Pregnant and Lactating WomenBoth the quadrivalent and bivalent HPV vaccines have been classified by the FDA as pregnancy category B. Although HPV vaccination in pregnancy is not recommended, neither is routine pregnancy testing before vaccination. Currently, there are few data on HPV vaccine administration in pregnancy; however, the available safety data regarding the inadvertent administration of the vaccine during pregnancy are reassuring. In clinical studies, the proportion of pregnancies with adverse outcomes was comparable in women who received the HPV vaccine and in women who received a placebo.However, it is wise to remind patients to use contraception during the period when they are receiving the vaccination series. The manufacturer should be contacted if pregnancy is detected during the vaccination schedule. Completion of the vaccine series should be delayed until pregnancy is completed. Lactating women can receive either HPV vaccine because inactivated vaccines, such as these vaccines, do not affect the safety of breastfeeding for mothers or infants.Immunosuppressed PatientsThe presence of immunosuppression, like that experienced in patients with HIV infection or organ transplantation, is not a contraindication to HPV vaccination. However, the immune response may be less robust in the immunocompromised patient.Women Older Than 26 YearsHuman papillomavirus vaccines are not currently licensed in the United States for women older than 26 years. Off-label use may be indicated on a case-by-case basis because vaccination may provide some marginal benefit.Current ACIP Vaccine Recommendations: Human Papillomavirus