If I Only Got the First Hpv Shot Can I Go Back to Get Them Again

Human Papillomavirus (HPV)

Illness Problems Contraindications and Precautions Vaccine Recommendations Vaccine Safety Scheduling and Administering Vaccines Storage and Treatment

Disease Problems

How mutual is human papillomavirus (HPV) infection?

HPV is the about mutual sexually transmitted infection in the U.s.. In the U.s.a., an estimated 79 meg persons are infected, and an estimated xiv million new HPV infections occur every year among persons age 15 through 59 years. Approximately half of new infections occur amidst persons age fifteen through 24 years. Showtime HPV infection occurs within a few months to years of becoming sexually active.

How serious is disease caused by HPV?

Most HPV infections are asymptomatic and go away completely on their own within 2 years after infection without causing clinical disease. Some infections are persistent and can lead to precancerous lesions or cancer. HPV infection caused by certain HPV types cause nearly all cases of anogenital warts in women and men and recurrent respiratory papillomatosis.

From 2014 through 2018, approximately 46,143 new cases of HPV-associated cancers* occurred each twelvemonth in the United States (25,719 among women and twenty,424 among men). Cervical cancer, the most widely known HPV-associated cancer, acquired an average of 12,200 cases in the U.S. each year during that time. HPV is besides associated with vulvar, and vaginal cancer in females, penile cancer in males, and anal and oropharyngeal cancer in both females and males. Between 2014 and 2018, oropharyngeal cancers were the most commonly occurring HPV-associated cancers, with an average of twenty,236 reported cases each twelvemonth (sixteen,680 among men and three,556 among women). See world wide web.cdc.gov/cancer/hpv/statistics/cases.htm for more information on trends in HPV-associated cancer.

*Annotation: CDC defines HPV-associated cancer equally cancers at specific anatomic sites with specific cell types in which HPV DNA is frequently found. These parts of the body include the cervix, vagina, vulva, penis, anus, and oropharynx.

Which types of HPV are most probable to cause disease?

In the United States, approximately 80% of HPV-related cancers are attributable to HPV 16 or 18 which are included in all three HPV vaccines that have been available in the U.S. Approximately 12% are attributable to HPV types 31, 33, 45, 52, and 58 (16% of all HPV-attributable cancers for females; 6% for males; approximately 3,800 cases annually), which are included in the 9-valent HPV vaccine. HPV types 16, 18, 31, 33, 45, 52, or 58 account for about 81% of cervical cancers in the U.s.a.. HPV types half-dozen or 11 cause xc% of anogenital warts (condylomata) and most cases of recurrent respiratory papillomatosis.

Is at that place a treatment for HPV infection?

There is no treatment for HPV infection. But HPV-associated lesions including genital warts, recurrent respiratory papillomatosis, precancers, and cancers are treated. Recommended treatments vary depending on the diagnosis, size, and location of the lesion. Local treatment of lesions might not eradicate all HPV containing cells fully; whether bachelor therapies for HPV-associated lesions reduce infectiousness is unclear.

Are healthcare personnel at risk of occupational infection with HPV?

Occupational infection with HPV is possible. Some HPV-associated conditions (including anogenital and oral warts, anogenital intraepithelial neoplasias, and recurrent respiratory papillomatosis) are treated with light amplification by stimulated emission of radiation or electrosurgical procedures that could produce airborne particles. These procedures should be performed in an appropriately ventilated room using standard precautions and local exhaust ventilation. Workers in HPV enquiry laboratories who handle wild-blazon viruses or "quasi virions" might be at risk of acquiring HPV from occupational exposures. In the laboratory setting, proper infection control should be instituted including, at minimum, biosafety level two. Whether HPV vaccination would exist of benefit in these settings is unclear because no data exist on transmission risk or vaccine efficacy in this situation.

Can human papillomavirus (HPV) be transmitted by non-sexual transmission routes, such every bit clothing, undergarments, sex toys, or surfaces?

Nonsexual HPV transmission is theoretically possible just has not been definitely demonstrated. This is mainly because HPV can't exist cultured and Dna detection from the surroundings is hard and likely decumbent to false negative results.

If a person has been infected with a wild-type strain of HPV tin can they be reinfected with the aforementioned strain?

If a person is infected with an HPV strain that does not clear (that is, the person becomes persistently infected) the person cannot be reinfected considering they are continuously infected. If a person is infected with an HPV strain that clears, some but not all persons volition accept a lower chance of reinfection with the same strain. Data suggest that females are more than likely than males to develop immunity after clearance of natural infection. Prior infection with an HPV strain does not lessen the take chances of infection with a different HPV strain.

Vaccine Recommendations Back to height

Delight describe the HPV vaccines available in the U.s.a..

Gardasil nine (9vHPV, Merck) is the only HPV vaccine being distributed in the Usa. Bivalent Cervarix (2vHPV, GlaxoSmithKline) and quadrivalent Gardasil (4vHPV, Merck) are no longer being distributed in the United States.

9vHPV is an inactivated ix-valent vaccine licensed by the Food and Drug Administration (FDA) in 2014. Information technology contains 7 oncogenic (cancer-causing) HPV types (xvi, 18, 31, 33, 45, 52, and 58) and two HPV types that cause most genital warts (half-dozen and 11). The 9vHPV vaccine is licensed for females and males age 9 through 45 years.

What are the recommendations for use of HPV vaccine in people historic period nine through 26 years?

The ACIP recommends that routine HPV vaccination exist initiated for all children at age 11 or 12 years. Vaccination can exist started as early as historic period nine years. Vaccination is also recommended for all people historic period thirteen through 26 years who have non been vaccinated previously or who take not completed the vaccination series.

Are catch-upwardly recommendations for the use of HPV vaccine different for males and females?

No. In June 2019, the Informational Commission on Immunization Practices (ACIP) voted to recommend routine take hold of-up HPV vaccination of all previously unvaccinated or incompletely vaccinated males historic period 22 through 26, the aforementioned every bit the recommendation for females. HPV vaccination recommendations differ past historic period grouping. At that place is one recommendation for people 9 through 26 years of age and another recommendation for people 27 through 45 years of age.

The virtually electric current ACIP recommendations for HPV vaccine are available at www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6832a3-H.pdf.

What are the recommendations for use of HPV vaccine in people age 27 through 45 years?

Catch-upwardly HPV vaccination is not recommended for all adults older than 26 years of age. Instead, shared clinical controlling regarding HPV vaccination is recommended for some adults aged 27 through 45 years who are not adequately vaccinated.

Ideally, HPV vaccine should be administered before potential exposure to HPV through sexual contact.

Why is shared clinical decision-making (a discussion betwixt the provider and the patient) recommended to determine whether to provide HPV vaccine to an adult age 27 through 45 years?

Although new HPV infections are most unremarkably acquired in adolescence and young machismo, at whatever historic period, having a new sex partner is a risk factor for acquiring a new HPV infection. In add-on, some persons accept specific behavioral or medical chance factors for HPV infection or affliction, including men who have sex with men, transgender persons, and persons with immunocompromising conditions. HPV vaccine works to forestall infection among persons who have non been exposed to vaccine-type HPV before vaccination. A give-and-take with your patient is the all-time way to decide together how much the patient may benefit from HPV vaccination to prevent new HPV infections.

Why is HPV vaccination not routinely recommended for all adults age 27 through 45 years?

Because HPV acquisition by and large occurs soon after offset sexual activeness, vaccine effectiveness will be lower in older age groups as the result of prior infections. In full general, exposure to HPV as well decreases among individuals in older age groups. Evidence suggests that although HPV vaccination is rubber for adults 27 through 45 years, population do good would be minimal; all the same, some adults who are unvaccinated or incompletely vaccinated might be at hazard for new HPV infection and might do good from vaccination in this age range.

Should I screen my patients historic period 27 through 45 years for previous HPV infection to determine whether to offer them HPV vaccine?

No. No screening laboratory test can determine whether a person is already immune or still susceptible to any given HPV blazon. Most sexually active adults have been exposed to i or more than HPV types, although not necessarily all of the HPV types targeted by vaccination. HPV vaccine works to prevent infection with vaccine types to which a person is notwithstanding susceptible.

I take a few patients who received their first or second dose of HPV vaccine at age 26 years or younger, simply did not consummate the series. Should I routinely consummate their series afterwards age 26 years, or practice I need to use the shared clinical determination-making approach?

Consummate the series based on shared clinical decision-making involving the patient�due south gamble and desire for protection.

What is the routine schedule for HPV vaccine?

ACIP recommends a routine 2-dose HPV vaccine schedule for adolescents who offset the vaccination serial before the 15th birthday. The two doses should be separated by half dozen to 12 months. The minimum interval between doses is five calendar months.

A 3-dose schedule is recommended for all people who get-go the serial on or afterwards the 15th birthday and for people with certain immunocompromising conditions (such as cancer, HIV infection, or taking immunosuppressive drugs). The second dose should exist given i to ii months later on the first dose and the third dose 6 months subsequently the offset dose. The minimum interval between the offset and second doses of vaccine is four weeks. The minimum interval between the second and third doses of vaccine is 12 weeks. The minimum interval between the first and tertiary dose is 5 calendar months. If the vaccination serial is interrupted, the serial does not demand to exist restarted.

I read that HPV vaccination rates are still low. What can nosotros practise as providers to improve these rates?

Coverage levels for HPV vaccine are improving but are withal inadequate. Results from the Centers for Illness Control and Prevention'southward 2020 National Immunization Survey-Teen (NIS-Teen) bespeak that 77.i% of girls age xiii through 17 years had started the series that they should have completed past historic period 13 years and 61.4% had completed the series. In 2020, 73.i% of boys age 13 through 17 years had received one dose but only 56% had received all recommended doses. A summary of the 2020 NIS-Teen survey is available at www.cdc.gov/mmwr/volumes/seventy/wr/mm7035a1.htm.

Providers can improve uptake of this life-saving vaccine in two primary means. First, studies have shown that missed opportunities are occurring. Up to xc% (depending on year of birth) of girls unvaccinated for HPV had a healthcare visit where they received another vaccine such as Tdap, merely not HPV. If HPV vaccine had been administered at the aforementioned visit, vaccination coverage for one or more doses could be 90% instead of lxx%. Second, research has shown that non receiving a healthcare provider'southward recommendation for HPV vaccine was one of the main reasons parents reported for non vaccinating their boyish children.

CDC urges healthcare providers to increase the consistency and strength of their recommendation of HPV vaccine, especially when patients are age xi or 12 years. CDC'south "Talking to Parents well-nigh HPV Vaccine," available at www.cdc.gov/hpv/hcp/for-hcp-tipsheet-hpv.pdf can help providers with these conversations. For more detailed information nigh HPV vaccination strategies for providers, visit www.cdc.gov/hpv/hcp/index.html.

Some parents resist HPV vaccination of their xi- and 12-year-olds considering they are non sexually agile. How should I counter this position?

Explicate to the parent that vaccination starting at 11 or 12 years volition provide the all-time protection possible long before the first of any kind of sexual activity. It is standard practice to vaccinate people before they are exposed to an infection, as is the case with measles and the other recommended childhood vaccines. Similarly, nosotros desire to vaccinate children before they go exposed to HPV. Studies of HPV vaccine indicate that younger adolescents answer better to the vaccine than older adolescents and young adults. Healthy children vaccinated at this age will demand only two doses of vaccine rather than 3 doses if vaccinated at an older age. Finally, numerous enquiry studies accept shown that getting the HPV vaccine does not brand kids more than likely to be sexually agile or starting time having sex at a younger historic period.

We have several males in our college wellness service whose records point that they received doses of Cervarix. Tin we count these doses every bit valid?

No. Cervarix was not approved or recommended for apply in males. Doses of Cervarix administered to males should not be counted and need to exist repeated using 9vHPV.

Are additional 9vHPV doses recommended for a person who started a 3-dose series with 2vHPV or 4vHPV and completed the series with one or two doses of 9vHPV?

At that place is no ACIP recommendation for boosted doses of 9vHPV for persons who started the iii-dose series with 2vHPV or 4vHPV and completed the serial with 9vHPV.

Does ACIP recommend revaccination with 9vHPV for patients who previously received a iii-dose series of 2vHPV or 4vHPV?

ACIP has not recommended routine revaccination with 9vHPV for persons who accept completed a 3-dose serial of some other HPV vaccine. There are data that bespeak revaccination with 9vHPV after a three-dose series of 4vHPV is safe. Clinicians should make up one's mind if the benefit of immunity against 5 additional oncogenic strains of HPV (which cause 12% of HPV-attributable cancers) is justified for their patients.

Is use of HPV vaccine covered under the Vaccines For Children (VFC) program?

Yes.

Are Pap smears even so necessary for women who receive HPV vaccine?

Yes. Vaccinated women still demand to see their healthcare provider for periodic cervical cancer screening. The vaccine does not provide protection confronting all types of HPV that cause cervical cancer, so even vaccinated women will still be at take a chance for some cancers from HPV.

Do women and men whose sexual orientation is same-sexual practice need HPV vaccine?

Yes. HPV vaccine is recommended for females and males regardless of their sexual orientation.

Should transgender persons receive HPV vaccine?

Yes. ACIP recommends routine HPV vaccination for transgender persons equally for all adolescents and young adults through age 26 years. Clinicians should discuss the risks of HPV disease and benefits of HPV vaccination with unvaccinated or incompletely vaccinated transgender persons age 27 through 45 years.

What immunocompromising conditions are an indication for a three-dose HPV schedule?

ACIP recommends vaccination with 3 doses of HPV vaccine for females and males historic period 9 through 26 years with primary or secondary immunocompromising conditions that might reduce jail cell-mediated or humoral immunity. Examples include B lymphocyte antibody deficiency, T lymphocyte complete or partial defects, HIV infection, cancerous neoplasm, transplantation, autoimmune disease, or immunosuppressive therapy.

Is asplenia considered to exist an indication for a 3-dose HPV schedule?

No. The recommendation for a iii-dose HPV schedule as well does not apply to children 9 through 14 years with asthma, chronic granulomatous disease, chronic liver disease, chronic renal illness, central nervous system anatomic barrier defects (such as a cochlear implant), complement deficiency, diabetes, middle affliction or sickle cell illness unless the person is receiving immunosuppressive therapy for the condition.

If a patient has been sexually agile for a number of years, is it nonetheless recommended to give HPV vaccine or to complete the HPV vaccine series?

Yes. HPV vaccine should be administered to people who are already sexually active. Ideally, patients should be vaccinated before onset of sex; notwithstanding, people who have already been infected with ane or more HPV types will still be protected from other HPV types in the vaccine that have not been caused.

I have a patient who was diagnosed with HPV types xvi and xviii. The patient received a properly spaced Gardasil series in 2006 when she was 25 years old. Did the HPV vaccine she received in 2006 fail to protect her?

In clinical trials, HPV vaccines were shown to be highly constructive (more 95%) for prevention of HPV vaccine-type infection and affliction among persons without prior infection with the HPV types included in the vaccine. The well-nigh likely explanation for this situation is that the patient was exposed to at least HPV types 16 and 18 prior to vaccination. The HPV vaccine is not constructive in preventing infection from HPV types a person has been exposed to prior to vaccination. The vaccine also cannot prevent progression of HPV infection or HPV-related disease. The 9vHPV vaccine protects confronting 9 different types of HPV.

Will patients who have already had genital warts benefit from receiving HPV vaccine?

A history of genital warts or clinically evident genital warts indicates previous infection with HPV, most oftentimes type 6 or 11 which crusade 90% of genital warts. However, people with this history might not accept been infected with both HPV half dozen and 11 or with the other HPV types included in HPV vaccine. Vaccination volition provide protection confronting infection with HPV serotypes the patient has not already acquired. Providers should suggest their patients/clients that the vaccine will not have a therapeutic effect on existing HPV infection or genital warts. It is important, however, that patients receive a full historic period-appropriate series of HPV vaccine to get full protection from genital warts, in addition to the cancer-causing HPV types in the vaccine.

Scheduling and Administering Vaccines Dorsum to top

What is the recommended schedule for administering HPV vaccine?

ACIP recommends a routine ii-dose HPV vaccine schedule for adolescents who start the vaccination series before the 15th birthday. The two doses should be separated past 6 to 12 months. The minimum interval between doses is 5 calendar months.

A three-dose schedule is recommended for people who kickoff the series on or after the 15th altogether and for people with certain immunocompromising conditions (such equally cancer, HIV infection, or taking immunosuppressive drugs). The 2d dose should be given 1 to two months after the kickoff dose and the third dose 6 months later the first dose. The minimum interval betwixt the starting time and second doses of vaccine is 4 weeks. The minimum interval between the second and 3rd doses of vaccine is 12 weeks. The minimum interval between the starting time and third doses is v calendar months. If the vaccination series is interrupted, the series does not need to exist restarted.

Has ACIP expressed a preference for the 2-dose over the three-dose schedule for adolescents nine through 14 years of age?

Yes. ACIP recommends the 2-dose schedule for people starting the HPV vaccination serial before the 15th birthday, as long as they are immunocompetent.

If a dose of HPV vaccine is significantly delayed, do I demand to offset the series over?

No, do not restart the series. Yous should continue where the patient left off and complete the serial.

Can the 4-twenty-four hour period "grace menstruum" be applied to the minimum intervals for HPV vaccine?

Yes.

A 16 year old received the 3rd dose of HPV vaccine 12 weeks after the 2nd dose but merely 4 months after the get-go dose. Should the third dose be repeated?

Yep. If an HPV vaccine dose is administered at less than the recommended minimum interval then the dose should be repeated. The repeat tertiary dose should be repeated 5 months afterward the first dose or 12 weeks afterward the invalid third dose, whichever is later.

Does the 2-dose HPV vaccine schedule need to exist completed with the same vaccine, or can it include different vaccines (such as bivalent or quadrivalent vaccine)?

The 2-dose schedule can exist completed with any combination of HPV vaccine brands equally long as dose #1 was given before age 15 years. Dose #2 should be administered six–12 months after dose #1.

If dose #1 of HPV vaccine was given before the 15th birthday and it has been more than than a twelvemonth since that dose was given, would the series be complete with just one additional dose?

Yep. Adolescents and adults who started the HPV vaccine series prior to the 15th birthday and who are non immunocompromised are considered to exist fairly vaccinated with just one additional dose of HPV vaccine.

Nosotros have adolescents in our practise who have received the outset 2 doses of the HPV series 1 or ii months autonomously according to the 3-dose schedule. Can we consider their HPV vaccine series to be complete or practise we need to requite these patients a tertiary dose?

People who have received 2 doses of HPV vaccine separated past less than 5 months should receive a third dose 6�12 months afterwards dose #1 and at least 12 weeks after dose #2.

Is the 2-dose recommendation retroactive for children and teens vaccinated prior to 2016?

Yeah. Any person who ever received 2 doses of whatsoever combination of HPV vaccines can be considered fully vaccinated if dose #1 was given before the 15th birthday and the two doses were separated by at least 5 months.

I work with university students and many of them miss coming in on time for their side by side dose of HPV vaccine. What's the longest interval immune before we need to start the serial over?

No vaccine series needs to be restarted because of an interval that is longer than recommended (with the exception of oral typhoid vaccine in certain circumstances). You should proceed the series where information technology was interrupted.

I accept read that HPV vaccine should not be administered during pregnancy. Practise we demand to perform a pregnancy exam prior to administering this vaccine to our patients? Currently, we ask about pregnancy prior to providing the vaccine.

HPV vaccine is not recommended for utilize during pregnancy. HPV vaccines have not been associated causally with adverse outcomes of pregnancy or adverse events in the developing fetus. Notwithstanding, if a person is constitute to be pregnant after initiating the vaccination serial, the remainder of the series should be delayed until completion of pregnancy. Pregnancy testing is not needed before vaccination.

If a vaccine dose has been administered during pregnancy, no intervention is needed.

We inadvertently gave HPV vaccine to a adult female who didn't know she was pregnant at the time. How should nosotros consummate the schedule?

Yous should withhold farther HPV vaccine until she is no longer meaning. Later the pregnancy is completed, administer the remaining doses of the serial using the usual ii- or 3-dose schedule (depending on the age at initiation of the serial).

Tin HPV vaccine be administered at the aforementioned time as other vaccines?

Yep, administration of a different inactivated or live vaccine, either at the same visit or at any time before or after HPV vaccine, is acceptable because HPV is not a live vaccine.

If HPV vaccine is given subcutaneously instead of intramuscularly, does the dose demand to be repeated?

Aye. No information exist on the efficacy or safety of HPV vaccine given past the subcutaneous route. All data on efficacy and elapsing of protection are based on a vaccine serial administered by the intramuscular road. In the absenteeism of information on subcutaneous administration, CDC and the manufacturer recommend that a dose of HPV vaccine given by any route other than intramuscular should be repeated. There is no minimum interval between the invalid (subcutaneous) dose and the repeat dose.

Contraindications and Precautions Back to top

What are the contraindications and precautions to HPV vaccine?

Contraindications are the following: HPV vaccine is contraindicated for persons with a history of immediate hypersensitivity to whatsoever vaccine component, including yeast. The precaution to HPV vaccine is a moderate or severe acute affliction with or without fever. Vaccination should be deferred until the condition improves. HPV vaccines are not recommended for use during pregnancy. If a person is found to exist significant after starting the vaccination series, the rest of the two or three-dose series (depending on the age of first HPV vaccination) should be delayed until completion of pregnancy. Pregnancy testing is not needed before vaccination. If a vaccine dose has been administered during pregnancy, no intervention is needed. You can find more than information well-nigh HPV vaccine and pregnancy in the ACIP recommendations at: www.cdc.gov/mmwr/preview/mmwrhtml/rr6305a1.htm.

If a woman has had HPV infection detected in cervical cancer screening, can she yet be vaccinated?

Yeah. A woman with bear witness of present or by HPV infection identified through cervical screening may exist vaccinated. Recipients of HPV vaccinations should be counseled that the vaccine will not accept a therapeutic effect on whatsoever existing HPV infections or cervical lesions.

Tin a woman who is breastfeeding receive HPV vaccine?

Yes.

Is the history of an aberrant Pap test a contraindication to the HPV vaccine series?

No. Even a woman found to be infected with a strain of HPV that is present in the vaccine could receive protection from the other strains in the vaccine.

Vaccine Rubber Back to peak

What agin events tin can exist expected following HPV vaccine?

In clinical trials of 9vHPV involving more than 15,000 subjects, the most common agin event was injection site pain, which was reported in about ninety% of recipients. Other local reactions, such as redness and/or swelling, were reported in about twoscore% of recipients. Fever was less common, reported by near half dozen% of recipients. The rates and severity of adverse reactions post-obit each dose of 9vHPV were similar between boys and girls.

We've heard stories in the media about severe reactions to the HPV vaccine. Is there whatsoever substance to these stories?

No. Since 2006, more than 120 million doses of HPV vaccine have been distributed in the United States. Amongst all reports to the Vaccine Adverse Event Reporting Organization (VAERS) following HPV vaccines, the most ofttimes reported symptoms overall were dizziness; fainting; headache; nausea; fever; and pain, redness, and swelling in the arm where the shot was given. Of the reports to VAERS, 6% were classified equally "serious." Well-nigh 22% of the VAERS reports were not related to health problems, merely were reported for reasons such as improper vaccine storage or the vaccine being given to someone for whom it was not recommended. Although deaths have been reported among vaccine recipients none has been conclusively shown to accept been caused by the vaccine. Occurrences of rare weather, such equally Guillain-Barré Syndrome (GBS) have as well been reported amid vaccine recipients simply there is no testify that HPV vaccine increased the rate of GBS higher up what is expected in the population.

CDC, working with the FDA and other immunization partners, will continue to monitor the safety of HPV vaccines. You can observe consummate information on this and other vaccine safety problems at world wide web.cdc.gov/vaccinesafety/vaccines/hpv/hpv-safety-faqs.html.

Practice HPV vaccines crusade fainting?

Virtually all vaccines have been reported to be associated with fainting (syncope). Post-vaccination syncope has been most ofttimes reported later on three vaccines usually given to adolescents (HPV, MenACWY, and Tdap). However, information technology is not known whether the vaccines are responsible for mail service-vaccination syncope or if the association with these vaccines merely reflects the fact that adolescents are generally more likely to experience syncope.

Syncope tin cause serious injury. Falls that occur due to syncope afterwards vaccination can be prevented by having the vaccinated person seated or lying down. The person should exist observed for xv minutes following vaccination.

How should HPV vaccine be stored?

HPV vaccine should exist stored at refrigerator temperature between 2°C and 8°C (36°F and 46°F). The vaccine must not be frozen and must non be used if it has been frozen. Protect the vaccine from light. Administer every bit before long equally possible after being removed from refrigeration. The manufacturer package insert contains additional information and can be found at world wide web.immunize.org/packageinserts. For consummate information on vaccine storage and handling best practices and recommendations please refer to CDC's Vaccine Storage and Treatment Toolkit at www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storage-handling-toolkit.pdf.

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Source: https://www.immunize.org/askexperts/experts_hpv.asp

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