By Rebecca Bowers

EXECUTIVE SUMMARY

About 14 million additional preteens, beyond those who will receive the HPV shot based on current rates, will need to be immunized between now and 2026 to reach the 80% vaccination rate goal, an American Cancer Society report indicates.

  • As of 2016, 35.5% of females and 31.5% of males were up to date with HPV vaccination by age 13, according to national statistics.
  • A disproportionate percentage of males, whites, and privately insured teens are not up to date with HPV immunization. Among these groups, more than 90% had received a wellness checkup between ages 11 and 12 years, with 80.4% living in households above the poverty level.

According to a new American Cancer Society report, about 14 million additional children 11-12 years of age will need to be immunized with the human papillomavirus (HPV) vaccine between now and 2026 to reach the 80% vaccination rate goal.1 This number exceeds the projected total of vaccinations based on current rates.

Researchers led by Stacey Fedewa, MPH, PhD, an investigator in the American Cancer Society’s surveillance and health services research unit, looked at the number of additional preteens who need to receive the vaccination to reach the 2026 goal, as well as focused on the characteristics of those who have not initiated or completed vaccination, in an effort to increase vaccine uptake.

As of 2016, 35.5% of females and 31.5% of males were up to date with HPV vaccination by age 13, according to national statistics. Researchers estimate that an additional 14.39 million preteens (6.77 million females and 7.62 million males) would need HPV vaccination to reach the 80% compliance goal by 2026. This amounts to 57.62 million total doses to be administered and requires 18.27 million doses above the current level to achieve the goal.1

In the analysis, the researchers noted that a disproportionate percentage of males, whites, and privately insured teens are not up to date with HPV immunization. Among these groups, more than 90% had received a wellness checkup between 11-12 years of age, with 80.4% living in households above the poverty level. More than half (56.5%) of teens who had not begun the HPV vaccine were covered by private insurance; less than 5% were uninsured.1

On the other hand, public health initiatives, such as Vaccines for Children, that provide free vaccines to low-income children, have led to moderate success in HPV vaccine coverage. The analysis data indicate that vaccination rates were higher in adolescents ensured by Medicaid than among those with private insurance.1

Look for Missed Opportunities

Where are providers missing the mark when it comes to HPV vaccination? More than 90% of adolescents who had not begun HPV vaccination by age 13 did have a wellness visit at 11 to 12 years of age, says Fedewa.

“Why it’s not happening is a critical question,” said Fedewa in a press statement. “While we could not determine whether a provider recommended the vaccine during these visits, previous studies show that only about half of parents reported that they had ever received a recommendation to vaccinate their child against HPV.”

Six out of 10 U.S. parents are choosing to get the HPV vaccine for their children, according to a 2017 report from the Centers for Disease Control and Prevention (CDC).2 Providers may be able to reach more parents with CDC information; visit the resource center at https://bit.ly/2pRvFXQ for fact sheets and answers to questions parents may have regarding vaccination.

Remind parents that HPV vaccination can prevent not only cervical cancer but also un-comfortable testing and treatment, even for cervical precancers. According to the CDC, nearly 300,000 U.S. women each year are diagnosed with high-grade cervical lesions, with testing and treatment for such precancers having lasting effects.

Reaching Teens in Rural Areas

A clinic’s location may play an important role. Fewer teens in rural areas are receiving the HPV shot, compared to adolescents in urban areas, results from the 2017 CDC report indicate. Statistics suggest that the rate of rural teens who received an initial dose of the HPV vaccine was 11 percentage points below the rate in urban areas.2

“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,” explains Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases.

How can providers help increase vaccination rates? The CDC notes that receiving a recommendation for vaccination from a provider is the main reason parents choose to vaccinate their children. Clinicians can take advantage of opportunities by recommending the vaccine strongly to parents of children ages 11-12 on the same day and in the same way that they recommend Tdap and meningococcal vaccines.

The low rate of uptake by parents of preteens can motivate those in family planning who care for young men and women to counsel about the importance of the vaccine and to offer it themselves once patients are old enough to make their own health decisions, says Anita Nelson, MD, professor and chair of the obstetrics and gynecology department at Western University of Health Sciences in Pomona, CA. This “catch up” vaccination effort is very important because it gives clinicians a second chance to prevent HPV-related malignancies and pre-malignancies, notes Nelson.

REFERENCES

  1. Fedewa SA, Preiss AJ, Fisher-Borne M, et al. Reaching 80% human papillomavirus vaccination prevalence by 2026: How many adolescents need to be vaccinated and what are their characteristics? Cancer 2018; doi:10.1002/cncr.31763. [Epub ahead of print].
  2. 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.