Caroline Helwick

November 18, 2014

NEW ORLEANS — Legislation that encourages vaccination against the human papillomavirus (HPV) does not result in greater uptake of the vaccine, researchers report after examining vaccine rates in states with and without such laws.

"Legislative status was not a strong indicator of initiation of HPV vaccination. After controlling for multiple factors, HPV vaccine initiation does not differ based on the expected political climate in a respondent's state," said Darius Taylor, MPH, from the School of Public Health at the University of North Texas Health Science Center in Fort Worth.

The study also revealed the influence of the primary care physician (PCP). "In our bivariate and stratified analyses, we noticed that when the PCP recommended vaccination, there was a higher chance of initiation, whether for females or males, but we also saw a large disparity by gender, with males much less likely to receive this recommendation," Taylor told Medscape Medical News.

HPV, which places people at risk for a variety of cancers, is the most common sexually transmitted infection around the world, with a global prevalence of about 11%, and 80 million cases in the United States. People 15 to 24 years of age are most at risk, and constitute about half of all new cases.

In March 2007, the Advisory Committee on Immunization Practices (ACIP) recommended that females 9 to 26 years of age receive the HPV vaccine. In 2009, that recommendation was expanded to include males.

New Laws

Since then, more than 25 states have introduced legislation to encourage HPV vaccination in adolescents. Such legislation takes many forms, ranging from education that encourages vaccination, insurance coverage requirements, and access to vaccines through state funding.

"Our hypothesis was that the political climate, measured by the status of HPV vaccine legislation, encourages higher vaccine initiation," Taylor said here at the American Public Health Association 142nd Annual Meeting.

Researchers used 2010 to 2012 data from the National Immunization Survey to analyze the initiation of HPV vaccination in adolescent boys and girls after the ACIP recommendations, and after many states passed endorsements. Using this annual survey — a household telephone interview — the researchers determined the prevalence of vaccine initiation, vaccine completion and intention patterns, and the influence of family physicians.

More than half the respondents lived in states that produced legislation before 2012; 50.8% of those bills were passed, 21.3% were active, and 17.9% were passive. Nearly 10% of the respondents lived in states with no legislation.

Among residents of states with no legislation, 45.3% of females and 9.4% of males were vaccinated. States that had passed legislation had similar vaccination initiation rates — 45.2% and 10.1%, respectively. The figures were similar for respondents in states with active and passive legislation, Taylor reported.

For parents who visited their family doctor in the previous month, the physician recommended immunization for approximately 60% of females and 17% of males. This indicates that despite the fact that males are at risk for HPV-related cancers, the risk is being ignored, the researchers report.

Those with sons were 82% less likely to have HPV vaccines recommended than parents of daughters.

"For parents reporting a visit to a PCP in the previous month, those with sons were 82% less likely to have HPV vaccines recommended than parents of daughters," Taylor said.

It is concerning that young males are being ignored, said senior researcher Sherrie Wallington, PhD, from the Georgetown University Medical Center in Washington, DC. "Education needs to go beyond concerns about cervical cancer because we know there is a strong link between HPV infection and oral, anal, and penile cancers."

Dr. Wallington said that the Centers for Disease Control and Prevention has begun "moving toward generating a gender-neutral message."

Future legislation efforts should encourage PCP recommendation of the HPV vaccine to parents of all adolescents, the researchers suggest.

Paula Amezola, MPH, from the University of Southern California at Los Angeles, said that her own experience mirrors these findings. In an interview with Medscape Medical News, she said she has an adolescent son whose PCP never mentioned the vaccine until she asked about it. He responded, "Yes, I recommend it," but, she noted, "he had to be asked."

Amezola suggested that school-wide vaccinations might be an answer.

"Panama has very high rates of HPV vaccination — around 90% I believe — because they have school-based vaccination and it is free. Contrast that with Los Angeles, where I live; our rate is 29%," she said. "The most important thing is that our country needs a systematic way of disseminating information, and we need it on all fronts — legislation, public health, the healthcare system, schools — sending the same message: 'You need to vaccinate. It will help your child'."

Mr Taylor, Dr. Wallington, and Ms Amezola have disclosed no relevant financial relationships.

American Public Health Association (APHA) 142nd Annual Meeting: Abstract 2012. Presented November 17, 2014.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.