COMMENTARY

Increasing HPV Vaccine Coverage

Anne Schuchat, MD

Disclosures

December 19, 2011

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Hello, I am Dr. Anne Schuchat, Director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. I am pleased to speak with you today as part of the CDC Expert Commentary Series on Medscape.

I have bad news today. Our latest national survey results for HPV vaccine coverage show we are not making progress in protecting girls against future cervical cancer. When we first recommended the vaccine in 2006, we looked forward to seeing strong and steady increases in coverage over time, similar to what we have seen with the introduction of other vaccines. But HPV vaccine coverage has started to plateau, while other teen vaccinations such as Tdap and meningitis continue to rise. Less than half of girls 13-17 years of age have received the first dose of HPV vaccine, and fewer than 1 in 3 have had all 3 doses. About 60,000 women in the United States have been diagnosed with cervical cancer since the HPV vaccine was licensed 5 years ago -- none of those women had the chance to be vaccinated against the virus strains that cause most cervical cancer before they were infected with HPV and before their cancers developed. But girls today do have that chance for vaccine protection. This incredible tool -- the HPV vaccine -- prevents infections that cause about 70% of cervical cancers. However, if we don't make major changes, far too many girls in this generation will suffer in the same way as their mothers and grandmothers.

I also have good news today. You can help turn this situation around. Here are some things you can do to help improve HPV vaccine use in your community.

Provide a strong recommendation for HPV vaccine for preteen and teen girls. Parents trust your opinion more than anyone else's when it comes to immunization. Studies consistently show that a provider's recommendation is the strongest predictor of getting vaccinated. If some parents are hesitant to have their daughters vaccinated, your advice can help them. Teens and their parents are more likely to follow a recommendation if they understand clearly what the recommendation is and why it is being offered.

For parents and girls who have safety concerns, let them know about the strong safety record of the vaccine. By 2011, more than 35 million doses of the vaccine have been distributed in the United States and we have found a very good safety record. Of adverse events following vaccination, 92% were not serious, and included pain, swelling at the injection site, headache, nausea, and fever. Some preteens and teens have fainted after vaccinations, but you can reduce the risks for syncope if you make sure your patients stay sitting or lie down for about 15 minutes after the injection.

You might hear parents ask if their daughter can wait until she is older to get the vaccine. A big problem with this is that the vaccine works best if it is given before sexual activity begins, and visits to the doctor become less frequent as teens age. Remind parents that it is critical to finish the 3-dose series long before exposure to HPV. Explain that the vaccine prevents infection upon exposure to HPV, but it won't treat the virus if you have already been infected. That is why it is recommended for preteens. Girls then have time to develop protection long before they begin sexual activity. Our data from the past few years show that waiting is not working. About half of girls who are 17 have not received any doses of HPV vaccine. Starting in 2012, a new HEDIS (Healthcare Effectiveness Data and Information Set) measure will go into effect that tracks the proportion of 13-year-old girls who have received all 3 doses of HPV vaccine. We need to aim to get the series completed in those first preteen years.

For teens who do start the HPV vaccine series, help them complete the series by making it easy to schedule follow-up appointments for the next 2 doses of HPV vaccine before leaving the office.

Standard operating procedures (SOPs) can also be useful in improving vaccine coverage for your practice. Work with your office team to create an SOP so every teen you see gets their vaccination status checked at every visit, even acute care visits. Practice staff can review a patient's immunization history and flag the patient's record to indicate which vaccines are needed. If your practice is using an electronic medical record, activate a prompt that will appear if an immunization is needed. Almost all states have immunization registries -- those can also provide reminders when follow-up vaccinations are due and give you feedback about which of your patients is overdue and needs to be recalled.

Reminder/recall systems can be very effective and they don't have to be costly. If you prefer a low-tech option, have your patients self-address reminder postcards before leaving the office. Indicate on the postcard the due date for the next HPV vaccine dose and organize your postcards by the months they should be mailed.

Our studies suggest that if HPV vaccine were given every single time another vaccine was being given to a teenager, more than 80% of girls would be vaccinated. If your practice vaccinates every girl on time and helps schedule appointments for the full series, we know we will see increases in coverage. And those increases should translate into fewer cancers when these girls grow up.

For additional resources, you can visit CDC's Vaccines for Preteens and Teens Website. This site includes materials designed specifically for your needs, as well as multimedia products that can be downloaded for use in your practice.

Thank you for helping the teens in your practice protect themselves from infections that can lead to cervical cancer. You can make a difference for a whole generation.

Web Resources

CDC: Vaccines for Preteens and Teens

Dr. Anne Schuchat (pronounced shook-it) joined CDC in 1988 as an Epidemic Intelligence Service Officer. She has made significant contributions to infectious disease prevention through research, surveillance, and policy, developing guidelines and disease monitoring systems, conducting prelicensure and postlicensure vaccine evaluations, and collaborating with partners to accelerate the availability of vaccines and prevention programs. She worked in West Africa on meningitis and pneumonia vaccine studies, in South Africa on surveillance and prevention projects, in China on SARS emergency response, and as CDC's Chief Health Officer during the H1N1 pandemic response. Dr. Schuchat graduated with highest honors from Swarthmore College and with honors from Dartmouth Medical School. She completed residency training at New York University's Manhattan VA Hospital. She has co-authored more than 180 scientific articles and reports, and received numerous awards including the Public Health Service's Meritorious Service Medal for preventing group B streptococcal infections in newborns. Since December 2005, Dr. Schuchat has served as the Director for the National Center for Immunization and Respiratory Diseases. From February through May 2009 she was CDC's Interim Deputy Director focusing on science and program and in 2008, she was elected to the Institute of Medicine. In 2006, she was promoted to the rank of Assistant Surgeon General within the US Public Health Service, and in 2010 she received her second star.

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