Academic Article, August 2026

HPV Vaccination: Clinical Update for Healthcare Providers

Assoc.Prof.Tanitra Tantitamit, MD.
Department of Obstetrics and Gynocology
Faculty of medicine, Srinakharinwirot University

        This concise review current clinical data and Royal Thai College of Obstetricians and Gynaecologists (RTCOG) guidelines to optimize HPV immunization strategies in clinical practice.

1. Current Status of HPV-Related Cancers in Thailand
   Cervical cancer remains the fourth most common cancer among Thai women, with approximately 8,662 new cases and 4,576 deaths annually (1). HPV-related oropharyngeal squamous cell carcinoma (OPSCC) is also increasing, with HPV-positive cases rising from 13% to 42% and projected to reach 50% by 2030 (2,3). Although HPV16/18 predominate globally, HPV58 is the most common genotype in Thai tonsillar squamous cell carcinoma (72%) (4).

2. Real-World Evidence & Clinical Efficacy
   A large-scale Swedish cohort study demonstrated that HPV vaccination before age 17 and between ages 17-30 could reduces the risk of invasive cervical cancer by 88% and 53% respectively (5).  A global meta-analysis showed that extensive national immunization programs reduced anogenital warts by 67% among female adolescents (aged 15–19) and high-grade precancerous cervical lesions (CIN2+) by 51% (6).

3. Single-Dose Vaccination Regimen
   In 2022, the WHO endorsed a single-dose schedule for individuals aged 9–20, citing comparable efficacy to a two-dose regimen (7). Clinical data confirm that a single dose provides >95% protection against persistent HPV 16/18 infections, with robust antibody durability lasting over 10 years (8-10). Immunocompromised individuals must strictly receive the standard 3-dose regimen.
   
   

4. Vaccination in Special Populations

• Males and the LGBTQ+ Population:. A 10-year trial confirmed high vaccine efficacy against genital warts and anal intraepithelial neoplasia in men who have sex with men (MSM) , supporting gender-neutral vaccination (11).

• Adults Aged 27–45 Years: Effecacy against HPV 16/18 is >80% in HPV-naive individuals but drops to 47.2% in those with prior exposure. RTCOG recommends shared decision-making based on individual risk profiles (12).

• Adjuvant Use Post-CIN Excision: Meta-analyses indicate that adjuvant vaccination post-surgical treatment reduces recurrent CIN2+ by 57% to 67%, particularly for types 16/18 (10). RTCOG recommends administering the vaccine as close to the surgical intervention as possible (13).

5. Dosing and Interchangeability (RTCOG Guidelines) (13)

• Interrupted schedules do not require restarting.

• 3-Dose Schedule (Age ≥15) : Minimum intervals: 1 month between doses 1–2, and 3 months between doses 2–3. Total duration must be ≥6 months.

• 2-Dose Schedule (Age <15): Administered at a 6–12 month interval. If dose 2 is given <5 months after dose 1, a third dose is mandatory.

• Interchangeability: Maintaining the identical formulation is preferred. If unavailable, any commercial HPV vaccine can complete the series.

• Transitioning to 9-Valent: Not routinely required after completing other series, but permissible broder type coverage.

6. Surgical Smoke & Occupational Risk

• Transmission Risk: While HPV DNA is consistently detected in electrosurgical and laser plumes (15,16), definitive occupational transmission remains unproven.

• Precautions: Facilities must utilize dedicated smoke evacuation systems. Healthcare workers should be evaluated for vaccination based on general public age and clinical criteria rather than occupational exposure alone.

7. MOPH Strategic Plan vs. RTCOG Guidelines

• MOPH (Public Health Focus) (17): prioritizes resource optimization. In 2026, the program covers Grade 5 female students (ages 11–12 years), with catch-up vaccination strategies for unvaccinated females aged 11–20 years and university students.

• RTCOG (Clinical Protection Focus) (13): Recommends broader, gender-neutral vaccination for all individuals aged 9–26 (2 doses if <15; 3 doses if ≥15), consideration for adults aged 27–45, and a strict 3-dose schedule for immunocompromised individuals.

References

1. 1. Ferlay J EM, Lam F, Colombet M, Mery L, Piñeros M, et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer 2024 [cited 2025 June 7 ]. Available from: https://gco.iarc.who.int/media/globocan/factsheets/populations/900-world-fact-sheet.pdf.

   2. Ngamphaiboon N, Dechaphunkul A, Vinayanuwattikun C, Danchaivijitr P, Thamrongjirapat T, Prayongrat A, et al. Changing Landscape of Head and Neck Squamous Cell Carcinoma and Nasopharyngeal Carcinoma Treatment and Survival Trends in Thailand: A 13-Year Multicenter Retrospective Study of Patients. JCO Glob Oncol. 2025;11:e2400285.

   3. Argirion I, Zarins KR, McHugh J, Cantley RL, Teeramatwanich W, Laohasiriwong S, et al. Increasing prevalence of HPV in oropharyngeal carcinoma suggests adaptation of p16 screening in Southeast Asia. J Clin Virol. 2020;132:104637.

   4. Heawchaiyaphum C, Ekalaksananan T, Patarapadungkit N, Vatanasapt P, Pientong C. Association of Human Papillomavirus and Epstein-Barr Virus Infection with Tonsil Cancer in Northeastern Thailand. Asian Pac J Cancer Prev. 2022;23(3):781-7.

   5. Lei J, Ploner A, Elfström KM, Wang J, Roth A, Fang F, et al. HPV Vaccination and the Risk of Invasive Cervical Cancer. N Engl J Med. 2020;383(14):1340-8.

   6. Drolet M, Bénard É, Pérez N, Brisson M, Ali H, Boily M-C, et al. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. The Lancet. 2019;394(10197):497-509.

   7. World Health Organization. Human papillomavirus vaccines: WHO position paper, December 2022. Weekly Epidemiological Record. 2022 Dec 16;97(50):645–72. Available from: https://www.who.int/publications/i/item/who-wer9750-645-672.

   8. Joshi S, Anantharaman D, Muwonge R, Bhatla N, Panicker G, Butt J, et al. Evaluation of immune response to single dose of quadrivalent HPV vaccine at 10-year post-vaccination. Vaccine. 2023;41(1):236-45.

   9. Kreimer AR, Porras C, Liu D, Hildesheim A, Carvajal LJ, Ocampo R, et al. Noninferiority of One HPV Vaccine Dose to Two Doses. N Engl J Med. 2025;393(24):2421-33.

   10. Barnabas RV, Brown ER, Onono MA, Bukusi EA, Njoroge B, Winer RL, et al. Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results. Nat Med. 2023;29(12):322-32.

   11. Goldstone SE, Giuliano AR, Palefsky JM, Lazcano-Ponce E, Penny ME, Cabello RE, et al. Efficacy, immunogenicity, and safety of a quadrivalent HPV vaccine in men: results of an open-label, long-term extension of a randomised, placebo-controlled, phase 3 Lancet Infect Dis. 2022;22(3):413-25.

   12. Skinner SR, Szarewski A, Romanowski B, Garland SM, Lazcano-Ponce E, Salmerón J, et al. Efficacy, safety, and immunogenicity of the human papillomavirus 16/18 AS04-adjuvanted vaccine in women older than 25 years: 4-year interim follow-up of the phase 3, double-blind, randomised controlled VIVIANE study. Lancet. 2014;384(9961):2213-27.

   13. แนวทางเวชปฏิบัติของราชวิทยาลัยสูตินรีแพทย์แห่งประเทศไทย เรื่อง การป้องกันมะเร็งปากมดลูกปฐมภูมิ (RTCOG Clinical Practice Guideline: Primary Prevention of Cervical Cancer) 2020.

   14. Kechagias KS, Kalliala I, Bowden SJ, Athanasiou A, Paraskevaidi M, Paraskevaidis E, et al. Role of human papillomavirus (HPV) vaccination on HPV infection and recurrence of HPV related disease after local surgical treatment: systematic review and meta-analysis. BMJ. 2022;378:e

   15. Fox-Lewis A, Allum C, Vokes D, Roberts S. Human papillomavirus and surgical smoke: a systematic review. Occup Environ Med. 2020;77(12):809-17.

   16. Palma S, Gnambs T, Crevenna R, Jordakieva G. Airborne human papillomavirus (HPV) transmission risk during ablation procedures: A systematic review and meta-analysis. Environmental Research. 2021;192:110437.

   17. กรมควบคุมโรค. แนวทางการให้บริการวัคซีนป้องกันการติดเชื้อไวรัสเอชพีวี (HPV) ปีงบประมาณ 2569 [อินเทอร์เน็ต]. กรุงเทพฯ: กรมควบคุมโรค; 2568 [เข้าถึงเมื่อ 22 พ.ค. 2569]. เข้าถึงได้จาก: https://dmsic.moph.go.th/index/detail/9837