Boost HPV vaccination numbers — next generation is at risk
3-dose coverage declined slightly from 2011 to 2012
According to just-released information, vaccination for human papillomavirus (HPV) rates in U.S. girls ages 13-17 failed to increase between 2011 and 2012; in fact, three-dose coverage actually declined slightly from 2011 to 2012.1In 2012, only 53.8% of girls had received one or more doses of HPV vaccine, and only 33.4% had received all three doses of the series.1
Drawn from data from the 2012 National Immunization Survey — Teen, among girls unvaccinated for HPV, 84% had a healthcare visit at which they received another vaccine, such as one for meningitis or pertussis, but not the HPV vaccine. If the HPV vaccine had been administered, vaccination coverage for one or more doses could be nearly 93%, rather than 54%, say officials with the Centers for Disease Control and Prevention (CDC).
"Progress increasing HPV vaccination has stalled, risking the health of the next generation," said CDC Director Tom Frieden, MD, MPH, in a statement accompanying the report. "Doctors need to step up their efforts by talking to parents about the importance of HPV vaccine just as they do other vaccines and ensure it’s given at every opportunity."
Time is of the essence, say public health officials. For each year the three-dose HPV vaccine series coverage remains near the current level of 33% — instead of achieving the Healthy People 2020 goal of 80% coverage — an additional 4,400 women will be diagnosed with cervical cancer, and 1,400 cervical cancer-attributable deaths will occur in the future, says the CDC.
What is the holdup?
Healthcare providers are urged to give a strong recommendation for HPV vaccination for boys and girls ages 11-12. Why? The analysis of the 2012 survey data shows that not receiving a healthcare provider’s recommendation for HPV vaccine was one of the five main reasons parents reported for not vaccinating daughters. Other reasons included vaccine not needed (19.1%), vaccine safety concerns (13.1%), lack of knowledge about the vaccine or the disease (12.6%), and daughter not sexually active (10.1%).
Results of a 2011 paper indicate a provider’s recommendation is the single most important factor in the decision by adolescents and parents to initiate and complete the HPV vaccination series.2(Contraceptive Technology Update offered provider tips in the article "Time to boost numbers for HPV vaccination," May 2013, p. 56.)
According to the survey analysis, responses provided by some parents indicate gaps in understanding about the vaccine, including why vaccination is recommended at ages 11 or 12. "Parents need reassurance that HPV vaccine is recommended at 11 or 12 because it should be given well in advance of any sexual activity," said Frieden. "We don’t wait for exposure to occur before we vaccinate with any other routinely recommended vaccine."
Address safety concerns with parents to alleviate their fear for not vaccinating. Public health officials note that in the seven years of postlicensure vaccine safety monitoring and evaluation conducted independently by federal agencies and vaccine manufacturers, no serious safety concerns have been identified. Reports of adverse events after HPV vaccination to the Vaccine Adverse Event Reporting System (VAERS) have decreased steadily from 2008 to 2012; the numbers of serious adverse events reported also has declined since 2009.1
During June 2006 to March 2013, the VAERS received 21,194 adverse event reports occurring in females after receipt of the HPV vaccine; 92.1% were classified as nonserious. Among nonserious adverse events, the most commonly reported generalized symptoms were syncope, dizziness, nausea, headache, fever, and urticaria; the most commonly reported local symptoms were injection-site pain, redness, and swelling. Among the 7.9% of vaccine-related reports classified as serious (requiring hospitalization), the most frequently reported symptoms were headache, nausea, vomiting, fatigue, dizziness, syncope, and generalized weakness.1
CDC is working with healthcare providers in several ways to increase the consistency and strength of recommending the HPV vaccine, says Anne Schuchat, MD, the director of CDC’s National Center for Immunizations and Respiratory Diseases.
"First, we are helping providers enhance their interactions with parents about HPV vaccine," says Schuchat. "We are pointing providers to research study findings to arm them with sound, scientific information they use to help them better address the questions and concerns raised by parents." (Download a free CDC handout, "Diseases That Vaccines Prevent — Human Papillomavirus," to educate parents. Go to http://1.usa.gov/1155KvD.)
The CDC also is doing health communication research with providers on the most effective ways to talk with parents about vaccination, says Schuchat. One of the resulting products from that research is a free tip sheet, "Tips and Time-savers for Talking with Parents about HPV Vaccine" at http://1.usa.gov/15JhxO5.
Schuchat also notes that the CDC is engaging provider partners, such as the American Academy of Pediatrics and the American Academy of Family Physicians, to help reach clinicians to ensure they have the information and resources they need to make strong recommendations for the vaccine.
Remind parents that for many families, it’s easier than ever to get the HPV vaccine. Because of the Affordable Care Act, most private health insurance plans must cover the HPV vaccine at no out-of-pocket cost, meaning no copay or deductible. (To see what preventive health services are covered for children, go to http://1.usa.gov/13BAhDo.)
Minorities at risk
Recent research indicates that women of color are at particular risk for cervical cancer. In 2009, Hispanic women had the highest rate of getting cervical cancer, followed by black, American Indian/Alaska Native, white, and Asian/Pacific Islander women.3
To determine HPV and vaccine awareness, knowledge, beliefs, and barriers, researchers at the University of California, Los Angeles (UCLA) conducted telephone interviews in six languages among mothers of vaccine-eligible girls using the Los Angeles County Department of Public Health, Office of Women’s Health service referral hotline. The sample consisted of low-income, uninsured, ethnic minority, and immigrant women. Only 29% of daughters initiated the vaccine, and only 11% received all three doses, data indicate. National data for the same time period found that 44% of adolescents had initiated the HPV vaccine and 27% had completed the series.4
In a separate study of the population designed to examine geographic access to HPV vaccines for underserved girls, researchers found that while most girls live in close proximity to safety-net vaccination services, rates of initiation were low.5
The UCLA School of Public Health & the Jonsson Comprehensive Cancer Center is working with the Los Angeles County Department of Public Health, Office of Women’s Health, to evaluate via a randomized trial a theoretically driven, culturally sensitive and individually tailored intervention to increase HPV vaccine receipt among underserved, high-risk girls in Los Angeles. The goal is to increase vaccination rates among low-income, ethnic minority, vaccine-eligible girls.
The program plans to speak directly to mothers of the target population: girls ages 11-18. When the mothers call the health department for information or services, the intervention will educate them about the vaccine and refer them to a conveniently located clinic offering free or low-cost vaccines. The intervention has not yet been launched, says Roshan Bastani, PhD, professor of health policy and management in the UCLA Fielding School of Public Health and director of the UCLA Kaiser Permanente Center for Health Equity.
Researchers with the project have translated the materials into six languages: English, Spanish, Mandarin, Cantonese, Vietnamese, and Korean, says Bastani.
- Centers for Disease Control and Prevention (CDC). Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013 — United States. MMWR 2013; 62(29):591-595.
- Dorell CG, Yankey D, Santibanez TA, et al. Human papillomavirus vaccination series initiation and completion, 2008-2009. Pediatrics 2011; 128(5):830-839.
- Centers for Disease Control and Prevention. Cervical Cancer Rates by Race and Ethnicity. Accessed at http://1.usa.gov/1cw4ExF.
- Bastani R, Glenn BA, Tsui J, et al. Understanding suboptimal human papillomavirus vaccine uptake among ethnic minority girls. Cancer Epidemiol Biomarkers Prev 2011; 20(7):1,463-1,472.
- Tsui J, Singhal R, Rodriguez HP, et al. Proximity to safety-net clinics and HPV vaccine uptake among low-income, ethnic minority girls. Vaccine 2013; 31(16):2,028-2,034.