Slow Growth in HPV Shots for Girls Requires Physician Action

August 30, 2012

August 30, 2012 — Another laggardly increase in vaccination rates among adolescent girls for the cancer-causing human papillomavirus (HPV) is a call for stronger recommendations by clinicians, more parental education, and viewing every visit as an opportunity to vaccinate, according to the Centers for Disease Control and Prevention (CDC).

In an article published in the August 31 issue of the Morbidity and Mortality Weekly Report, the CDC said that coverage rates in 2011 for HPV vaccine among adolescent girls aged 13 through 17 years stood at 53.0% for 1 or more doses and 34.8% for 3 or more doses. The 4.3 percentage point rate of increase from 2010 for HPV 1-dose coverage was roughly half the increase among all adolescents for 1 or more doses of the tetanus, diphtheria, acellular pertussis (Tdap) vaccine and the meningococcal conjugate vaccine. It was the third consecutive year for this gap in vaccination growth rates.

These findings contrast sharply with exceptionally high HPV vaccination rates in some other countries. Researchers recently reported an uptake of at least 80%, and in some countries well over 90%, in 4 countries targeted in the so-called PATH initiative: India, Peru, Uganda, and Vietnam.

A CDC analysis of the National Immunization Survey–Teen showed that coverage with 1 or more doses of HPV vaccine was higher among older adolescents than younger ones, which is the opposite pattern for coverage with the Tdap; measles, mumps, and rubella; varicella; and hepatitis B vaccines. When parents delay HPV vaccination for adolescent girls — as the data suggest — coverage rates suffer, according to the CDC.

Immunization for HPV has encountered headwinds of public opinion since the CDC's Advisory Committee on Immunization Practices expanded routine adolescent vaccination to include the vaccine for girls aged 11 and 12 years in 2006 (boys followed in 2011). Some social conservatives have decried HPV vaccine as a temptation for teenagers to engage in premarital sex, and last year, US Rep. Michele Bachmann (R-MN), then a presidential candidate, went a step further by questioning the vaccine's safety, saying that she had met a mother whose daughter developed "mental retardation" after getting the shot.

Bachmann's unsubstantiated statements drew a rebuke from the American Academy of Pediatrics and repeated assurances from the CDC that the 2 HPV vaccines on the market were "very safe."

Physicians are in a position to dispel myths about HPV vaccine, yet the report released today said that "fewer and weaker health-care provider recommendations for the HPV vaccine to younger adolescents most likely contribute to lower vaccination rates."

In addition to more vigorously promoting HPV immunization, clinicians should attempt to administer all vaccinations simultaneously and take advantage of every visit to catch kids up on their shots, the CDC said.

A related goal is making sure that adolescent girls get all 3 doses of HPV vaccine. In 2011, almost 71% of adolescent girls who started the series completed it, according to the report. Adolescent girls in households below the poverty level were more likely to begin the 3-dose regimen than those in households at or above the poverty level, but less likely to finish it. Information systems that remind physicians and patients about missing shots could improve the completion rate, the CDC said.

Morb Mortal Wkly Rep. 2012;61:661-686. Full text

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