New 2-dose HPV Vaccine: Exceptions are Part of the Rules

Based on the CDC's new 2-dose HPV vaccine recommendation, in which of these 7 scenarios would this male teen still need a third dose?

The administration of vaccines involves lots of CDC and FDA rules: age ranges, timing between doses, location, needle lengths, and so on. In the small print of the footnotes one can often find a number of “exceptions” that technically are part of the rules. For example, the CDC recently decided that an adolescent only needs two doses of HPV vaccine instead of three under certain circumstances.

Assume a 17-year- and 0-month-old male is in your office today. In which of the following scenarios should you administer a third HPV vaccine? (More than one may be correct.) 

A. First dose given at age 15 years 0 months (15/0) and second dose at age 17 and 9 months (17/9)

B. First dose given age 14/0 and second dose given at age 14/4  

C. First dose given at age 11/0 and second dose age 14/0

D. First dose given age 9/0 and second dose at age 16/0

E. He was diagnosed with Crohn disease at age 9/0 and started on Humira at age 12/0. He received first dose of HPV vaccine at age 11/0 and the second dose at age 14/0 while on Humira.

F. First dose given at age 11/0 and second dose at age 16/0. He has been on 25 mg of prednisone every other day since age 15/0.

G. First dose given at age 11/0 and second dose at age 16/0. Three months ago he was started on 25 mg of prednisone daily for persistent asthma.

Please click "next" for answers and discussion.

 

The new CDC rules for HPV administration allow for 2 doses instead of 3 when the first dose was given before age 15 AND the second dose was given at least 6 months after the first. The exceptions to the rule, in the fine print, say that individuals with immunocompromising conditions that might interfere with the immune response at the time of vaccination should receive 3 doses.

Doses of prednisone under 20 mg per day or any dosage given every other day are not considered immunocompromising with regard to vaccine administration by the CDC.

For each scenario on the left, see CDC guidance on the right.

17-year-old male, HPV vaccine statusNeed for third dose - why or why not?
A.A
B.B.
C.C. and D.
E.E.
F. F.
G.G

 

Resources

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. 2016;65:1405-1408.  The new rules of 2 doses of HPV

Kroger AT, Atkinsom WL, Marcuse EK, Pickering LK. General Recommendations on Immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Rec Rep. 2006;55(RR15):1-48. (CDC rules on vaccine administration and definition of immunocompromising conditions.)