Recommendations and guidance for human papillomavirus (HPV) vaccination for adults in Taiwan

Human papillomavirus (HPV) is the most prevalent viral infection globally, transmitted primarily through sexual or intimate skin-to-skin contact. Certain HPV types can cause anogenital warts and has the potential to cause cervical cancer, other anogenital, and oropharyngeal cancers. Adjuvanted, non-live, HPV recombinant vaccines, including the bivalent, quadrivalent, and 9-valent vaccines, are widely recommended for adolescents and young adults to prevent HPV infection and lower the incidence of HPV-related cancers. However, recommendations for adults aged 26 years or older have been lacking due to insufficient evidence until recently. The Working Group on Adult Immunization Practice of the Infectious Diseases Society of Taiwan (IDSTAIP working group) addressed this gap and drafted recommendations for HPV vaccination in adults using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. These recommendations were then reviewed and revised by expert panels and endorsed by eight national medical societies. This document is positioned as a guidance to provide recommendations for HPV vaccination in adults, considering gender, age, immune status, and prior HPV vaccination history. Safety evaluations, dosing schedules, and special considerations regarding the occupational exposure of healthcare providers, based on potential modes of HPV transmission, are provided. In summary, a 3-dose HPV vaccination schedule is recommended for all adults through age 45 years, regardless of sex, to prevent genital warts, anogenital cancers, as well as oropharyngeal infections and cancers. This guidance serves to assist healthcare providers in facilitating shared decision-making but does not supersede clinical judgment in assessing individual risk and making specific recommendations.