By Rebecca Bowers

EXECUTIVE SUMMARY

Just-released data indicate human papillomavirus (HPV) vaccination completion in U.S. adolescents increased by five percentage points from 2016 to 2017, and initiation of the vaccine has gone up 5.1 percentage points, on average, each year since 2013.
  • About two-thirds of teens ages 13-17 received the initial HPV vaccine dose, and about half of teens received the complete set of recommended doses.
  • Fewer teens in rural areas are getting the HPV shot compared to adolescents in urban areas. Statistics suggest that among rural teens, the rate of those who received the initial HPV vaccine dose was 11 percentage points lower than among teens in urban areas.

Good news just-released data indicate human papillomavirus (HPV) vaccination completion in U.S. adolescents has gone up by five percentage points from 2016 to 2017, and initiation of the vaccine has increased 5.1 percentage points, on average, each year since 2013. According to the statistics, about two-thirds of teens ages 13-17 received the initial HPV vaccine dose, and about half of teens received the complete set of recommended doses.1

“This vaccine is the best way to protect our youth from developing cancers caused by HPV infection,” says Robert Redfield, MD, director of the Centers for Disease Control and Prevention (CDC). “Vaccination is the key to cervical cancer elimination.”

CDC researchers compiled data from the NIS-Teen annual survey, which estimates adolescent vaccination coverage in the 50 U.S. states, the District of Columbia, selected local areas, and territories. The telephone survey is conducted with parents and guardians of eligible adolescents.

Although more teens are receiving the HPV shot, public health officials say there is room for improvement. A little more than half (51%) have not received the full series of injections, data indicate. Location plays an important role; results indicate that fewer teens in rural areas are getting the HPV shot compared to adolescents in urban areas. Statistics suggest that among rural teens, the rate of those who received the initial HPV vaccine dose was 11 percentage points lower than among teens in urban areas.1

“While we understand it can be a challenge for some clinicians in rural areas to stock all recommended vaccines, these clinicians can still play a critical role in their patients’ health and protect them from serious diseases by referring them to other vaccine providers,” notes Nancy Messonnier, MD, director of the National Center for Immunization and Respiratory Diseases at the CDC.

Use Lags Behind Other Vaccines

Researchers note that HPV vaccination initiation lags behind coverage with quadrivalent meningococcal conjugate vaccine (MenACWY) and tetanus and reduced diphtheria toxoids and acellular pertussis vaccine (Tdap). It is routinely recommended that children ages 11-12 receive two doses of the vaccine.

Public health officials are working to improve the number of teens who receive the vaccine on schedule. Officials are implementing a new measure of adolescent vaccines, known as the combined Healthcare Effectiveness Data and Information Set, that evaluates whether adolescents have received all three vaccines, including the HPV vaccine, that are recommended for completion by age 13.2

Are Shots Making Impact?

Has the HPV vaccine made an impact since the first shot formulation was approved in the United States in 2006? Because it takes many years for HPV infection to advance to invasive cancer, measuring the shot’s impact on cervical cancer may take decades. Looking for early indicators of the vaccine’s effect, public health officials now are monitoring the incidence of high-grade cervical lesions that could progress to invasive cancer if left untreated. Through the CDC’s HPV Impact Monitoring Project, researchers are looking at the incidence of cervical lesions among women age 18 and older in five different communities in California, Connecticut, New York, Oregon, and Tennessee.

Demographic and clinical information from laboratory and medical records is being collected in these areas on every woman who has a high-grade cervical lesion; for women ages 18-39 who have a high-grade cervical lesion, additional information such as insurance, cervical cancer screening history, and vaccination history is recorded. In addition, archived tissue specimens are obtained and sent to CDC for HPV type testing for 37 HPV types, including those targeted by HPV vaccines.

According to one study conducted from 2008 to 2012, among women who received at least one HPV vaccine dose, the prevalence of HPV 16/18 in cervical squamous intraepithelial neoplasia 2 (CIN2+) lesions decreased from 53.6% to 28.4%. There was no significant statistical difference among unvaccinated women or those with unknown vaccination status.3

Information from national surveys suggests a reduction in the prevalence of HPV vaccine type in young women in the first four years of the HPV vaccine program. There was a reduction of 56% in HPV vaccine types in the cervical-vaginal samples from teens ages 14-19.4 Decreases among women ages 20-24 were seen within six years of vaccination introduction.5 Among teens 14-19, there was a 71% reduction in prevalence of HPV vaccine type after eight years.5 In women ages 20-24, there was a 61% reduction.6

REFERENCES

  1. Walker TY, Elam-Evans LD, Yankey D, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years — United States, 2017. MWR Morb Mortal Wkly Rep 2018;67:909-917.
  2. National Committee for Quality Assurance. NCQA updates quality measures for HEDIS 2018. Washington, DC: National Committee for Quality Assurance; 2018.
  3. Hariri S, Bennett NM, Niccolai LM, et al; HPV-IMPACT Working Group. Reduction in HPV 16/18-associated high grade cervical lesions following HPV vaccine introduction in the United States — 2008-2012. Vaccine 2015;33:1608-1613.
  4. Markowitz LE, Hariri S, Lin C, et al. Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003-2010. J Infect Dis 2013;208:385-393.
  5. Markowitz LE, Liu G, Hariri S, et al. Prevalence of HPV after introduction of the vaccination program in the United States. Pediatrics 2016;137:e20151968.
  6. Oliver S, Unge, ER, Lewis R, et al. Prevalence of human papillomavirus among females after vaccine introduction — National Health and Nutrition Examination Survey, United States, 2003-2014. J Infect Dis 2017;216:594-603.