Recommending HPV Vaccine Successfully

Anne Schuchat, MD (RADM, USPHS)


September 03, 2013

Editorial Collaboration

Medscape &

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

The CDC has had both encouraging and disappointing study results to share about human papillomavirus (HPV) vaccine this year. One report[1] showed how well the vaccine is working, whereas the second[2] showed how poorly we are doing at immunizing teenagers.

In June, we reported that since the HPV vaccine was introduced in 2006, vaccine-type HPV prevalence has declined 56% among female teenagers 14-19 years of age.[1] In July, we reported that HPV vaccination coverage did not increase at all from 2011 to 2012 in 13- to 17-year-old girls.[2] Only one half of teen girls in the United States have received the first dose of this anticancer vaccine, and only one third have received the full protection provided by all 3 doses.[2] However, our National Immunization Survey also showed that if HPV vaccine were given every time a preteen received another vaccine, the coverage rate for 1 dose of HPV vaccine would be more than 90%.[3] The HPV vaccine is effective, and teenagers are in our offices, but we are missing opportunities to vaccinate (Figure 1).

Figure 1. Actual vs missed opportunities to vaccinate teenage girls against HPV.

Why are we missing opportunities to vaccinate teens against HPV? In the same survey that measured the HPV vaccine coverage, we ask parents why they didn't plan to vaccinate their child. Many parents said their doctor had not recommended the vaccine to them. This is critical. Research consistently shows that a provider's recommendation to vaccinate is the single most influential factor in determining whether a parent gets their child vaccinated. Doctors and nurses need to step up our efforts by talking to parents about the importance of this vaccine. I know this can be done.

Our research suggests that there are some approaches that work. The way that you make the recommendation matters. One of the best ways to reach parents is to recommend HPV vaccine in the same way you recommend any other vaccine. Try saying, "Today your child needs 3 vaccines. These vaccines prevent HPV cancers, meningitis, diphtheria, tetanus and whooping cough." Many parents will accept this confident recommendation without question.

However, some parents may have questions. Don't assume that a conversation about HPV vaccine represents vaccine hesitancy. Parents of preteens and teenagers may be interested in having their child vaccinated against HPV, but before saying yes, they may need your reassurance that you feel strongly that their child should get this vaccine. One message that parents find the most reassuring is when you share that you have protected your own children, grandchildren, or other close family members from HPV cancers by making sure that they are vaccinated.

Some parents may ask what diseases are caused by HPV infection. CDC research has shown that parents want straightforward information and the facts about the cancers caused by HPV. Tell them that persistent HPV infection can cause vaginal, vulvar, and cervical cancers in women and penile cancers in men. Both men and women can get anal cancer and cancer of the mouth and throat caused by HPV. With the exception of cervical cancer, no screening programs exist for these cancers, and by the time they are caught, they are often advanced and devastating.

Some parents will tell you that their child doesn't need the vaccine because they aren't yet sexually active. Help these parents understand that HPV vaccine should be given long before their child is exposed to the virus. Explain that we want 11- and 12-year-old girls and boys to get all 3 doses of HPV vaccine and have time to build an immune response well in advance of the onset of sexual activity.

Parents may also be concerned that this vaccine will give their child permission or license to have sex. Multiple studies have shown that preteens and teens who receive this vaccine do not have sex any sooner than their peers who have not received the vaccine.[3,4] Parents need to hear that from you. We know that sexuality is a sensitive and uncomfortable topic for many families, especially with their son or daughter present. You may want to tell parents that HPV vaccine doesn't open the door to sex; it closes the door on cancer. Parents want to hear from you that HPV vaccine is about cancer prevention. Let me say that again: the HPV vaccine prevents cancer.

There is one other topic that parents frequently raise about all vaccines, including HPV: vaccine safety. Multiple studies and ongoing monitoring systems continually reaffirm that the HPV vaccine is safe. Since 2006, about 57 million doses of HPV vaccine have been distributed in the United States, and in the 7 years of HPV vaccine safety studies and monitoring that we have been conducting, no serious safety concerns have been identified.[2]

It is important to share with parents that preteens and teens may faint after getting a vaccine. That happens with many vaccines given to teenagers and may have nothing to do with the actual vaccine. We strongly recommend that the teen be observed sitting down for 15 minutes after an injection is given.

For additional resources, visit the links at the end of this page. A new resource has been designed to help you have clear, confident HPV vaccine conversations, Tips and Timesavers for Talking With Parents About HPV Vaccine. The messages on this tip sheet address parents' key questions and have phrases that parents have found helpful.

Web Resources

CDC: Preteen and Teens Still Need Vaccines

CDC: Tips and Timesavers for Talking With Parents About HPV Vaccine

Dr. Anne Schuchat (pronounced "shook-it") joined the 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 coauthored 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.