Gardasil 9 schedule by age: Current recommendations

Gardasil 9 is a brand-name vaccine used to protect against nine types of human papillomavirus (HPV). While HPV often clears up on its own, it can cause serious health problems if the body does not clear the virus. Conditions caused by HPV include genital warts and several types of cancer. 

So, who should get the HPV vaccine, and what is the Gardasil 9 dosing schedule? The Centers for Disease Control and Prevention (CDC) recommends that most people ages 15–45 follow a three-dose schedule, while most people ages 9–14 follow a two-dose schedule. The CDC and World Health Organization agree that the first dose may be given as young as age 9. 

Who is the HPV vaccine for?

HPV is spread through sexual activity. It is the most common sexually transmitted infection (STI) in the United States, according to the CDC. And while most cases of HPV resolve on their own, some HPV types can lead to serious health issues, including:

• Anal cancer
• Cervical cancer
• Neck cancers
• Vulvar cancers 
• Penile cancer
• Oral cancer

These complications can occur regardless of gender. “This vaccine is routine and recommended for everyone, all genders, ages 9–26,” says Christina M. Madison, Pharm.D., founder and CEO of The Public Health Pharmacist. 

Gardasil 9 is also recommended for many adults ages 27–45. “If a person has had no prior sexual partners or a limited number of prior sexual partners, their risk of HPV exposure may be very low,” explains Blair Gingerich, Pharm.D., an ambulatory care pharmacist in northern Indiana. “If a person expects to have new sexual partners, they should consider receiving the vaccine.” 

The recommendation for an HPV vaccination for adolescents as young as 9 years old may take some people by surprise. However, the incidence of STIs among adolescents is rising. The 15–24 age bracket accounts for about 50% of new STI diagnoses, according to a research review published in 2019. 

Recommended HPV vaccination schedule

The Food & Drug Administration (FDA) has approved Gardasil-9 for males and females ages 9–45. However, dosing schedules vary by age.  

*A healthcare professional will advise whether a three-dose or two-dose schedule is needed.

Gardasil 9 schedule for people ages 15–45

The HPV vaccine offers the most protection when administered at the recommended time: ages 9–14. “The longer the person waits to get vaccinated, the more likely an exposure will be and reduce the full benefits of the vaccine,” Madison said. However, people ages 15–45 who have not yet been vaccinated can still benefit from the HPV vaccine.

The recommended dosing schedule for people ages 15–45 is as follows:

• The first shot should be administered as soon as possible.
• The second shot should be administered two months after the first dose.
• The third shot should be administered four months after the second dose (six months after the first dose).

RELATED: Why you should get the HPV vaccine—even in your 30s or 40s

Gardasil 9 side effects and warnings

Possible side effects of the HPV vaccine include:

• Pain, redness, or swelling at the injection site
• Fever
• Headache
• Fatigue
• Muscle or joint pain
• Nausea

Some people experience lightheadedness or fainting during appointments for vaccine injections. If you have a fear of needles or have experienced dizziness, lightheadedness, or fainting during or after a previous injection, alert your pharmacist or provider at your HPV vaccine appointment. 

What should I do if I miss an HPV vaccine?

Do your best to stick to your healthcare provider’s recommended Gardasil 9 schedule—but if you miss a dose, just make an appointment for the next dose as soon as possible.

“No need to restart the series; just take the vaccine dose as if you were ‘on time’ for your recommended vaccine,” Madison said. 

Stretching the recommended time frame between doses does not negate the benefits of the dose(s) you received, but it does mean you are not fully immunized against the virus. 

Do schools and colleges require the HPV vaccine?

Many schools and colleges in the United States require proof of vaccination from incoming students before the academic year begins. Proof of vaccination typically involves a written statement from a healthcare provider. But HPV vaccine requirements are state-dependent. 

State vaccine requirements may change at any time. Currently, the HPV vaccination is required for high school students in:

• District of Columbia (DC)
• Hawaii
• Rhode Island
• Virginia

If a student cannot receive the HPV vaccine for a medical or religious reason, they can be exempt from this requirement. In Rhode Island, a school nurse may help individuals obtain religious exemption forms, but doctors must provide medical exemptions. Exemption criteria may vary by state, so check with your state health department for details.

Does insurance cover Gardasil 9?

Most private insurance plans do cover Gardasil 9, according to the drug’s manufacturer, Merck & Co. Inc. However, the specifics of coverage—like whether you pay part or none of the cost—depend on the insurer and the conditions of your insurance plan. 

The federal Vaccines for Children (VFC) program provides vaccines such as Gardasil at no cost to children who are uninsured, underinsured, or who receive Medicaid. Most state Medicaid programs also cover Gardasil for adults.

Talk to your insurance provider to find out what you or a family member will pay to be vaccinated against HPV.

How much does Gardasil 9 cost without insurance?

Without insurance, Gardasil 9 costs about $362 for one 0.5 milliliter (mL) syringe. However, drug prices vary. It’s a good idea to check with your insurance company for more information.

You can use SingleCare coupons to bring the cost of Gardasil 9 down to about $306. A SingleCare prescription discount card can help lower the cost of Gardasil 9 and other drugs.