Supplementary Table 2 supports figure 2 in the main text and includes the proportions of CIN2+ that were HPV16/18 positive that are used to make the graphs.

PURPOSE:To investigate the percent of adolescents who receive human papillomavirus (HPV) vaccine with one or more other vaccines recommended for adolescents in a single medical visit. METHODS:Data from the 2023 National Immunization Survey-Teen were analyzed. Timing of receipt of HPV vaccine, tetanus, diphtheria, and acellular pertussis vaccine (Tdap), quadrivalent meningococcal conjugate vaccine (MenACWY), and influenza vaccine was assessed using provider-reported vaccination histories. RESULTS:In 2023, among adolescents aged 13-17 years, 69.5% received HPV vaccine with one or more other vaccines recommended for adolescents in a single medical visit. In addition, 47.8% received specifically HPV vaccine, Tdap, and MenACWY together in a single medical visit. DISCUSSION:The HPV vaccine is commonly given with other vaccines recommended for adolescents in a single medical visit. These findings demonstrate variation in simultaneous vaccination patterns, suggesting that flexibility in the recommended adolescent vaccination schedule allows for different approaches to vaccination across clinical settings and family preferences while maintaining adherence to the recommended schedule.

Supplementary Figure 1 shows the different assays used for HPV typing by collection date, HPV-IMPACT, 2008 to 2019.

Data from the 2025 National Immunization Survey-Teen for 18,692 adolescents aged 13-17 years were analyzed to assess trends in adolescent vaccination coverage. The 2025 CDC Child and Adolescent Immunization Schedule (updated July 2, 2025) recommended routine vaccination of persons aged 11-12 years with tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); quadrivalent meningococcal conjugate vaccine (MenACWY); and human papillomavirus (HPV) vaccine (which may be started at age 9 years). In 2025, coverage with ≥1 dose of Tdap and ≥1 dose of MenACWY decreased compared with 2024 but remained approximately 90%. HPV vaccination coverage (≥1 dose and up to date with HPV vaccination series) did not increase for the fourth consecutive year and remained lower than coverage with ≥1 dose of Tdap and ≥1 dose of MenACWY. Differences in vaccination coverage between nonmetropolitan statistical areas (mostly rural) and metropolitan statistical areas (mostly urban) persisted in 2025: coverage with ≥1 dose of HPV vaccine was 12.0 percentage points lower among adolescents living in mostly rural areas than among those living in mostly urban areas. Vaccination coverage varied by jurisdiction, with the largest variation observed for HPV vaccine. To ensure that adolescents are up to date, providers can review adolescent vaccination records, discuss recommended vaccines with families, and during all clinical encounters, administer all recommended vaccines that are due.

Supplementary Table 1 shows characteristics by HPV typing data availability, HPV 16/18 results, and vaccination status.

BACKGROUND:Monitoring human papillomavirus (HPV) types detected in cervical precancers has been one approach to evaluate HPV vaccination impact in the United States. During 2008 to 2014, the proportion of cervical precancers positive for HPV16/18 decreased overall and among some demographic and histologic subgroups. This updated analysis describes trends through 2019. METHODS:We analyzed cervical precancers among women 20 to 39 years of age from a five-site, population-based surveillance program for cervical intraepithelial neoplasia grade 2 or higher and adenocarcinoma in situ (AIS; collectively CIN2+). Available archived diagnostic tissue was tested for HPV16, HPV18, and other HPV types. We evaluated the average annual percent change (AAPC) in the proportion of cervical precancers with HPV16 or 18 detected overall and by vaccination status, age group, diagnosis, race/ethnicity, and surveillance site. RESULTS:During 2008 to 2019, 17,323 CIN2+ cases had valid typing results. The proportion of cases positive for HPV16/18 significantly decreased by 3.6% per year. The largest decrease occurred among cases in vaccinated women (AAPC = -8.9), with smaller but still significant decreases among unvaccinated women (AAPC = -2.3). Significant decreases were observed among all subgroups evaluated, except women 35 to 39 years of age, AIS, and Asian women. CONCLUSIONS:During 2008 to 2019, decreases in the proportion of CIN2+ cases that were HPV16/18 positive among vaccinated and unvaccinated women and in most subgroups evaluated suggest direct and indirect HPV vaccination impact. IMPACT:HPV vaccination impact on precancers is prognostic of future decreases in cervical cancer. Continued monitoring can enable evaluation of vaccination impact in population subgroups.

BACKGROUND:We assessed temporal trends in prevalent anal human papillomavirus (HPV) infection among men who have sex with men (MSM) without HIV who attended sexual health clinics in three U.S. cities during 2018-2024. METHODS:Residual anal specimens from MSM without HIV, aged 18-45 years, were tested for 28 HPV genotypes. Demographic information was obtained from clinic records. Trends in quadrivalent vaccine (4vHPV)-type prevalence and non-vaccine-type HPV prevalence were evaluated using Joinpoint regression, stratified by age group (18-26 and 27-45 years). Non-vaccine-type HPV prevalence was used as a measure of sexual exposure; these HPV types are not targeted by any available vaccine. Joinpoint regression fits a series of joined straight lines on a logarithmic scale to the trends in prevalence; trends were reported as annual percent change (APC). RESULTS:Among persons aged 18-26 years, 4vHPV-type prevalence declined from 23.7% in 2018-2019 to 13.4% in 2023-2024 (APC = -13.4%), while non-vaccine-type HPV prevalence had a slight but non-significant decline. Among persons aged 27-45 years, 4vHPV-type prevalence declined from 37.2% in 2018-2019 to 28.2% in 2023-2024 (APC = -5.6%), while non-vaccine-type HPV prevalence remained stable. CONCLUSIONS:Among MSM aged 18-26 and 27-45 years, there was a decline in 4vHPV-type prevalent anal infections during 2018-2024. There was little to no decline in non-vaccine-type HPV prevalence during the same time period, suggestive of unchanging sexual exposure to HPV. These data demonstrate the impact of HPV vaccine on anal HPV infections in MSM.Summary: During 2018-2024, vaccine-type anal HPV infection declined by 13.4% and 5.6% annually among 18-26-year-old and 27-45-year-old men who have sex with men, respectively.

Background The Advisory Committee on Immunization Practices (ACIP) recommends routine human papillomavirus (HPV) vaccination at age 11 or 12 years (vaccination can be given starting at age 9 years), with catch-up vaccination for all persons through age 26 years. ACIP recommends shared clinical decision-making for HPV vaccination of persons aged 27 through 45 years, although modeling indicated that broadly vaccinating persons in this age group would not be cost-effective. To help inform clinical decision-making, the objective of this study was to estimate the cost-effectiveness of HPV vaccination among gay, bisexual, and other men who have sex with men (GBMSM) aged 27 through 45 years in the United States. Method We used an age-specific, compartmental, susceptible-infectious-susceptible (SIS) model of HPV transmission and disease among GBMSM to estimate changes in HPV, anogenital wart, and HPV-attributable cancer incidence when the upper age for vaccination among GBMSM was raised to age 30, 35, 40, or 45 years. We then estimated changes in quality adjusted life years (QALYs), costs (vaccination costs and direct medical costs of HPV disease), and the incremental cost-effectiveness ratio under each of these scenarios. Results Our estimates showed that HPV vaccination of GBMSM was cost-saving through age 45 years, i.e., the costs of vaccination are more than offset by decreases in the direct medical costs of HPV disease. Vaccination of GBMSM through at least age 40 years was cost-saving across most sensitivity analyses. Conclusions Vaccination of GBMSM through age 45 years is likely a cost-saving use of public health resources.

The Advisory Committee on Immunization Practices recommends routine human papillomavirus (HPV) vaccination at 11-12 years; the series can begin at age 9. U.S. HPV vaccination coverage is lower than other adolescent vaccinations. One proposed strategy to increase coverage is initiation at 9-10 years. We systematically reviewed studies addressing vaccination at age 9 to identify and evaluate evidence regarding potential programmatic advantages. Among 30 publications from 2014 to 2024 there were retrospective cohort studies (N = 11), intervention studies with a component focused on vaccination at 9-10 (N = 12), and studies of feasibility or acceptability by providers or caregivers (N = 7). While retrospective analyses found earlier initiation associated with completion, limitations in methodology preclude a cause-and-effect interpretation. Impact of age 9 vaccination is difficult to isolate in intervention studies that had multiple components. While initiating vaccination at age 9 is feasible, questions remain regarding the benefit of this approach to increase coverage.

BACKGROUND:In June 2019, the U.S. Advisory Committee on Immunization Practices recommended shared clinical decision making regarding potential human papillomavirus (HPV) vaccination of men and women aged 27 to 45 years ("mid-adults"). OBJECTIVE:To examine the incremental cost-effectiveness ratios (ICERs) and number needed to vaccinate (NNV) to prevent 1 HPV-related cancer case of expanding HPV vaccination to subgroups of mid-adults at increased risk for HPV-related diseases in the United States. DESIGN:Individual-based transmission dynamic modeling of HPV transmission and associated diseases using HPV-ADVISE (Agent-based Dynamic model for VaccInation and Screening Evaluation). DATA SOURCES:Published data. TARGET POPULATION:All U.S. mid-adults and higher-risk subgroups within this population. TIME HORIZON:100 years. PERSPECTIVE:Health care sector. INTERVENTION:Expanding 9-valent HPV vaccination to mid-adults and higher-risk subgroups. OUTCOME MEASURES:ICERs and NNVs. RESULTS OF BASE-CASE ANALYSIS:Expanding 9-valent HPV vaccination to all mid-adults, those with more lifetime partners, and those who have just separated was projected to cost an additional $2 005 000, $763 000, and $1 164 000 per quality-adjusted life-year (QALY) gained, respectively. The NNVs to prevent 1 additional HPV-related cancer case were 7670, 3190, and 5150, respectively, compared with 223 for vaccination of persons aged 9 to 26 years (vs. no vaccination). RESULTS OF SENSITIVITY ANALYSIS:The mid-adult strategy with the lowest ICER and NNV was vaccinating infrequently screened mid-adult women who have just separated and have a higher number of lifetime sex partners (ICER, $86 000 per QALY gained; NNV, 470). LIMITATION:Uncertainty about rate of new sex partners and natural history of HPV among mid-adults. CONCLUSION:Vaccination of mid-adults against HPV is substantially less cost-effective and produces higher NNVs than vaccination of persons younger than 26 years under all scenarios investigated. However, cost-effectiveness and NNV are projected to improve when higher-risk mid-adult subgroups are vaccinated, such as mid-adults with more sex partners and who have recently separated, and women who are underscreened. PRIMARY FUNDING SOURCE:Centers for Disease Control and Prevention.

Human papillomavirus (HPV)-associated cancers are vaccine preventable. In 2016, the previously recommended three-dose HPV vaccination series was changed to a two-dose series and nine-valent HPV vaccine (9vHPV) became the only HPV vaccine available in the United States. Data on longer-term duration of antibodies following a 9vHPV two-dose series are limited. We evaluated the immunogenicity and duration of antibodies up to three years after vaccination with a two-dose series of 9vHPV in a cohort of Alaska Native children. We enrolled Alaska Native children aged 9–14 years who received 9vHPV in Anchorage, Alaska during 2017–2018. We collected sera at six months after dose one and at one month, one year, and three years after dose two to measure type-specific immunoglobulin G (IgG) concentrations for the 9vHPV types (HPV6/11/16/18/31/33/45/52/58). Aggregate type-specific IgG concentrations were reported as geometric mean concentrations (GMC). A total of 227 children completed the two-dose series of 9vHPV and provided ≥ 1 blood sample. The median age at enrollment was 11.0 years (range: 9.0–14.6) and was similar between males and females (p = 0.11). At one month after dose two, all 197 participants with available serum were seropositive for all 9vHPV types. Among 145 participants who had a specimen available at three years after dose two, 134 (92

Three vaccines are recommended for routine administration to adolescents by the Advisory Committee on Immunization Practices: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); quadrivalent meningococcal conjugate vaccine (MenACWY); and human papillomavirus (HPV) vaccine. Data from the 2024 National Immunization Survey-Teen were analyzed to determine national, state, and selected local area vaccination coverage in 2024. Household response rate (21.0%) and receipt of adequate provider data for adolescents with completed interviews (42.8%) were comparable to prior survey years. Among 16,325 adolescents aged 13-17 years with adequate provider data included in the survey, coverage with ≥1 Tdap dose increased from 89.0% in 2023 to 91.3% in 2024; coverage with ≥1 MenACWY dose increased from 88.4% to 90.1%. HPV vaccination coverage remained stable for the third consecutive year; 78.2% of adolescents had received ≥1 dose, and 62.9% were up to date with the HPV vaccination series. Coverage with ≥1 Tdap dose was ≥90% in 39 states, with ≥1 MenACWY dose was ≥90% in 30 states, and with ≥1 dose of HPV vaccine was ≥80% in 26 states and the District of Columbia. Since 2016, lower HPV vaccination coverage in nonmetropolitan statistical areas (MSAs) compared with that in MSA principal cities has persisted, with an 11 percentage point difference in coverage with ≥1 HPV vaccine dose and percentage of adolescents up to date with HPV vaccination in 2024. Health care providers can support adolescent health by discussing and recommending vaccines, as well as reviewing patient records to ascertain whether adolescents are up to date with recommended vaccines.

BACKGROUND:We evaluated human papillomavirus (HPV) vaccine effectiveness (VE) against prevalent anal HPV among men who have sex with men (MSM) by age, age at vaccination, and age at vaccination relative to age at first sex. METHODS:Residual anal specimens from 1092 MSM aged 18 to 45 years attending a Seattle, Washington, sexual health clinic in 2018 to 2020 were tested for 28 HPV types. Demographic, clinical, sexual behavioral, and HPV vaccination data were extracted from clinic and electronic medical records. We calculated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between vaccination (≥1 dose of any HPV vaccine) and quadrivalent HPV vaccine (4vHPV)-type infection, by age group (18-26, 27-35, 36-45 years), vaccination age (among age groups 18-26, 27-35 years), and vaccination age relative to first sex (among those 18-26 years). Analyses were adjusted for race and ethnicity, preexposure prophylaxis use for HIV prevention, and lifetime number of sex partners. Vaccine effectiveness was calculated as (1 - aPR) × 100. RESULTS:Among persons aged 18 to 26 years, 4vHPV-type HPV prevalence was lower among those vaccinated before first sex (aPR, 0.12 [95% CI, 0.02-0.87]; VE, 88%) or at <18 years of age (aPR, 0.22 [95% CI, 0.07-0.68]; VE, 78%) versus unvaccinated, but no VE was observed in those vaccinated at 18 to 26 years of age. Among persons aged 27 to 35 years, 4vHPV-type HPV prevalence was lower among those vaccinated at 18 to 26 years of age versus unvaccinated (aPR, 0.56 [95% CI, 0.36-0.87]; VE, 44%). No VE was observed in persons aged 27 to 35 or 36 to 45 years who were vaccinated at >26 years of age. CONCLUSIONS:Results highlight the importance of routine HPV vaccination in adolescence and support efforts to increase catch-up vaccination among MSM.

Supplemental Figure S1. Percentage of Immunization Information System (IIS) records matched with birth records, by birth year and matching method, Michigan, 1980-2004.

Investigations of type replacement after human papillomavirus (HPV) vaccine introduction have found increases in some non-vaccine types, but findings have been inconsistent. National Health and Nutrition Examination Survey data were used to explore potential type replacement through 12 years after introduction of the U.S. HPV vaccination program. We determined weighted prevalences of 14 individual high-risk (HR) types (HPV16/18/31/33/35/39/45/51/52/56/58/59/66/68), HPV16/18, and other type categories and compared prevalences among 14-29-year-old females in 2015-2018 compared with the prevaccine era (2003-2006), overall and among non-Hispanic Black (NHB) and non-Hispanic White (NHW) females. Overall, HPV16/18 prevalence decreased; no non-vaccine-HR types increased. There were similar decreases in HPV16/18 prevalence among NHB and NHW females. Type replacement was not seen overall, although there were increases of specific types in two racial/ethnic groups; HPV68 increased among NHB but not NHW females; HPV35 increased among NHW but not NHB females, although the 2003-2006 prevalence estimate for HPV35 was unstable.

In addition to oropharyngeal cancers, evidence suggests that there may be an etiologic role for human papillomavirus (HPV) in some other head and neck cancers arising from the oral cavity and larynx. We estimated the burden of HPV16-attributable cancers of the oral cavity (International Classification of Diseases for Oncology, 3rd Edition, site codes C02.0-C02.3, C02.9, C03.0, C03.1, C03.9, C04.0, C04.1, C04.8, C04.9, C05.0, C05.8, C05.9, C06.0-C06.2, C06.8, C06.9) and larynx (C32.0-C32.3, C32.8, C32.9) in the United States by pooling estimates from published case studies to calculate HPV16-attributable fractions and applying the HPV16-attributable fractions to 2016-2020 US Cancer Statistics data. During 2016-2020, of an average annual number of 12 612 oral cavity cancers, 3.9% (n = 497) were estimated to be attributable to HPV16. Of an average annual number of 11 170 laryngeal cancers, 2.8% (n = 309) were estimated to be attributable to HPV16. This information can improve surveillance of HPV16-attributable cancers in the US population and inform our understanding of the potential impact of HPV vaccination on cancers of the oral cavity and larynx.

BACKGROUND:Men who have sex with men (MSM) with HIV are disproportionately affected by human papillomavirus (HPV) and related diseases. We assessed HPV vaccine effectiveness (VE) against anal HPV among MSM with HIV. METHODS:During 2018-2023, residual anal specimens from MSM with HIV, aged 18-45 years, attending sexual health clinics in three U.S. cities were collected and tested for HPV. Demographic and vaccination information were obtained from clinic records or immunization registries. Timing of vaccination relative to HIV acquisition was unknown. Log-binomial regression was used to calculate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for associations between vaccination (≥1 dose) and quadrivalent vaccine (4vHPV)-type infection, adjusting for city. Models were stratified by age group (18-26, 27-45 years). VE was calculated as (1-aPR) x 100. RESULTS:Among 224 persons aged 18-26 years, 54% were vaccinated. Compared with unvaccinated persons, 4vHPV-type prevalence was lower in those vaccinated at age <18 (aPR=0.31, 95% CI:0.14-0.72, VE=69%) and ≥2 years before specimen collection (aPR=0.54, 95% CI:0.31-0.92, VE=46%). Among 700 persons aged 27-45 years, 17% were vaccinated. Compared with unvaccinated persons, 4vHPV-type prevalence was lower in those vaccinated at ages 18-26 (aPR=0.63, 95% CI:0.45-0.89, VE=37%) and ≥2 years before specimen collection (aPR=0.63, 95% CI:0.46-0.86, VE=37%). CONCLUSIONS:While timing of vaccination relative to HIV acquisition was unknown, we found significant VE against prevalent HPV infection in adult MSM with HIV. Within each age group, VE was higher with younger age at vaccination.

In 2006, human papillomavirus (HPV) vaccine was first recommended in the United States to prevent cancers and other diseases caused by HPV; vaccination coverage increased steadily through 2021, and increasing numbers of young women had received HPV vaccine as children or adolescents. Since 2008, CDC has monitored incidence of precancerous lesions (cervical intraepithelial neoplasia [CIN] grades 2-3 and adenocarcinoma in situ [AIS], collectively CIN2+), which are detected through cervical cancer screening and can be used as an intermediate outcome for monitoring vaccination impact, via the five-site Human Papillomavirus Vaccine Impact Monitoring Project. This analysis describes trends in incidence of CIN2+ and CIN3+ (i.e., CIN grade 3 and AIS) lesions during 2008-2022. Among women aged 20-24 years who were screened for cervical cancer, rates during 2008-2022 decreased for CIN2+ by 79%, and for CIN3+ by 80%. In the same period, CIN3+ rates among screened women aged 25-29 years decreased by 37%. These data are consistent with considerable impact of HPV vaccination for preventing cervical precancers among women in the age groups most likely to have been vaccinated, and support existing recommendations to vaccinate children at the routinely recommended ages as a cancer prevention measure.

BACKGROUND:Randomized control trials in sub-Saharan countries found that male circumcision may prevent high-risk human papillomavirus (HR-HPV) acquisition. Using 2013-2016 National Health and Nutrition Examination Survey data, we explored the association between circumcision and HR-HPV among sexually experienced 18- to 59-year-old men. METHODS:Self-collected penile specimens were tested for HPV DNA. We estimated weighted HR-HPV prevalence (positivity to ≥1 HR type: HPV-16/18/31/33/35/39/45/51/52/56/58/59/66/68) by circumcision status. The association between circumcision and HR-HPV was assessed using multivariable logistic regression models. Effect modification by circumcision on the association between number of lifetime sex partners and HR-HPV was explored. RESULTS:Overall, 77.7% of men reported being circumcised, with large variation by race/ethnicity and country of birth. High-risk HPV prevalence was significantly higher among circumcised (25.7%) than uncircumcised (20.4%) men; this was attenuated after adjustment for lifetime and new past-year sex partners (adjusted prevalence ratio, 1.10; 95% confidence interval, 0.92-1.32). There was evidence that circumcision modified the association between lifetime partners and HR-HPV, but HR-HPV prevalence increased with increasing number of partners in circumcised and uncircumcised men. CONCLUSIONS:Our observed lack of statistical association between circumcision and HR-HPV may differ from randomized trial results because of the differences between circumcised and uncircumcised men or differences in anatomic site sampled or timing of circumcision.