine from women who are already sexually active or who have an abnormal Pap smear, assuming it is "too late". This is clinically incorrect. The vaccine covers several oncogenic strains (16, 18, 31, 33, 45, 52, 58). Having met one of them is not the same as carrying all of them, and the protection against the rest is intact. She gains less than she would have gained at twelve. She still gains.
3. Vaccination Is Not a Substitute for Screening
Safety Alert: Vaccination is not a substitute for screening. The nonavalent vaccine covers the strains responsible for ~90% of cervical cancers. The other 10% of cancers are caused by types no current vaccine covers, and no schedule of doses will reach them. A fully vaccinated woman is therefore screened on the same interval as an unvaccinated one, by visual inspection with acetic acid under the national programme, or by cytology or HPV DNA testing where a laboratory is available. Nothing on her vaccination card moves that date.
4. The Three HPV Vaccines Available in India
| Vaccine Type | Strains Covered | Clinical Utility |
|---|---|---|
| Bivalent (Cervarix) | 16, 18 | Protects against ~70% of cervical cancers. Does not protect against anogenital warts. |
| Quadrivalent (Gardasil / Cervavac) | 16, 18, 6, 11 | Protects against cervical cancer AND anogenital warts (strains 6, 11). Cervavac is the indigenous Indian quadrivalent vaccine, developed by the Serum Institute of India. The vaccine used in the national programme launched on 28 February 2026 is Gardasil-4, also quadrivalent. |
| Nonavalent (Gardasil-9) | 16, 18, 6, 11, 31, 33, 45, 52, 58 | Broadest coverage. Protects against ~90% of cervical cancers and anogenital warts. |
5. The WHO 90-70-90 Global Strategy
Three targets, to be met by 2030, for eliminating cervical cancer as a public health problem:
- 90 per cent of girls fully vaccinated with HPV vaccine by age 15.
- 70 per cent of women screened with a high-performance test by 35 years of age, and again by 45.
- 90 per cent of women identified with cervical disease receive treatment.
Abbreviations
ACVIP (Advisory Committee on Vaccines and Immunization Practices) · CIN (Cervical Intraepithelial Neoplasia) · DNA (Deoxyribonucleic Acid) · HIV (Human Immunodeficiency Virus) · HPV (Human Papillomavirus) · IAP (Indian Academy of Pediatrics) · IARC (International Agency for Research on Cancer) · MoHFW (Ministry of Health and Family Welfare) · NTAGI (National Technical Advisory Group on Immunisation) · Pap (Papanicolaou Smear) · VIA (Visual Inspection with Acetic Acid) · VLP (Virus-Like Particle) · WHO (World Health Organization)References
- Shastri DD, Dhir SK, Rajsekhar B, et al. Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines and Immunization Practices (ACVIP): Recommended Immunization Schedule (2025) and Update on Immunization for Children Aged 0 Through 18 Years. Indian Pediatr. 2026;63:311-324.
- World Health Organization (WHO). Human papillomavirus vaccines: WHO position paper, December 2022. Wkly Epidemiol Rec. 2022;97(50):645-672.
- Press Information Bureau, Government of India. Cervical Cancer Vaccination Campaign Launched. New Delhi: PIB; 28 February 2026.
- Basu P, Malvi SG, Joshi S, et al. Vaccine efficacy against persistent human papillomavirus (HPV) 16/18 infection at 10 years after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre, prospective, cohort study. Lancet Oncol. 2021;22(11):1518-1529.
- Ministry of Health and Family Welfare, Government of India. Operational Framework: Management of Common Cancers. New Delhi: MoHFW; 2016.
- National Technical Advisory Group on Immunisation (NTAGI) 17th Meeting Recommendations (2022): HPV vaccine inclusion in the Universal Immunisation Programme (UIP). [The recommendation that preceded the programme. The programme itself launched on 28 February 2026.]
- Merck Sharp & Dohme. GARDASIL 9 (Human Papillomavirus 9-valent Vaccine, Recombinant): prescribing information. Rahway, NJ: Merck; accessed 28 August 2026.
- Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2016;65(49):1405-1408.
How to Cite This Tool
DOIhttps://doi.org/10.5281/zenodo.22401600
AMA Style:Umakanth S. HPV Vaccination and Screening. Version 1.3. MEDiscuss Clinical Decision Support System. Published 2026. Accessed . https://mediscuss.org/cdss/hpv-vaccine. doi:10.5281/zenodo.22401600
Vancouver Style:Umakanth S. HPV Vaccination and Screening [Internet]. Version 1.3. MEDiscuss.org; 2026 [cited ]. Available from: https://mediscuss.org/cdss/hpv-vaccine. doi:10.5281/zenodo.22401600
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Category Immunisation & ProphylaxisPathway
Specialties Internal Medicine, Infectious Diseases, Obstetrics & Gynaecology