Physicians Blamed for Low HPV Vaccination Rates

Laird Harrison

July 30, 2015

Physicians must take responsibility for improving the rate of human papillomavirus (HPV) vaccinations among teenagers, according to Anne Schuchat, MD, assistant surgeon general and director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.

Overall, US teenagers had more vaccinations in 2014 than in previous years, including against HPV, said Dr Schuchat, when discussing the results of a new survey in a press conference held July 30. But most parts of the country are still lagging, primarily because physicians are not doing enough, she said.

"We think the principle road block is providers not recommending the vaccine," she said.

Researchers from the Centers for Disease Control and Prevention published the findings from a survey of 20,827 teenagers in the July 31 issue of the Morbidity and Mortality Weekly Report.

General trends in the annual National Immunization Survey–Teen are positive. An uptick in HPV vaccination started in 2012 after years in which HPV vaccination rates appeared to be stagnating, Dr Schuchat said.

There are some particular bright spots. For example, the proportion of teenage boys who had gotten at least the first of the three recommended doses of HPV vaccine increased from 33.6% in 2013 to 41.7% in 2014.

However, the proportion among boys is still far below the 60.0% rate of first-dose HPV vaccination seen for girls in 2014.

Moreover, girls are lagging in their HPV vaccinations when compared with vaccination rates for tetanus-diphtheria-acellular pertussis (Tdap) and for meningococcal conjugate (MenACWY). Among boys and girls combined, 87.6% had gotten at least one dose of Tdap and 79.3% got at least one dose of MenACWY in 2014.

This suggests that parents and clinicians are not taking HPV vaccination as seriously as the other vaccinations recommended for teenagers, Dr Schuchat noted.

"Our research shows that a recommendation from a healthcare provider is crucial to parents getting an HPV vaccination for their child," she said. "And the way to give an effective vaccination is to recommend an HPV vaccination in the same way and on the same day that you recommend other routinely recommend teenage vaccines."

Although the rate of HPV vaccination increased among children older than 13 years, it did not increase among younger adolescents, leading Dr Schuchat and colleagues to conclude that physicians and parents are delaying HPV vaccination until children get older.

"I want to stress to clinicians and parents that 11- to 12-year-olds are recommended to get the HPV vaccine," she said. "That's not too early."

Table. Estimated Vaccination Coverage

Vaccine 2013, n = 18,948 2014, n = 20,827
Tdap ≥ 1 dose 84.7 87.6
MenACWY ≥ 1 dose 76.6 79.3
HPV ≥ 1 dose, girls 56.7 60.0
HPV ≥ 1 dose, boys 33.6 41.7

The annual National Immunization Survey–Teen survey included both telephone interviews and efforts to verify vaccinations by contacting healthcare providers.

The findings reveal a handful of other reasons for optimism. In contrast to other vaccinations, the rate of HPV vaccination among teenagers living in poverty is higher than among wealthier teenagers, the results showed.

"There may be differences in provider behavior where many kids are low income," Dr Schuchat said. "There may be better practices in those areas."

She also pointed out that HPV is more expensive than other vaccinations, and government subsidies are available to cover the cost for low-income children.

However, research shows that the expense of HPV does not explain the difference in coverage for HPV compared with other teenage vaccinations in the population as a whole, she noted.

The researchers point out that successful initiatives in cities and states scattered around the country suggest that the right approach can yield results.

In particular, Dr Schuchat highlighted improvements in vaccination rates in Illinois, Montana, North Carolina, and Utah among states, and in Chicago, Illinois, and Washington, DC, among cities.

The experience of these communities suggests a combination of strategies is needed, including:

  • coordination of cancer prevention and immunization initiatives,

  • clinician-to-clinician education sessions,

  • education of staff within healthcare practices practice,

  • public media campaigns, and

  • use of registries or information systems to send reminders to patients.

"Instead of just patchwork progress, we have the chance to blanket the country with protection from HPV-associated cancers," Dr Schuchat concluded.

Dr Schuchat has disclosed no relevant financial relationships.

Morb Mortal Wkly Rep, 2015;64:784-790. Full text


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