State and Territory Level
HPV Vaccination Laws

  • Published: April 15, 2020
  • Updated: April 16, 2020

High-risk human papillomavirus (HPV) strains cause the majority of oropharyngeal (throat), cervical, anal, vulvar, penile, and vaginal cancers. Over 33,000 cancers caused by HPV are diagnosed annually among men and women in the United States alone.

Gender-neutral vaccination of children is effective in preventing infection by the HPV strains that cause cancer and genital warts. The vaccine is most effective before exposure to the virus. The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) and the American Cancer Society recommend HPV vaccination for children aged 11-12, while the American Academy of Pediatrics (AAP) recommends beginning the two-dose vaccination series between 9 and 12 years, “at an age that the provider deems optimal for acceptance and completion of the vaccination series.”

The CDC notes that uptake rates for one or more doses of the HPV vaccine for adolescents have increased slowly since 2012. However, only slightly more than half of boys and girls in the U.S. receive at least the first dose of HPV vaccine. Many adolescents do not complete the vaccine series and, as a result, are not fully protected against HPV-related cancers.

Several U.S. states and territories have taken action to mandate HPV vaccination for adolescents:

Virginia’s law, the first in the country, was passed in 2007 and went into effect on October 1, 2008. It requires all female children to receive a complete series of the HPV vaccine, with the first dose administered before the child enters the 6th grade.

In Washington, DC, a law passed on July 12, 2007 and went into effect on January 1, 2009, with the key provision that every female child enrolling in 6th grade for the first time must submit certification of HPV vaccination. The law allows parents to opt out by submitting a signed form with an explanation of their decision.

Rhode Island’s school immunization regulations require vaccination for 7th, 8th, and 9th grade students. Rhode Island’s provision was put into place by their state’s Department of Health in July 2015 without legislative action and was effective in September 2015.

In Puerto Rico, all 11- and 12-year-olds must be vaccinated. The law was passed in 2017 and went into effect in 2018.

Hawaii’s law, passed in 2019 and effective in 2020, requires all 6th graders to get the HPV vaccine before the start of the school year.