Executive Summary

According to results of a national survey, physicians recommend human papillomavirus (HPV) vaccination to less than 15% of their male patients ages 9-26. Pediatric specialists and doctors who support new vaccines were more likely to recommend the vaccine, data indicate.

  • One way to increase uptake is to strongly encourage HPV vaccination of age-eligible males whenever other vaccines are administered.
  • Nearly 85% of adolescents received diphtheria, tetanus, and pertussis (Tdap) vaccines in 2012, but only about half of girls and 20% of boys received their first HPV vaccine dose.

What’s your practice when it comes to recommending the human papillomavirus (HPV) vaccine for young men? According to results of a national survey, physicians recommend HPV vaccination to less than 15% of their male patients ages 9-26. Pediatric specialists and doctors who support new vaccines were more likely to recommend the vaccine, data indicate.1

In 2009, the quadrivalent HPV vaccine was approved and permissively recommended for U.S. males ages 9-26 to protect against genital warts. The recommendation was moved to routine use in 2011.

The purpose of this study was to examine and explore factors associated with U.S. physicians’ HPV vaccine recommendations to early (ages 11-12), middle (13-17), and late adolescent/young adult (ages18-26) males.

While the HPV vaccine is best known in the context of preventing cervical cancer, there are other HPV-related cancers that affect men, including anal and penile cancer, explains Susan Vadaparampil, PhD, MPH senior faculty member in the Health Outcomes and Behavior Program at the Moffitt Cancer Center in Tampa. In fact, one of the most rapidly increasing cancers that is also linked to HPV is head and neck cancer, states Vadaparampil, a co-author of the current research. These cancers are more than twice as common in men as in women, she states.

The Moffitt Center researchers were motivated to conduct the survey because it is well-established that physician recommendation is one of the most important factors related to whether adolescents actually receive the vaccination, says Vadaparampil. "The Centers for Disease Control and Prevention [CDC] strongly supports increasing physician recommendation as a main way to increase adolescent HPV vaccination rates, yet, little is known about whether physicians actually recommend vaccination and their reasons for doing — or not doing — so," Vadaparampil says. "This information is greatly needed to develop interventions to increase physicians’ HPV vaccine recommendations to males."

One way to increase uptake is to strongly encourage HPV vaccination of age-eligible males whenever other vaccines are administered. Case in point: Nearly 85% of adolescents received diphtheria, tetanus, and pertussis (Tdap) vaccines in 2012, but only about half of girls and 20% of boys received their first HPV vaccine dose.2

Four leading national medical associations — the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and American College of Obstetricians and Gynecologists – and the Immunization Action Coalition and the CDC issued a call in February 2014 urging physicians across the United States to educate their patients about the HPV vaccine and to strongly recommend HPV vaccination.3 Research findings indicate that when a provider strongly recommends HPV vaccination, patients are four to five times more likely to receive the HPV vaccine.4 It is time for providers to strongly recommend the HPV vaccine to prevent cervical and other cancers, say public health advocates.

In a statement accompanying the physician call, Deborah Wexler, MD, executive director of the St. Paul, MN-based Immunization Action Coalition, says, "What you say matters, and how you say it matters even more. A lukewarm recommendation may lead people to perceive HPV vaccination as less important than other vaccines."

HPV vaccination should be viewed as a community effort against cancer by adolescent males and females, says Melanie Gold, DO, FAAP, medical director of school-based health centers at Columbia University in New York City. With more teens getting HPV vaccinations, the herd immunity effect begins to take place in protecting the population against HPV-related cancers, she notes.

It’s time to get behind HPV vaccination, especially for males. Results of a new national survey indicate among males ages 13-17, 8.3% had received greater than or equal to one dose, and 1.3% had received up to three doses.5 What can you do to make sure your patients are fully vaccinated against HPV? The CDC offers the following tips:

  • Strongly recommend adolescent vaccines to parents of your patients ages 11-18. "Parents trust your opinion more than anyone else’s when it comes to immunizations," states the CDC. "Studies consistently show that provider recommendation is the strongest predictor of vaccination."
  • Use every opportunity to vaccinate your teen patients. Ask about vaccination status when they come in for sick visits and sports physicals.
  • Patient reminder and recall systems such as automated postcards, phone calls, and text messages can be effective tools for increasing office visits.
  • Educate parents about the diseases that can be prevented by adolescent vaccines. Parents may know very little about pertussis, meningococcal disease, or HPV.
  • Implement standing orders policies so that patients can receive vaccines without a physician examination or individual physician order.6

Also, download free patient handouts from the CDC website, http://1.usa.gov/1eGPIdM. Click on "Handouts to Give Patients and Parents" for vaccine fact sheets and schedules for parents and patients and HPV specific vaccine information sheets. Resources also are available in Spanish.

REFERENCES

  1. Malo TL, Giuliano AR, Kahn JA, et al. Physicians’ human papillomavirus vaccine recommendations in the context of permissive guidelines for male patients: a national study. Cancer Epidemiol Biomarkers Prev 2014; doi:10.1158/1055-9965.EPI-14-0344.
  2. Centers for Disease Control and Prevention. National and state vaccination coverage among adolescents aged 13-17 years — United States, 2012. MMWR 2013; 62(34):685-693.
  3. Immunization Action Coalition. Leading medical and public health organizations join efforts urging physicians to strongly recommend human papillomavirus (HPV) vaccination. Press release. Accessed at http://bit.ly/1cx70bn.
  4. Ylitalo KR, Lee H, Mehta NK. Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US National Immunization Survey. Am J Pub Health 2013; 103(1)164-169.
  5. Curtis CR, Dorell C, Yankey D, et al. National human papillomavirus vaccination coverage among adolescents aged 13-17 years — National Immunization Survey — Teen, United States, 2011. MMWR Surveill Summ 2014; 63:61-70.
  6. Centers for Disease Control and Prevention. Preteen and teen vaccines. Accessed at http://1.usa.gov/NKQFuC .