EXECUTIVE SUMMARY

The CDC now recommends that 11- to 12-year-olds receive two doses of HPV vaccine at least six months apart, rather than the previously recommended three doses.

  • Teens and young adults who start the series later, at ages 15-26, will continue to need three doses of HPV vaccine to protect against cancer-causing HPV infection.
  • The FDA has approved a two-dose schedule for the nine-valent HPV vaccine, Gardasil 9, for adolescents ages 9-14. The CDC encourages clinicians to begin implementing the two-dose schedule in their practice to protect their preteen patients from HPV cancers.

Time to update your practice. The CDC now recommends that 11- to 12-year-olds receive two doses of HPV vaccine at least six months apart, rather than the previously recommended three doses. Teens and young adults who start the series later, at ages 15-26, will continue to need three doses of HPV vaccine to protect against cancer-causing HPV infection.

“Safe, effective, and long-lasting protection against HPV cancers with two visits instead of three means more Americans will be protected from cancer,” says CDC Director Tom Frieden, MD, MPH, in a statement accompanying the announcement. “This recommendation will make it simpler for parents to get their children protected in time.”

The Advisory Committee on Immunization Practices, a panel of experts that advises the CDC on U.S. vaccine recommendations, voted Oct. 19, to recommend a two-dose HPV vaccine schedule for young adolescents. Frieden approved the committee’s recommendations shortly after the vote.

The move comes shortly after the FDA’s Oct. 7, approval to add a two-dose schedule for the nine-valent HPV vaccine (Gardasil 9, Merck and Co., Whitehouse Station, NJ) for adolescents ages 9-14. The CDC encourages clinicians to begin implementing the two-dose schedule in their practice to protect their preteen patients from HPV cancers. The quadrivalent form of Gardasil ceased production in October, and the bivalent vaccine, Cervarix, manufactured by GlaxoSmithKline, will no longer be distributed in the United States, which leaves Gardasil 9 as the sole HPV vaccine in the United States.

Preteens generally receive HPV vaccine at the same time as whooping cough and meningitis vaccines. Two doses of HPV vaccine administered at least six months apart at ages 11 and 12 will provide safe, effective, and long-lasting protection against HPV cancers, according to the CDC. Adolescents ages 13-14 also are able to receive HPV vaccination on the new two-dose schedule, the agency notes.

How to Raise Vaccination Rates

The first HPV vaccines became available in the United States in 2006; however, vaccination rates lag behind other immunizations. According to data from the 2015 National Immunization Survey-Teen, 63% of teen girls and 50% of teen boys in the United States have received at least one dose of HPV vaccine. However, fewer teens are receiving the HPV vaccine compared to the tetanus, diphtheria, and pertussis (Tdap) and meningococcal vaccines — 86% of girls and boys have received the Tdap shot, while 81% have received the meningococcal vaccines.1

Results of a new five-year national study of 100,000 U.S. teens found that vaccination rates to protect against Tdap and meningococcal disease improved when they were required for school entry, and could provide a spillover effect to boost the HPV vaccination rate among teens.2

“Leveraging school entry requirements to improve vaccination can have implications for herd immunity, herd severity, and protecting the population from vaccine-preventable infectious and chronic diseases,” authors say in the recent analysis.2

Analysts found that by the 2015 school year, 47 states had adopted requirements for Tdap booster, 25 states for meningococcal vaccine, and three states for HPV vaccine completion. States with requirements for Tdap booster and meningococcal vaccination demonstrated 22 and 24 percentage point increases in coverage for these vaccines, respectively, compared to states without requirements. The study found that Tdap booster and meningococcal vaccination requirements were effective at increasing coverage for the targeted vaccines and were associated with larger spillover increases in HPV vaccination coverage.2

Your Recommendation Counts

Nearly 90 million doses of HPV vaccines were distributed in the United States from June 2006 through March 2016, according to the CDC. Most of the CDC’s HPV vaccine safety monitoring and research has focused on Gardasil because it represents 87% of HPV vaccines distributed in the United States. Statistics indicate 79 million doses of Gardasil were distributed in the United States from 2006 to 2016; during the same period, 33,945 reports of adverse events were received following Gardasil vaccination. The most frequently reported symptoms overall were fainting, dizziness, headache, nausea, fever, pain, redness, and swelling in the arm where the shot was given. Of such reports, just 7% were classified as “serious.”3

Clinicians are challenged to bring HPV vaccination rates up to the Healthy People 2020 goal of vaccinating more than 80% of children by the time they are 17.

“My challenge, which is based on information that is available on the safety and effectiveness of the HPV vaccine, is that we need to look in our own practices to determine what we need to bring that level up to 80% or better,” says Joseph Bocchini, Jr., MD, FAAP, former chair of the American Academy of Pediatrics’ Committee on Infectious Diseases and member of the Section on Infectious Diseases. Bocchini presented information during the academy’s October 2016 National Conference.

REFERENCES

  1. Reagan-Steiner S, Yankey D, Jeyarajah J, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13–17 years — United States, 2015. MMWR Morb Mortal Wkly Rep 2016;65:850-858.
  2. Moss JL, Reiter PL, Young K, et al. School entry requirements and coverage of nontargeted adolescent vaccines. Pediatrics 2016; doi: 10.1542/peds.2016-1414.
  3. CDC. Frequently Asked Questions about HPV Vaccine Safety. Available at: http://bit.ly/1OqX0Zz.