Two HPV Vaccine Doses Advised for Children Under Age 15

Diana Swift

October 20, 2016

Children and adolescents aged 15 years and younger need just two, not three, doses of the human papilloma virus (HPV) vaccine, according to an updated recommendation from the Advisory Committee on Immunization Practices (ACIP).

ACIP, an expert panel that advises the Centers for Disease Control and Prevention (CDC), voted Wednesday on the reduction in doses, which is recommended because of the vaccine's enhanced immunogenicity in preteens and adolescents aged 9 to 14 years.

"The antibody response is stronger in the younger children, which is something we've known for a long time," said Melinda Wharton, MD, MPH, director of the CDC's Immunization Services Division in Atlanta, in an interview with Medscape Medical News. "In comparing antibody levels, the efficacy trials showed the response in younger children following two doses is as good as or better than after three doses in older teens and young adults."

In addition to dropping the third dose for the under-15 age group, the recommendation expands the time interval from the first to the second dose from 1-2 months to 6-12 months. "This makes it convenient to give the second dose at the annual physician visit," Dr Wharton said. "Getting two doses instead of three should keep things much simpler for families."

CDC Director Tom Frieden, MD, MPH, approved the committee's recommendations, which will be published as guidelines in Morbidity and Mortality Weekly Report (MMWR).

The schedule for older adolescents and young adults aged 15 to 26 remains the same, at three inoculations within 6 months.

Earlier this month, the US Food and Drug Administration approved adding a two-dose schedule for the 9-valent HPV vaccine (Gardasil 9, Merck) for children and adolescents aged 9 to 14 years.

To increase uptake in 11- and 12-year-olds, which are the recommended ages for starting vaccination, Dr Wharton advised healthcare providers to present the HPV vaccine to parents as just one of the vaccines that are routinely recommended for this age group, such as those for meningitis and whooping cough.

"There is evidence that providers who treat it as just a normal vaccine have better acceptance rates with parents than providers, who, for whatever reason, feel they need to get into a big conversation," she said. Some parents view the vaccine as potentially promoting precocious sexual activity.

Another point providers should make is that the vaccine prevents HPV-related cancers. "Cancer prevention is something that resonates strongly with parents," Dr Wharton said.

In 2015, about 63% of US girls and about 50% of boys had received at least one HPV shot, according to data from the CDC's National Immunization Survey–Teen.

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