HPV and Other Vaccinations Lagging in Teens

Troy Brown

March 18, 2013

Many teens are still not getting the recommended vaccines, and fewer parents plan to give their adolescent daughters the human papillomavirus (HPV) vaccine because of concerns about its safety, despite increased clinician recommendations, according to an analysis of data from the 2008–2010 National Immunization Survey of Teens.

Paul M. Darden, MD, professor and section chief and CMRI James Paul Linn Endowed Chair in the Department of Pediatrics, College of Medicine at the University of Oklahoma Health Sciences Center, Oklahoma City, and colleagues published their findings online March 18 in Pediatrics.

The researchers examined the reasons parents give for not vaccinating with the HPV vaccine; the tetanus toxoid, diphtheria toxoid, and acellular pertussis (Tdap)/tetanus toxoid and reduced diphtheria toxoid (Td) vaccine; and the quadrivalent meningococcal conjugate (MCV4) vaccine.

The percentage of teens who were not up to date for Tdap/Td remained stable (odds ratio, 0.96; 95% confidence interval [CI], 0.92 - 1.0), and the percentage not up to date for MCV4 decreased from 68.8% in 2008 to 62.6% in 2010 (OR, 0.87; 95% CI, 0.84 - 0.90). The percentage of females who were not up to date for HPV decreased each year (OR, 0.77; 95% CI, 0.74 - 0.81), from 83.8% in 2008 to 75.2% in 2010.

Clinician recommendations increased for each of the 3 vaccines and were highest for HPV (in female teens), increasing from 46.8% (95% CI, 45.3% - 48.3%) in 2008 to 52.4% (95% CI, 51.0% - 53.8%) in 2010 (OR, 1.12; 95% CI, 1.07 - 1.17).

The percentages of parents not planning to vaccinate female teens with HPV increased from 39.8% (95% CI, 38.4% - 41.3%) in 2008 to 41.1% (95% CI, 39.8% - 42.4%) in 2009 and 43.9% (95% CI, 42.5% - 45.3%) in 2010 (OR, 1.08; 95% CI, 1.04 - 1.13).

The 4 primary reasons parents gave for not immunizing with MCV4 and Tdap/Td were the same for both vaccines: (1) not recommended, (2) not needed or not necessary, (3) lack of knowledge, and (4) don't know.

Parents gave those same reasons for not immunizing with HPV, along with "not sexually active," "not appropriate age," "safety concern/side effect," and multiple other reasons.

The percentage of parents with no plans to vaccinate with HPV because of "safety concerns/side effects" nearly quadrupled between 2008 and 2010 (4.5% in 2008, 7.7% in 2009, and 16.4% in 2010).

Clinician recommendation for HPV in female teens who were not up to date was higher for the HPV vaccine than for other vaccines: 40.0% (95% CI, 38.3% - 41.7%) in 2008, 44.6% (95% CI, 43.1% - 46.2%) in 2009, and 43.7% (95% CI, 42.0% - 45.3%) in 2010.

Yvonne Maldonado, MD, a professor of pediatrics and chief of infectious diseases at Stanford University School of Medicine, California, commented on the study in a telephone interview with Medscape Medical News. Dr. Maldonado is a member of the American Academy of Pediatrics Committee on Infectious Diseases. "[Clinicians] need to understand that families are not taking advantage of [the HPV] vaccine and it really seems to be a differential between this vaccine and other vaccines that are offered in the same age group," Dr. Maldonado explained. "Physicians and providers need to really focus on…spending time with families [and explaining] why this is an important vaccine," Dr. Maldonado added.

The study was supported by the US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program. Dr. Darden has consulted and served on an advisory board to Pfizer Inc in the past 3 years. One author has served in the past 3 years as a principal investigator for 2 multicenter vaccine studies funded by Pfizer and 1 funded by Novartis, all conducted at Mayo Clinic. He currently is a member of a safety review committee for 1 vaccine study and a member of a data and safety monitoring board for 2 other vaccine studies, all funded by Merck. The other authors and Dr. Maldonado have disclosed no relevant financial relationships.

Pediatrics. Published online March 18, 2013.

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