By Rebecca Bowers

EXECUTIVE SUMMARY

According to a new study, only about 16% of U.S. adolescents have received the complete vaccination against human papillomavirus (HPV) by the time they turn 13 years of age, despite national recommendations for vaccination at ages 11-12.

  • The analysis indicates that while about 43.4% of teens ages 13-17 received complete vaccination against HPV, just 15.8% of adolescents had received all recommended doses of the vaccine by their 13th birthday. Data show that about 34.8% of teens had received full vaccination by their 15th birthday.
  • About 33,700 women and men are diagnosed every year in the United States with a cancer caused by HPV infection. Vaccination against HPV could prevent more than 90% of these cancer cases from ever developing, data indicate.

According to a new study, only about 16% of U.S. adolescents have received the complete vaccination against human papillomavirus (HPV) by the time they turn 13 years of age, despite national recommendations for vaccination at ages 11-12.1

Although HPV vaccination coverage has improved, providers still are falling behind when it comes to providing immunization at younger ages, says Robert Bednarczyk, PhD, assistant professor in the Hubert Department of Global Health and Department of Epidemiology at Emory University’s Rollins School of Public Health. Clinicians need to improve their efforts in recommending the HPV vaccine during routine visits and adolescent and well-child visits, particularly focusing on children 11 to 12 years of age, notes Bednarczyk, who served as lead author of the study.

To perform the analysis, investigators looked at 2016 data from the National Immunization Survey-Teen (NIS-Teen), which monitors vaccination coverage among adolescents 13-17 years of age. Survey participants are the parents or guardians of teens in the selected age set, who provide information about their children’s sociodemographic characteristics and vaccination providers.

According to the analysis, although 43.4% of teens ages 13-17 were completely vaccinated against HPV, just 15.8% of adolescents had received all of the recommended doses of the vaccine by their 13th birthday. About 34.8% of teens had received full vaccination by their 15th birthday.1 Adolescent females were more likely than adolescent males to be up to date on the vaccine by the specified cutoff ages (20.1% vs. 11.6%, respectively, for vaccine completion before 13 years of age; 41.6% vs. 28.3%, respectively, for vaccine completion before 15 years of age).1

In a 2017 study conducted by the Centers for Disease Control and Prevention (CDC), which also looked at 2016 NIS-Teen data, researchers found that 43.4% of teens ages 13-17 were up to date with the recommended HPV vaccination series (49.5% for females; 37.5% for males).2

Early Vaccination Is Key

Why is it important that HPV vaccination begin so early? Public health officials say receiving the vaccine on time protects preteens long before they are ever exposed to the virus.

By not receiving the vaccine on time, more young Americans are at risk for cancers associated with HPV infection. The current national Healthy People 2020 goal for HPV vaccination in the United States is 80%. Data indicate that failure to reach that goal could result in more than 50,000 future cervical cancer cases for the current population of girls 12 years of age and younger.3

Much hinges on clinicians’ recommendation practices when it comes to HPV vaccination.4 Research indicates that most teens who receive a provider’s recommendation for HPV vaccination receive the immunization.5 However, not all providers are delivering the message. Reports from parents indicate that about half of eligible teens receive such vaccine recommendations.5 About one-third of physicians recommend HPV vaccination for most of their patients who are 11-12 years of age.6

According to the CDC, 33,700 women and men are diagnosed every year in the United States with a cancer caused by HPV infection. The CDC estimates that HPV vaccination could prevent more than 90% of these cancer cases (31,200) from ever developing. In general, HPV is thought to be responsible for more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and more than 60% of penile cancers. Traditionally, oropharyngeal cancers have been caused by tobacco and alcohol use, but recent studies indicate that about 70% of oropharynx cancers may be linked to HPV.

Information from the CDC indicates that cancers of the back of the throat (oropharyngeal cancer) have surpassed cervical cancer as the most common type of cancer caused by HPV. Unlike cervical cancer in women, there are no recommended screening tests for the other types of cancers caused by HPV, so they may not be found until they cause health problems.7

Video May Aid in Effort

Just-published research indicates that patient-centered education strategies delivered in the provider’s office could lead to more people choosing HPV vaccination.8 The research was conducted by scientists from Regenstrief Institute, Indiana University School of Medicine and Indiana University Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis.

To conduct the study, the research team developed a video detailing the risks and benefits of the HPV vaccine. Parents of children who had not received the HPV vaccine or had not completed the vaccine series were shown the video while they waited in the examination room of a pediatric clinic during a routine visit. The researchers used electronic health records, as well as the state’s immunization registry system, to identify patients eligible for the study. A total of 1,596 eligible adolescents ages 11-17 were included in the trial; one-third visited a clinic where the video was available. The analysis indicates that the proportion of adolescents in whom a change in vaccine status was observed was greater among those who attended an intervention clinic (64.8%) compared to those who visited the control clinic (50.1%; odds ratio, 1.82; 95% confidence interval [CI], 1.47-2.25; P < 0.001). Among adolescents whose parents watched the video, there was a three times greater odds of receiving a dose of the HPV vaccine (78.0%; odds ratio, 3.07; 95% CI, 1.47-6.42; P = 0.003).8

“These results are very promising for those concerned with public health,” notes primary author Brian Dixon, PhD, director of public health informatics at Regenstrief and associate professor at Indiana University. “If we can educate patients/caregivers at the doctor’s office, where they can take immediate action for their health, we can ensure more eligible patients receive the HPV vaccine, potentially saving lives as well as healthcare dollars spent on treating disease.”

REFERENCES

  1. Bednarczyk RA, Ellingson MK, Omer SB. Human papillomavirus vaccination before 13 and 15 years of age: Analysis of National Immunization Survey Teen data. J Infect Dis January 2019; doi: 10.1093/infdis/jiy682. [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.
  3. Chesson HW, Ekwueme DU, Saraiya M, et al. The estimated impact of human papillomavirus vaccine coverage on the lifetime cervical cancer burden among girls currently aged 12 years and younger in the United States. Sex Transm Dis 2014;41:656-659.
  4. Gilkey MB, Moss JL, McRee A-L, Brewer NT. Do correlates of HPV vaccine initiation differ between adolescent boys and girls? Vaccine 2012;30:5928-5934.
  5. Stokley S, Jeyarajah J, Yankey D, et al. Human papillomavirus vaccination coverage among adolescents, 2007-2013, and postlicensure vaccine safety monitoring, 2006-2014 — United States. MMWR Morb Mortal Wkly Rep 2014;63:620-624.
  6. Vadaparampil ST, Kahn JA, Salmon D, et al. Missed clinical opportunities: Provider recommendations for HPV vaccination for 11-12 year old girls are limited. Vaccine 2011;29:8634-8641.
  7. Centers for Disease Control and Prevention. HPV Vaccine is Cancer Prevention for Boys, Too! Available at: https://bit.ly/2smftx8. Accessed Feb. 21, 2019.
  8. Dixon BE, Zimet GD, Xiao S, et al. An educational intervention to improve HPV vaccination: A cluster randomized trial. Pediatrics 2019;143. doi: 10.1542/peds.2018-1457.