HPV Vaccination Rates Low Among Adolescent Males

Troy Brown, RN

October 26, 2015

Human papillomavirus (HPV) vaccination in adolescent males has increased since it was recommended in 2011, but only 13.9% of adolescent males have completed the three-dose series, according to a new study.

Peng-jun Lu, MD, PhD, from the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues published their findings online October 26 in Pediatrics.

HPV is the most common sexually transmitted infection in the United States, with more than half of sexually active men and women becoming infected during their lifetime. Most infections will cause no symptoms, but continued infection can cause disease or cancer, the authors write. Men who have sex with men are particularly at risk for HPV infection.

"HPV-related cancers in males include many anal, penile, and oropharyngeal cancers. HPV-associated oropharyngeal and anal cancers have increased among males," the authors write.

HPV4, a quadrivalent HPV vaccine, is recommended for routine use among males aged 11 or 12 years and for males aged 13 to 21 years who have received no previous HPV vaccination or who have not completed the three-dose series.

The researchers analyzed data from the 2013 National Immunization Survey-Teen, a national, random-digit-dial telephone survey the Centers for Disease Control and Prevention sponsors to evaluate factors associated with vaccination. The survey collects data from families and providers.

The researchers identified 9554 male adolescents aged 13 to 17 years whose provider data were sufficiently detailed.

HPV vaccination coverage increased significantly among male adolescents from 2010 to 2013 overall (test for trend, P < .05).

HPV immunization coverage with at least one dose was 34.6% overall; receipt of at least one dose was significantly higher among non-Hispanic black males (42.2%) and Hispanic males (49.6%) compared with non-Hispanic whites (29.7%; P < .05).

HPV vaccination coverage with at least three doses was 13.9% overall, and was significantly higher among non-Hispanic black males (15.7%) and Hispanic males (20.3%) compared with among non-Hispanic whites (11.1%; P < .05).

The researchers adjusted for potential confounders including mother's marital status, immigration status, insurance status, Vaccines for Children eligibility, number of physician contacts in the previous 12 months, whether or not the male had a well-child visit at age 11 to 12 years, number of vaccination providers, and metropolitan statistical area.

After adjustment for these characteristics, factors associated with an increased likelihood of receiving at least one HPV vaccine included non-Hispanic black race or Hispanic ethnicity; having a mother who was widowed, divorced, or separated; having one to three physician visits in the previous 12 months; attending a well-child visit at age 11 to 12 years; having one or two vaccination providers; urban or suburban residence; and getting vaccinations from a mix of facility types (P < .05).

In contrast, characteristics associated with a decreased likelihood of receiving at least one HPV vaccine included having a mother with at least some college education, higher socioeconomic status, living in the South or Midwest, and receiving all vaccinations at sexually transmitted disease/school/teenager clinics or other facilities (P < .05).

Among boys who have received no HPV vaccination, the most common reason parents gave for not vaccinating their sons was that the parent believed their provider did not recommend it (24.0%).

Other reasons were a belief that the vaccine was not needed or was not necessary (18.9%), lack of knowledge (16.4%), that the boy was not sexually active (8.1%), and concern about safety or adverse effects (7.3%).

"These stated reasons for not receiving HPV vaccine indicate that parents may have limited knowledge regarding HPV vaccine and [Advisory Committee on Immunization Practices] recommendations," the authors write.

The authors have disclosed no relevant financial relationships.

Pediatrics. 2015;136:839-849.

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