EXECUTIVE SUMMARY

Six of 10 U.S. parents now are choosing to have their teens vaccinated against HPV. However, although most teens are getting their first dose of the vaccine, many are not completing the full vaccination schedule, data indicate.

  • In December 2016, the Advisory Committee on Immunization Practices revised its HPV vaccine recommendations to include a two-dose schedule for teens initiating the vaccination series prior to their 15th birthday.
  • The latest estimate shows that approximately 65% of girls received the first dose of HPV vaccine, compared to 56% of boys receiving the first dose, a 6% jump from 2015 for boys.

Good news: Six of 10 U.S. parents now are choosing to have their teens vaccinated for HPV.1 However, while most teens are getting their first dose of the vaccine, many are not completing the full vaccination schedule, data indicate.

In December 2016, the Advisory Committee on Immunization Practices (ACIP) revised its HPV vaccine recommendations to include a two-dose schedule for teens initiating the vaccination series prior to their 15th birthday. (Contraceptive Technology Update reported on the issue; see “Just Two HPV Shots Recommended for Younger Teens,” January 2017, available at http://bit.ly/2li1dma.) To understand the breadth of adolescent vaccination coverage in the United States, CDC analysts reviewed data from the 2016 National Immunization Survey-Teen for 20,475 adolescents ages 13-17.

The analysis indicates that 60% of teens in the 13-17 age range received one or more doses of HPV vaccine in 2016, representing an increase of four percentage points from 2015. In addition, data suggest that HPV vaccination is becoming more common among boys. The latest estimate shows that approximately 65% of girls received the first dose of HPV vaccine, compared to 56% of boys receiving the first dose, a 6% jump from 2015 for boys. The 2016 rates for girls were similar to 2015, the analysis reflects.1

Despite these gains, areas for improvement remain, say public health officials. Although most teens have received the first dose of HPV vaccine, data indicate that 43% of teens are up to date on all the recommended doses of HPV vaccine. Teens who receive the first dose of HPV vaccine before their 15th birthday need two doses of HPV vaccine to be protected against cancers caused by HPV, while teens and young adults who start the series at ages 15-26 must receive three doses of HPV vaccine to be protected.1

“I’m pleased with the progress, but too many teens are still not receiving the HPV vaccine — which leaves them vulnerable to cancers caused by HPV infection,” said Brenda Fitzgerald, MD, director of the Centers for Disease Control and Prevention (CDC), in a press statement. “We need to do more to increase the vaccination rate and protect American youth today from future cancers tomorrow.”

The two-dose option for young people can be used as a strong incentive to persuade parents to vaccinate early, notes Anita Nelson, MD, professor and chair of the obstetrics and gynecology department at Western University of Health Sciences in Pomona, CA.

Simplify completing the series for the parent and patient, suggests Susan Wysocki, WHNP-BC, FAANP, president and chief executive officer of iWomansHealth in Washington, DC, which focuses on information on women’s health issues for clinicians and consumers. Have them put a reminder in their cell phone at the end of the visit, she notes.

“Know whether pharmacies in your area can provide the HPV vaccine and provide an Rx for the next shot,” says Wysocki. “Be creative to strongly convey that the series must be completed to be effective.”

Alix Casler, MD, medical director and chief of pediatrics at Orlando Health Physician Associates in Orlando, has had success in increasing HPV vaccination rates in her practice. Her practice experienced a 20% increase in HPV vaccination rates for boys and girls after she led a successful quality improvement project to boost percentages.

How can you positively affect HPV vaccination rates in your practice? Casler offers three suggestions:

  • Make it part of the whole office culture so that everyone on your team is aware of the disease burden and effect of HPV disease, and therefore the importance of HPV vaccination.

This needs to be a clear message throughout the whole office experience, from phone, to check in, to rooming, to the provider visit to the nurse, says Casler. “If your messaging is consistent and clear, parents and patients really grasp the passion and importance of the message.”

When parents hear a clear recommendation for same-day vaccination, 80% of those parents choose to vaccinate, notes Casler. This is supported by data on HPV and flu vaccine acceptance.2

  • Recommend HPV vaccination “same day, same way.” In other words, the HPV vaccine should be recommended the same way that we recommend all vaccines.

Casler offers the following script for discussing vaccination: “Today we have three vaccines to do: the meningitis vaccine, the HPV vaccine, and the Tdap.” Clinicians should offer enough explanation of each vaccination, including what diseases are being prevented, such as “certain rare, but devastating, forms of bacterial meningitis; multiple common forms of cancer, tetanus, diphtheria (which is not seen in the United States due to vaccinations), and whooping cough, which not only results in a bad cough for several months, but also could be spread to someone’s baby, who could die from it.”

Providers also should discuss side effects, in the following manner: “All of these shots could cause local reaction with pain, redness, and swelling, and a small group of patients also may feel a little bit unwell with symptoms as if they were coming down with something, which is really just the immune system responding and doing its job. Usually a little ibuprofen will help. Occasionally, teens will faint with blood draws or shots, so you may want to lie down for a few minutes after being vaccinated to avoid this.”

  • Be knowledgeable and confident in your knowledge so that you can respond openly to parental concerns.

Casler says providers should be prepared to discuss topics that parents have read on social media, and explain why much of what is circulated is mythical in nature. Also, clinicians should be prepared to discuss how the ACIP makes its decisions on when to vaccinate with what shot.

“The HPV vaccine is recommended at an age where essentially no one has been exposed, so we can protect everyone from this viral infection that most if not all of us will get at some time in our lives,” says Casler. “This is a common viral illness that goes on to cause multiple cancers in perhaps more than 40,000 people per year, and pre-cancers in perhaps half a million people per year, in the U.S. alone, most of which are completely preventable with the vaccine.”

The HPV vaccine is recommended at an age when the immune system is at its best, notes Casler. This results in a robust immune response, so that if and when that immune response is needed later on in life, it will be there and ready to go, she says.

Clinicians should remember that if vaccines cause negative effects, they are withdrawn, says Casler. For example, the RotaShield vaccine in the 1990s that was on the market for less than a year was associated with a few nonfatal cases of intussusception, and was withdrawn, she explains. Safety monitoring systems such as the Vaccine Adverse Event Reporting System, a national vaccine safety surveillance program run by the CDC and the Food and Drug Administration, and the Vaccine Safety Data Link, a collaborative project between the CDC’s Immunization Safety Office and nine healthcare organizations, are in place to ensure vaccine safety, she notes.

REFERENCES

  1. Walker TY, Elam-Evans LD, Singleton JA, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years — United States, 2016. MMWR Morb Mortal Wkly Rep 2017;66:874-882.
  2. Sturm L, Donahue K, Kasting M, et al. Pediatrician-parent conversations about human papillomavirus vaccination: An analysis of audio recordings. J Adolesc Health 2017;61:246-251.