HPV vaccine continues to be underutilized
According to new data from the Centers for Disease Control and Prevention’s (CDC) 2013 National Immunization Survey — Teen, the number of girls and boys ages 13-17 years receiving human papillomavirus (HPV) vaccine remains unacceptably low, despite a slight increase in vaccination coverage since 2012.1
Executive Summary
According to new data from the Centers for Disease Control and Prevention's (CDC's) 2013 National Immunization Survey — Teen, the number of girls and boys ages 13-17 years receiving human papillomavirus (HPV) vaccine remains unacceptably low, despite a slight increase in vaccination coverage since 2012.
- Data indicates that there is a substantial gap between the number of teens receiving tetanus, diphtheria, and pertussis (Tdap) vaccine, and those receiving HPV vaccine.
- While about 57% of teen girls and 35% of teen boys received one or more doses of HPV vaccine, nearly 86% of adolescents had received one dose of Tdap vaccine.
Data indicates that there is a substantial gap between the number of teens receiving tetanus, diphtheria, and pertussis (Tdap) vaccine, and those receiving HPV vaccine. While about 57% of teen girls and 35% of teen boys received one or more doses of HPV vaccine, nearly 86% of adolescents had received one dose of Tdap vaccine.1
Such gaps in coverage indicate missed opportunities to vaccinate boys and girls with HPV vaccine at the same time as other routinely recommended adolescent vaccines like Tdap and meningococcal vaccines. "The high coverage rate of Tdap vaccine shows us that it is certainly possible to reach our goal of vaccinating 80% of adolescents against cancers caused by HPV," says Anne Schuchat, MD, assistant surgeon general and director of the CDC’s National Center for Immunization and Respiratory Diseases.
The CDC estimates that if missed opportunities to vaccinate adolescent girls before their 13th birthdays were eliminated, 91% of adolescent girls would gain some protection from cancers caused by HPV infection. Pediatricians and family physicians can help to prevent missed opportunities by giving the HPV vaccine during the same visit that Tdap and meningococcal vaccines are administered, says Schuchat.
There are several resources available to assist providers in preventing missed opportunities to completing the HPV vaccine series, says Schuchat. Healthcare professionals can use electronic medical records (EMR) or registry systems to set up reminders to recommend the vaccines preteen patients need. The CDC has developed the "You Are The Key" website (http://1.usa.gov/1kH4yc0) with resources to assist healthcare professionals in strengthening their recommendation for HPV vaccine, notes Schuchat.
The website includes a Tips and Timesavers factsheet (http://1.usa.gov/1phjRrM) to ease conversations with parents about HPV vaccine, says Schuchat. The site also has several educational videos that can help healthcare professionals give a strong recommendation for HPV vaccine.
"The key to preventing missed opportunities is to give a bundled recommendation for all three adolescent vaccines — Tdap, meningococcal, HPV — during the same visit without singling out HPV vaccine," notes Schuchat.
It is important that parents understand three core concepts about HPV vaccination, said Jill Roark, MPH, a CDC health communication specialist. Roark spoke on "You Are the Key to HPV Cancer Prevention" at the May 2014 National Conference on Immunization and Health Coalitions in Seattle.
Parents need to realize that the HPV vaccine is cancer prevention, understand that the HPV vaccine is best at 11 or 12 years old, and recognize the importance of their children receiving all three shots, said Roark. Recommend the HPV vaccine series the same way you recommend other adolescent vaccines, Roark suggested. She suggested this message: "Your child needs three shots today: HPV vaccine, meningococcal vaccine, and Tdap vaccine. Your child will get three shots today that will protect him/her from many cancers caused by HPV, as well as to prevent tetanus, diphtheria, pertussis, and meningitis."
The "HPV vaccine is cancer prevention" message resonates strongly with parents, noted Roark. Try saying "HPV vaccine is very important because it prevents cancer. I want your child to be protected from cancer. That’s why I’m recommending that your daughter/son receive the first dose of the HPV vaccine series today."
Parents might have questions. Try this message suggested by Roark: "HPV is so common that almost everyone will be infected at some point. It is estimated that 79 million Americans are infected, with 14 million new HPV infections each year. Most people infected will never know. Even if your child waits until marriage to have sex, or only has one partner in the future, he/she could still be exposed, if their partner already has been exposed." Use handouts from the CDC for parents and teens on HPV vaccination, advised Roark. The handouts are available for free download at http://1.usa.gov/1yFkTz5.
The following evidence-based strategies have been shown to improve vaccination coverage in healthcare settings, said Roark: reminder/recall system, standing orders, provider assessment and feedback, using immunization information systems.
Roark pointed to two studies that indicate effectiveness of such strategies. In the first one, a randomized controlled trial in four private pediatric practices in metropolitan Denver was conducted to assess the effectiveness of reminder/recall for immunizing adolescents in private pediatric practice. Data indicated that such a reminder/recall system was successful at increasing immunization rates in adolescents.2 In the second study designed to determine the impact of text message immunization reminder-recalls in an urban, low-income population, researchers found that text messaging improved immunization coverage in the study population.3
Healthcare professionals need to be familiar with all of the indications for HPV vaccine, make strong recommendations for receiving vaccine at ages 11 or 12, and be aware of, and interested in, systems that can improve practice vaccination rates, said Roark. "Studies consistently show that a strong recommendation from you is the single best predictor of vaccination," Roark stated.
Robert Hatcher, MD, MPH, professor emeritus of gynecology and obstetrics at Emory University School of Medicine in Atlanta, asks, "If cervical cancer is a bad disease -- and it is most certainly a bad disease — then why isn’t the vaccine against cervical cancer being used? It is a safe vaccine. It is an effective vaccine. What is in the heads of boys, girls, young women, young men, and their parents that stops them from getting an effective vaccine against a common reproductive tract cancer?"
- Stokley S, Jeyarajah J, Yankey D, et al. Immunization Services Division, National Center for Immunization and Respiratory Diseases, CDC. Human papillomavirus vaccination coverage among adolescents, 2007-2013, and postlicensure vaccine safety monitoring, 2006-2014 — United States. MMWR 2014; 63(29):620-624.
- Suh CA, Saville A, Daley MF, et al. Effectiveness and net cost of reminder/recall for adolescent immunizations. Pediatrics 2012; 129(6):e1437-1445.
- Stockwell MS, Kharbanda EO, Martinez RA, et al. Text4Health: impact of text message reminder-recalls for pediatric and adolescent immunizations. Am J Public Health 2012; 102(2):e15-21.
