In November 2022, NIAC issued updated recommendations with respect to HPV vaccine dosage. The NIAC now recommend:
- - A single dose schedule of HPV vaccine for all those aged 9 to 24 years of age.
- - A two dose schedule of HPV vaccine at an interval of 0 and 6-12 months for those aged 25 years and older (up to the age of 45 years).
If the second dose is given less than five months after the first dose, a third dose should be administered. This should be given 6–12 months after the first dose and at least 12 weeks after the incorrect second dose.
- - Immunocompromised (for further information see the NIAC Chapter 10. Human Papillomavirus)
Those with the following conditions require a three dose schedule of HPV vaccine at 0, 2 and 6 months regardless of age.
- Haematopoietic stem cell or solid organ transplant recipients
- HIV infection
- Malignant haematological disorders affecting the bone marrow or lymphatic systems, e.g., leukaemia, lymphomas, blood dyscrasias
- Non-haematological malignant solid tumours
- Primary immunodeficiency
- Within two weeks of commencing, on or within three to six months of receiving significant immunosuppressive therapy* (for further information see NIAC Chapter 3)
For those with the above immunocompromising conditions, the three dose HPV vaccination schedule should be recommended by their treating Specialist/Consultant. They can then either receive the vaccine as part of the national immunisation schedule or choose to pay for it privately.
*Advice from the NIAC for clinicians to aid in assessing whether their patient commencing, receiving, or post immunosuppressive therapy should receive 3 doses of HPV vaccine:
Ideally, recommended vaccines should be administered at least two weeks prior to commencing immunosuppressive therapy. Provided the HPV vaccine is administered two weeks or longer before starting immunosuppressive therapy, then the usual recommended dose schedule for age applies.
When considering vaccinating people who are about to start, are receiving or have received immunosuppressive therapy, it is important to review:
- the mechanism of action of the treatment and duration of its effect on the immune system
- the consequence of using combination therapies which can contribute to the nature, extent and length of the immunocompromising condition, e.g., corticosteroids with other immunosuppressive therapies such as disease-modifying anti-rheumatoid drugs
- the anticipated duration of immunocompromise due to the disease or treatment
- the underlying disease or condition
- the interval since completing treatment
The degree of immunosuppression and the interval until immune reconstitution vary with the type and intensity of immunosuppressive therapy, radiation therapy, underlying disease, and other factors. Therefore, it may not be possible to make a definitive recommendation for an interval after cessation of immunosuppressive therapy when HPV vaccine can be administered effectively. Clinical assessment of each individual case is necessary to determine the likely degree and duration of immunosuppression.
Following clinical assessment by the specialist treating physician, seek further expert advice from an Immunologist if needed.
Immunosuppression may occur in the following (the lists are not exhaustive):
|Those who are receiving or have received in the previous six months
||Immunosuppressive therapy for a solid organ transplant
Immunosuppressive chemotherapy or radiotherapy for any indication
|Those who are receiving or have received in the previous three months
|| Targeted therapy for autoimmune disease e.g.,
- JAK inhibitors
- Biologic immune modulators including:
- B-cell targeted therapies
- monoclonal tumour necrosis factor inhibitors (TNFi)
- T-cell co-stimulation modulators
- soluble TNF receptors
- interleukin (IL)-1, IL-6, IL-17/23 inhibitors
Non-biological oral immune modulating drugs e.g.,
- methotrexate > 0.4 mg/kg/week
- azathioprine >3.0mg/kg/day
- 6-mercaptopurine >1.5mg/kg/day
- mycophenolate >1g/day
Certain combination therapies at individual doses lower than stated above, including:
- on prednisolone ≥7.5 mg per day with other immunosuppressants (other than hydroxychloroquine or sulfasalazine)
- methotrexate (any dose) with leflunomide
|Those who are receiving high dose corticosteroids
Prednisolone or its equivalent:
Adults and children weighing ≥10kg:
- ≥40mg/day for more than one week,
- ≥20mg/day for two weeks or longer
Children <10 kg:
- 2 mg/kg/day for two weeks or longer