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HPV vaccine: Used widely in United States, not always strongly recommended

Daley MF. Pediatrics. 2010;doi:10.1542/peds.2009-3500.

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Within 18 months of licensure, administration of the human papillomavirus vaccine began in nearly all family physician and pediatrician offices in the United States, according to survey results. However, only about half of those administering the vaccine strongly recommended it for patients aged 11 to 12 years.

Physicians from the AAP (n=429) and the AAFP (n=419) were surveyed between January and March 2008 to determine current HPV vaccination practices. Physicians were surveyed about their attitudes toward vaccination and any observed obstacles; those who reported administering the vaccine were asked about vaccination practices and experiences with vaccine refusal. Eighty-one percent of pediatricians and 79% of family physicians responded.

According to the results, 98% of pediatricians and 88% of family physicians were administering the vaccine in their offices (P<.001). Fifty-seven percent of pediatricians and 50% of family physicians strongly recommended the vaccine to 11- and 12-year-olds.

The rate of recommendation was higher for patients aged 13 to 15 years (90% of pediatricians and 86% of family physicians). Reasons for not strongly recommending the vaccine to younger patients included the need to discuss sexuality with patients before recommendation (RR=1.27; 95% CI, 1.07-1.51), the time needed to discuss vaccination with parents (RR=1.30; 95% CI, 1.04-1.58) and parental refusals (RR=2.09; 95% CI, 1.66-2.81).

Financial barriers to vaccination were also noted, including a lack of coverage by some insurance companies, inadequate reimbursement and out-of-pocket purchasing costs for practices.

“Although widespread availability of HPV vaccine in primary care offices should facilitate immunization delivery to targeted patient populations, these data suggest that HPV vaccination often may not be started until after 12 years of age,” the researchers wrote.

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