Cent Eur J Public Health 2026, 34(3):155-159 | DOI: 10.21101/cejph.a8941

Adult HPV vaccination (27–45 years): who benefits, when to offer, and how to counsel

Marek Broul1, 2, 3, Pavel Dlouhý4, Aneta Hujová3, Michaela Liegertová5
1 Department of Sexology, Masaryk Hospital in Ústí nad Labem, Ústí nad Labem, Czech Republic
2 Department of Urology, Litoměřice Hospital, Litoměřice, Czech Republic
3 Faculty of Health Studies, Jan Evangelista Purkyně University in Ústí nad Labem, Ústí nad Labem, Czech Republic
4 Infectious Diseases Department and HIV Centre, Masaryk Hospital in Ústí nad Labem, Czech Republic
5 Faculty of Science, Jan Evangelista Purkyně University in Ústí nad Labem, Ústí nad Labem, Czech Republic

Objectives: The aim of the study was to translate major international recommendations and the current evidence base into a practical approach for counselling adults aged 27-45 years about human papillomavirus (HPV) vaccination.

Methods: We conducted a targeted narrative review of guidance from the World Health Organization, the European Centre for Disease Prevention and Control and US public health sources that frame HPV vaccination in mid-adults as shared clinical decision-making. We prioritised systematic reviews, randomised trials and recent evidence syntheses relevant to mid-adult vaccination and vaccination after cervical excisional treatment.

Results: Global and European guidance emphasises that the greatest population impact is achieved by high vaccination coverage before sexual debut and therefore does not support routine population-wide vaccination programmes for mid-adults. In contrast, US guidance supports shared clinical decision-making for adults aged 27-45 years because some individuals may still derive meaningful personal benefit, particularly those not adequately vaccinated who anticipate new sexual partners or belong to higher-exposure networks (e.g., men who have sex with men) or who are immunocompromised. Vaccine effectiveness is highest in individuals not previously exposed to vaccine HPV types; vaccination prevents new infections but does not treat established infection or existing HPV-related disease. Evidence on vaccination after cervical conisation is mixed: observational studies often suggest reduced recurrence, whereas randomised-trial-only syntheses do not show a consistent overall reduction in recurrence of high-grade lesions (high-grade squamous intraepithelial lesion) or cervical intraepithelial neoplasia.

Conclusions: Adult HPV vaccination should be considered selectively and framed as prevention of future infections. A brief shared decision-making conversation focusing on anticipated future exposure, realistic benefits, dosing, and ongoing screening can support consistent practice. We provide a decision algorithm and practice scenarios to facilitate implementation.

Keywords: human papillomavirus, vaccination, adults, shared clinical decision-making, counselling, immunocompromised

Received: February 5, 2026; Revised: August 7, 2026; Accepted: August 7, 2026; Published: September 30, 2026  Show citation

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Broul M, Dlouhý P, Hujová A, Liegertová M. Adult HPV vaccination (27–45 years): who benefits, when to offer, and how to counsel. Cent Eur J Public Health. 2026;34(3):155-159. doi: 10.21101/cejph.a8941.
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