Human Papillomavirus Vaccination Beyond Age 26: Evidence, Limitations, And Implications For Vaccination Policy

Human papillomavirus (HPV) is the most prevalent sexually transmitted infection globally and a major cause of anogenital and oropharyngeal cancers. Prophylactic HPV vaccination is most effective when administered before sexual debut and is routinely recommended for adolescents and young adults up to 26 years of age. However, ongoing HPV exposure throughout adulthood has prompted increasing interest in vaccination beyond this age group.This narrative review examines evidence for HPV vaccination in adults aged 26 years and older from randomized trials, observational studies, and modeling analyses, with a focus on immunogenicity, clinical effectiveness, safety, and population-level impact. Data from randomized controlled trials, immunogenicity-bridging studies, and modeling analyses indicate that HPV vaccines remain highly immunogenic and safe in mid-adult adults and can prevent new infections with vaccine-covered HPV types. Nevertheless, the overall public health benefit and cost-effectiveness of extending routine vaccination to this age group are limited, largely due to prior HPV exposure and indirect protection conferred by established adolescent vaccination programs.Overall, current evidence does not support routine HPV vaccination beyond age 26 at a population level. However, vaccination may still provide individual benefit in selected adults with ongoing or anticipated risk of new HPV exposure. These findings support a targeted, risk-based approach guided by shared clinical decision-making.