HPV vaccine rates trail teen vaccines

Results from a new survey by the Centers for Disease Control and Prevention (CDC) show that teen vaccination rates for human papillomavirus (HPV) remain low in comparison with other vaccines administered to young adults.1 The Advisory Committee on Immunization Practices recommends that teens routinely receive three vaccines: meningococcal conjugate (MenACWY, 2 doses); tetanus, diphtheria, acellular pertussis (Tdap, 1 dose); and the three-dose HPV vaccine. To conduct the current survey, more than 19,000 parents of teenagers ages 13-17 were contacted by telephone regarding vaccination rates. The calls were followed by verification of records with healthcare providers.

While vaccination coverage increased for all three vaccines from 2009 to 2010, rates for HPV vaccination lagged behind, statistics indicate. Tdap coverage increased from 55.6% to 68.7%, while MenACWY rates climbed from 53.6% to 62.7%. When it came to the HPV vaccine, though, girls who had received one dose of the three-shot series increased 4.4 percentage points to 49%. Just 32% of girls received the entire series, reflecting a 5 percentage point increase over the previous year.1

The HPV results are very concerning, noted Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases in a press release accompanying the survey results publication. "Our progress is stagnating, and if we don't make major changes, far too many girls in this generation will remain vulnerable to cervical cancer later in life," stated Schuchat.

Two vaccines are available to prevent the HPV types that cause most cervical cancers: Cervarix, manufactured by GlaxoSmithKline, and Gardasil, manufactured by Merck. As of July 2011, the CDC reported the retail price of the vaccine at about $130 per dose, or $390 for full series.

The HPV vaccine is covered under the Vaccines for Children (VFC) program, which helps families of eligible children who might not otherwise have access to coverage. The program provides vaccines at no cost to providers who serve eligible children. The VFC program covers those who are younger than age 19 if they are Medicaid-eligible, American Indian, Alaska Native, or have no health insurance. Those youth who have health insurance that does not cover vaccination can receive VFC vaccines through federally qualified health centers or rural health centers.

HPV vaccination is recommended with either vaccine for 11- and 12 year-old girls; it also is recommended for girls and women ages 13-26 who have not yet been vaccinated or completed the vaccine series. For males, the Advisory Committee on Immunization Practice's guidance is that the three-dose series of quadrivalent HPV vaccine might be given to males ages 9-26 to reduce their likelihood of acquiring genital warts. (See the box, below, for information to provide to parents & young adults about the vaccines.)

What to Tell Parents,Teens about HPV Shot

  • Vaccination with either brand of HPV vaccine (Gardasil or Cervarix) is routinely recommended for girls ages 11-12. It is also recommended for girls and women ages 13-26 who have not yet been vaccinated or completed the vaccine series.
  • Gardasil, is also licensed, safe, and effective for males ages 9-26. Boys and young men may choose to get this vaccine to prevent genital warts.
  • If a pre-teen was not vaccinated against HPV at ages 11 or 12, the vaccines can be given later in the teen years. However, studies show that 11 through 12 years is the ideal age to get maximum protection from HPV vaccines.
  • Pre-teens should get vaccinated before their first sexual contact (i.e., when they could be exposed to HPV). This is because the vaccine prevents disease in people who have not previously gotten one or more HPV types. It does not work as well for those who were exposed to the virus before getting the vaccine.

Source: Centers for Disease Control and Prevention, Questions & Answers for Parents of Pre-Teens and Teens about Human Papillomavirus (HPV) and the HPV Vaccine; accessed at http://www.cdc.gov/vaccines/who/teens/products/downloads/print-materials/f-qahpv-parents-color.pdf.

The CDC is urging healthcare providers to make strong recommendations for HPV vaccinations and vaccinate every eligible patient on time. "Stronger provider recommendations for HPV vaccination, implementing reminder-recall systems, eliminating missed opportunities, and educating parents of adolescents regarding the risk for HPV infection and the benefits of vaccination, are needed to effectively protect adolescent girls against cervical cancer," the new analysis states.1 (To help providers get across the vaccination message, the CDC has developed several free provider resources. Visit the Vaccines and Immunizations portal at the CDC web site, www.cdc.gov/vaccines. Under "For Specific Groups," select "Preteens and Teens" then "Health Care Professionals." At the bottom of the page, under "Related Pages," select the links under "Adolescent Campaign Materials" to download free resources, such as a fact sheet on HPV vaccinations. Also, text messaging might help patients complete three doses.)

HEDIS measure may help

More impetus to follow through with HPV vaccination might come in the form of a new measure added to the 2012 edition of the Healthcare Effectiveness Data and Information Set (HEDIS) by the National Committee for Quality Assurance (NCQA). HEDIS is the most widely used performance measurement tool in healthcare; it is used by more than 90% of U.S. health plans.

NCQA's human papillomavirus vaccine measure aligns with guideline recommendations released by the CDC's Advisory Committee on Immunization Practices, says Andy Reynolds, NCQA spokesperson. The HPV measure will assess whether female adolescents complete the three-dose vaccination series by age 13, Reynolds states.

The new measure went through NCQA's review and approval processes, going through field tests, a public comment session, and feedback from experts and stakeholders, says Reynolds. The HPV measure was added as a first-year measure for the HEDIS 2012 measure set, he states.  

How might the new measure impact HPV vaccination rates? Melinda Wharton, MD, MPH, deputy director of the National Center for Immunization and Respiratory Disease at the CDC, says, "We hope that the new HEDIS measure will help improve coverage in this age group."

As is the case with texting while driving, buckling one's seat belt prior to ignition, and drinking and driving, accepting and acting upon the most important public health initiatives fall upon the shoulders of an individual, says Robert Hatcher, MD, MPH, professor of gynecology and obstetrics at Emory University School of Medicine in Atlanta. "It is the obligation of the medical community and health educators to inform women and men about the vaccine for human papillomavirus and its protective effects against cervical and other reproductive health cancers," says Hatcher.

The effectiveness of Gardasil, the initial HPV vaccine, has been well-documented, notes Hatcher. In clinical trials, among persons not previously exposed to a targeted HPV type, data indicate nearly 100% vaccine efficacy in preventing cervical precancers, vulvar and vaginal precancers, and genital warts in women caused by the four HPV types (16, 18, 6 and 11), as well as 90% vaccine efficacy in preventing genital warts and 75% vaccine efficacy in preventing anal precancers in men.2

References

  1. Centers for Disease Control and Prevention (CDC). National and state vaccination coverage among adolescents aged 13 through 17 years — United States, 2010. MMWR 2011; 60:1,117-1,123.
  2. Centers for Disease Control. HPV Vaccine Information for Clinicians. Fact sheet. Accessed at http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-hcp.htm.