CDC: HPV Vaccination Rates Too Low

Emma Hitt, PhD

August 25, 2011

August 25, 2011 — Compared with the tetanus and meningococcal vaccines, human papillomavirus (HPV) vaccine comes in a paltry third place when it comes to increases in vaccination rates in teenagers, according to data released today from the Centers for Disease Control and Prevention (CDC).

"Coverage rates for the other two vaccines — Tdap, which protects against tetanus, diphtheria and pertussis, and MenACWY, which protects against meningococcal meningitis — are continuing to increase, but vaccination rates for HPV vaccine remain low," a CDC press release regarding the advisory explains.

Christina Dorell, MD, from the Immunization Services Division, National Center for Immunization and Respiratory Diseases, and colleagues reported data from the 2010 National Immunization Survey-Teen in this week's Morbidity and Mortality Weekly Report.

The CDC's National Immunization Survey-Teen has been ongoing since 2006 and has collected provider-verified vaccination data on 19,488 teenagers aged 13 to 17 years. The survey is a random telephone survey of parents or caregivers, followed by verification of records with healthcare providers.

The latest survey found that nearly half (48.7%) of respondents received 1 dose of the recommended 3 doses for HPV vaccine, 62.7% had received MenACWY, and 68.7% had received the Tdap vaccine.

From 2009 to 2010, vaccination coverage increased for all 3 vaccines. Among girls who received the recommended 3 doses of HPV vaccine, coverage increased 5.3%, from 26.7% to 32%, during the previous year, but coverage increases for HPV were less than half those observed for the Tdap (13.3%) and meningitis (9.1%) vaccines.

Nearly One Third Start but Do Not Finish HPV Series

Of the teenagers who commenced the 3-dose HPV series, 30% did not complete the series. The survey also found that Hispanics had higher coverage for 1 dose of the MenACWY and HPV vaccines, but fewer blacks and Hispanics, compared with whites, received the third dose for HPV coverage. In addition, girls living below the poverty level were also less likely to complete the HPV series.

Massachusetts, Rhode Island, and Washington had the highest coverage, with more than 65% coverage for 1 or more dose of all 3 routinely administered adolescent vaccines. "Coverage for the 3 adolescent vaccines was significantly lower among adolescents living in the southeastern United States compared with adolescents living in other regions," Dr. Dorell and colleagues write.

"Far too few US girls are getting the HPV vaccine," said Melinda Wharton, MD, MPH, deputy director of the CDC's National Center for Immunization and Respiratory Diseases, in a CDC telebriefing held today. "We can do better at this — we've got in our possession a very powerful tool: a vaccine that prevents cancer," she said. "If we all take actions to protect girls starting today, we'll have generations of women who will never be diagnosed with cervical cancer."

Perception That Girls Are "Too Young"

According to Dr. Wharton, there may be "multiple things" going on that could explain why the increase in vaccine rates is lower for HPV than the other 2 vaccines. Factors include the fact that it is a 3-dose series, and also that there is a perception that girls are too young at the recommended age to receive the vaccine; however, she pointed out that the vaccine "won't work unless it is given prior to the onset of sexual activity, and that's why we recommend it so young."

"Even if we know our children very well, we don't know when they are going to be first sexually active," Dr. Wharton told Medscape Medical News during the telebriefing. "It's also possible that most parents are not going to be as concerned about [the young age at first dose] as providers think they might," she said. "If a provider makes a strong recommendation for this vaccine...it may be that parents won't have many questions about it."

National Goals May Not Be Met

The CDC's Advisory Committee on Immunization Practices recommends that adolescents routinely receive 2 doses of MenACWY, 1 dose of Tdap, and 3 doses of HPV.

Healthy People 2020 targets for adolescents aged 13 through 15 years are 80% coverage for 1 or more dose of Tdap, 1 or more dose of MenACWY, and 3 or more doses of HPV (among girls), and 90% coverage for 2 or more doses of varicella vaccine (among adolescents without a reported history of varicella disease).

"Although adolescent vaccination is increasing, additional strategies are needed to meet Healthy People 2020 vaccination objectives for adolescents, particularly for HPV vaccination, because the increase in HPV coverage significantly lags behind other adolescent vaccines," the CDC advisory states.

The currently available HPV vaccines Cervarix (GlaxoSmithKline) and Gardasil (Merck) have demonstrated efficacy in females aged 9 through 26 years. CDC recommends that all girls who are 11 or 12 years old get the 3 doses of either vaccine to protect against cervical cancer. In addition, females aged 13 through 26 should get all 3 doses of an HPV vaccine if they have not yet received all doses.

Morb Mortal Wkly Rep. 2011:117;60:1117-1123. Full text

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