The number of boys and girls age 13-17 receiving the human papillomavirus (HPV) vaccine is unacceptably low despite a slight increase in vaccination coverage since 2012, according to data from the Centers for Disease Control and Prevention’s 2013 National Immunization Survey-Teen published in this week’s Morbidity and Mortality Weekly Report.
The HPV vaccine prevents various forms of cancer, but remains underutilized, according to a press release from the CDC. There is a substantial gap between the number of adolescents receiving tetanus, diphtheria, and pertussis (Tdap) vaccine (generally given around 11 years of age) and the number receiving HPV vaccine, the data shows. It is estimated that only 57 percent of adolescent girls and 35 percent of adolescent boys ages 13-17 had received one or more doses of HPV vaccine. However, nearly 86 percent of adolescents had received one dose of Tdap vaccine.
These gaps in coverage indicate missed opportunities to vaccinate boys and girls with HPV vaccine at the same time as other routinely recommended adolescent vaccines like Tdap and meningococcal vaccines, the CDC release stated.
“The high coverage rate of Tdap vaccine shows us that it is certainly possible to reach our goal of vaccinating 80 percent of adolescents against cancers caused by HPV,” said Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases.
CDC estimates that if missed opportunities to vaccinate adolescent girls before their 13th birthdays were eliminated, 91 percent of adolescent girls would have some protection from cancers caused by HPV infection.
“Pediatricians and family physicians are uniquely situated to prevent missed opportunities by giving HPV vaccine during the same visit they give Tdap and meningococcal vaccines,” said Schuchat.
Katie Fearon, a nurse practitioner with Bayside Pediatrics in Annapolis, said that this is a topic she is passionate about. Many parents have concerns about giving their 11- and 12-year-olds a vaccine that protects against a virus that is transmitted by sexual contact, she said. They think that the HPV series is not needed at that age and that it would give the child a sense of permission to become sexually active. She stresses to the parents, however, that it is the best age because it offers long term protection against a dangerous strain of HPV and also because older teens don’t come to well visits as consistently.
“I really try to reassure parents that research has shown that individuals who have received the vaccine series are not more likely to engage in risky sexual behavior,” she said. “When parents tell me their child isn’t having sex I say, ‘Great, then this is the perfect time to start the series!'”
Dr. Margaret Turner from Annapolis Pediatrics, however, said that the issue of the HPV vaccine is a touchy one.
“My advice to parents is different depending on the age and maturity level of the kid,” she said.
Pediatrician influence in HPV vaccine
The CDC data also illustrate the influential role a clinician’s recommendation plays in whether or not parents choose to vaccinate their children. For parents that had their daughters vaccinated against HPV, 74 percent received a recommendation from a health care professional, compared to 52 percent of parents who did not have their daughters vaccinated. For boys, 72 percent of parents who chose to vaccinate their sons received a recommendation, compared to 26 percent of parents who did not have their sons vaccinated, according to the CDC release. Not receiving a clinician’s recommendation for HPV vaccine was one of the five main reasons parents listed during the NIS-Teen interviews for not vaccinating their children against HPV.
“I try to put it to parents this way — we have a vaccine that helps prevent cancer! Yes, HPV is a virus spread by sexual contact, but it is a virus that we are ultimately worried about leading to cancers that can at best incur costly and painful treatments, even worse affect reproductive options later in life, and at worst cause death,” Feron said. “Just as it is our duty as parents and healthcare providers to protect very young children from dangerous illnesses like whooping cough through vaccination, it is also our duty to protect our older children against devastating conditions caused by HPV through the vaccination series.”
Turner, however, does not always feel it is necessary to recommend the vaccine at age 11.
“One of the greatest benefits of having a primary care physician is having someone who has a sense of what your kid needs when,” she said. “I really like to collaborate with the parent and later, the parent and child, in making the decision about when we should vaccinate.”
Turner said she starts the discussion with parents when a child is 11 but doesn’t usually start giving the vaccine until age 14 or 15.
“I have found many parents to be quite resistant at 11, but very accepting at 14-15,” she said.
HPV vaccine safety concerns
According to the CDC data, parents also reported safety concerns as a reason for not having their children vaccinated against HPV. In the eight years of post-licensure vaccine safety monitoring and evaluation conducted independently by federal agencies and vaccine manufacturers, and after 67 million doses of HPV vaccine have been distributed, no serious safety concerns have been linked to HPV vaccination. According to this week’s MMWR article, the most commonly reported symptoms after receiving an HPV vaccine include injection-site reactions such as pain, redness, and swelling; other commonly reported symptoms include dizziness, fainting, nausea, and headache.
CDC urges health care professionals to give a strong recommendation for all of the adolescent vaccines recommended for boys and girls aged 11 or 12 years. Clinicians should recommend HPV vaccine as they would recommend Tdap and meningococcal vaccines, the press release states. Reviewing vaccination status at every health care visit is another strategy doctors and nurses should take to increase vaccine coverage, according to the CDC.
The NIS-Teen is a random-digit-dialed survey of parents and guardians of teens 13–17 years old and in 2013, included data for more than 18,000 adolescents. The telephone survey is followed by verification of records with health care professionals.
For details visit the CDC website.