How to boost use of HPV vaccine in boys
Results of a new study indicate individuals who contract sexually transmitted infections (STIs) during their teen years have a greater HIV risk into young adulthood. Data from the study indicate the greater the number of STIs contracted during teen years, the greater the risk of subsequent HIV.
• To conduct the retrospective cohort study, researchers with the Philadelphia (PA) Department of Public Health analyzed data from 75,273 Philadelphia high school students born between 1985 and 1993 who
participated in the Philadelphia High School STD Screening Program.
• Americans ages 15-24 make up just 27% of the sexually active population, but account for 50% of the 20 million new STIs in the United States each year.
New data from the Centers for Disease Control and Prevention (CDC) show about one in five boys got at least one of the recommended three doses of human papillomavirus (HPV) vaccine last year.1
The report is the first snapshot of male vaccine use following the Advisory Committee on Immunization Practices' (ACIP) recommendation for routine HPV vaccination in this population. (Contraceptive Technology Update reported on the recommendation. See "Finally! HPV male shot routinely recommended," January 2012, p. 6.) The data is based on telephone calls to families for about 19,000 boys and girls ages 13 to 17.
The Food and Drug Administration in December 2010 approved Gardasil, the Merck & Co. quadrivalent vaccine, for prevention of anal cancer and associated precancerous lesions (anal intraepithelial neoplasia grades 1, 2, and 3), related to HPV types 6, 11, 16, and 18 in males and females ages 9-26. (See "New indication OK'd for HPV vaccine," STI Quarterly supplement, March 2011, p. 3.) The vaccine also is approved for the prevention of genital warts caused by types 6 and 11 in males and females.
While the new data appears encouraging regarding HPV vaccination rates among males, what can providers do to further boost rates among this population?
HPV vaccination is important for cancer prevention in boys and girls, says Robin Curtis, MD, MPH, FAAP, a pediatrician with CDC's National Center for Immunization and Respiratory Diseases and lead author of the current research. Providers should recommend the HPV vaccine series in the same way that they recommend other vaccines, she states.
At ages 11 through 12, the Advisory Committee on Immunization Practices recommends that preteens receive one dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, one dose of meningococcal conjugate vaccine, and three doses of HPV vaccine.2-4ACIP recommendations call for administration of all age-appropriate vaccines during a single visit.5For example, a clinician can say "Your child needs these shots today," and name all of the vaccines recommended for the child's age, explains Curtis. When a vaccine such as Tdap is given to boys and girls, providers also should be sure to administer recommended HPV and meningococcal vaccinations during those very same visits, she notes.
Room for improvement
There is room for improvement for increasing HPV vaccination rates in young males and females, say medical and health advocacy groups. Rates of HPV vaccine uptake for adolescent females during 2012 did not change from rates in 2011.6(To read the CTU article, see "Public health officials say boost HPV vaccination numbers," October 2013, p. 109.)
The American Academy of Pediatrics is participating in a joint project with the CDC to educate pediatricians about the need for a strong recommendation to parents for on-time adolescent vaccinations. It also is implementing quality improvement activities to reduce missed opportunities; raise parental awareness of adolescent vaccines by creating educational material for pediatric offices; and improve practice tools, such as prompts in electronic medical records and implementing standing orders that patients can receive vaccinations without a physician's exam.7
Reaching young males can be tough. America's healthcare system does not adequately address the needs of adolescent and young adult males, notes Dennis Barbour, JD, co-founder of The Boys Initiative, a Washington, DC-based non-profit organization centered on issues surrounding adolescent and young adult males. On the whole, a young man's last visit to his pediatrician often marks his exit from primary and continuous care until he reaches middle age, says Barbour.
The Boys' Initiative is reaching out to and engaging a range of medical experts in all fields that have an interest in adolescent and young adult male health, says Barbour. It is working with such experts to develop a male health checklist for clinicians, as well as a health checklist for use by young men.
The HPV vaccine in males offers a good starting point for reaching young men. Widespread use of any medical service is dependent on reimbursement for it; that is why any education effort must be coupled with efforts to ensure insurance coverage for the vaccine, Barbour notes. One vehicle for this coverage can be the Affordable Care Act (ACA), which mandates a package of preventive services for women, but not for men.
"The HPV vaccine would appear to be an excellent candidate for moving the ACA, and our healthcare system with it, toward improved health care for adolescent and young adult males," says Barbour.
1. Centers for Disease Control and Prevention (CDC). National and state vaccination coverage among adolescents aged 13-17 years United States, 2012. MMWR 2013; 62(34):685-693.
2. Centers for Disease Control and Prevention (CDC). Advisory Committee on Immunization Practices (ACIP) recommended immunization schedules for persons aged 0 through 18 years and adults aged 19 years and older United States, 2013. MMWR 2013; 62(Suppl 1):1-19.
3. Centers for Disease Control and Prevention (CDC). Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices. MMWR 2007; 56(No. RR-2):1-24.
4. Centers for Disease Control and Prevention (CDC). Recommendations on the use of quadrivalent human papillomavirus vaccine in males Advisory Committee on Immunization Practices (ACIP), 2011. MMWR 2011; 60:1,705-1,708.
5. Centers for Disease Control and Prevention . General recommendations on immunization: Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly 2011; 60(No. RR-2).
6. Centers for Disease Control and Prevention. Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013 United States. MMWR 2013; 62(29):591-595.
7. McInerny TK. Letter from the president. AAP News 2013; 34(9):6.