Human Papillomavirus (HPV) Vaccine at Age Nine

HPV Vaccine is Most Effective Between Ages 9 and 12 Years

• The HPV vaccine provides long-lasting protection against the most common cancers caused by HPV.
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• Doctors and nurses recommend the HPV vaccine for children starting at age nine years.
• The HPV vaccine is most effective at this age, it produces the most infection-fighting cells, or antibodies. This also ensures immunity is already in place before any exposure to the virus.
• If your teen hasn't received the vaccine, it is not too late! Talk to their doctor or nurse about getting them immunized as soon as possible. This is a recommended vaccine up through age 26.
• If you are an adult age 27 through age 45, talk with your health care provider to see if you should get the HPV vaccine.

Efforts to Increase HPV Vaccination Coverage Rates

Since 2017, the Washington State Department of Health (DOH) has worked with providers and advocates around the state to improve HPV vaccination coverage rates. In 2022, the Washington State Vaccine Advisory Committee passed a motion to routinely start HPV vaccination at age nine and to track and publish state and county data on HPV vaccination coverage rates for children ages 9-10 years.

As a result, in January 2023, DOH updated the software in the state's immunization information system that determines vaccine eligibility to recommend HPV vaccination at age nine instead of age 11. With this update, providers received a reminder to start the HPV vaccine series once a child turns nine years old. This provides more time for the child to complete the two-dose series before they turn 13.

IIS Update Notification to Providers

HPV At Nine Provider Letter (PDF)

HPV at Nine Data and Research

Research over the years shows that the HPV vaccine is most effective when given between ages nine and 12. Below are some of the research papers that support this:

• HPV Vaccination at 9 Years Old, Washington State (PDF)
• For a more depth look at Washington state’s HPV at nine initiative: Effect of immunization registry-based provider reminder to initiate HPV vaccination at age 9, Washington state (tandfonline.com)
• Why the American Academy of Pediatrics recommends initiating HPV vaccine at age 9 Pub Med (nih.gov)
• Article collection: HPV Vaccination Starting at Age 9 (tandfonline.com)

HPV At Nine Resources

Handouts: 

• HPV Flyer (English)
  • Spanish (PDF) 
  • Russian (PDF)
  • Ukrainian (PDF)
  • Chinese (PDF)
  • Marshallese (PDF)
  • Vietnamese (PDF)
• HPV Brochure: Protect your child against viruses that can cause cancer (PDF)
  • Spanish (PDF)
  • Marshallese (PDF)
  • Russian (PDF)
  • Ukrainian (PDF)
  • Vietnamese (PDF)
• HPV Poster: Long-Lasting Cancer Protection (PDF)
  • Spanish (PDF)
• Talking to Parents About HPV Vaccines (PDF) (CDC)
• HPV Vaccination Algorithm (PDF)
• Reminder Recall Letter

HPV Dose Reminder Cards:

• Age 9-14, English (PDF) / Age 9-14, Spanish (PDF)

• Age 15+ English (PDF) / Age 15+ Spanish (PDF) 

Adolescent Immunization Schedule: 

• Adolescent Immunization Schedule at a Glance (PDF)
  • Spanish (PDF)
  • Marshallese (PDF)
  • Russian (PDF)
  • Ukrainian (PDF)
  • Vietnamese (PDF)
  • Korean (PDF)
  • Punjabi (PDF)

Announcement Approach

• Flyer (PDF)
• Training Video 9-10
• Training Video 11-12

School Letters

Beginning with sixth grade entry, every public and private school in the state shall provide parents and guardians with information about HPV and meningococcal disease and its vaccine at the beginning of every school year.

To view and download letters, see the School and Child Care Immunization page.

Additional Places to Find HPV at Nine Resources:

• HPV Information for Parents (CDC)
• National HPV Roundtable
• Vaccines – WCAAP - Washington Chapter of the American Academy of Pediatrics
• Human Papillomavirus (HPV) (aap.org)
• Order and print DOH resources through MyPrint

HPV at Nine Webinars and Trainings 

Past and upcoming trainings for improving HPV vaccination at age nine rates. Continuing Education (CE) credits available.

• HPV Vaccine Starts at 9: Why? How? Now! Cancer Prevention Made Easy
• Strategies for Improving HPV Vaccination Rates (nfid.org)
• Cancer Prevention through Human Papillomavirus (HPV) Vaccination (nfid.org)
• You Are the Key to HPV Cancer Prevention – 2022 (CDC)
• Understanding HPV Disparities in Rural Communities & Addressing HPV Vaccine Hesitancy

Quality Improvement for HPV Vaccination

Several resources exist to help providers and clinics with improving immunization rates.

• Immunization Quality Improvement for Providers (IQIP) 
• Training Tools (HPV IQ)
• Washington Child Health Improvement Partnership (wa-chip.org)
• Scheduling Future Coverage Rate Reports: Example provided for HPV 2 dose series for age 9-10 years (youtube.com)

Washington State HPV Free Taskforce

Are you interested in getting more involved with HPV vaccination efforts? If so, the Washington State HPV Free Taskforce is for you! Their mission is to increase human papillomavirus (HPV) vaccination rates in Washington state and reduce the amount of HPV associated disease by engaging and supporting diverse partners and increasing knowledge about HPV and cancer prevention.

The taskforce includes representatives from various sectors including Federally Qualified Health Centers, managed care organizations/payers, hospitals, primary care providers, government, tribal entities, HPV cancer survivors, and others involved in HPV vaccination and prevention. For more information visit Washington State HPV Free Task Force (immunitycommunitywa.org).

Please familiarize yourself with the Taskforce’s Group Agreements (PDF) prior to attending our meetings.