NFID: Recommend HPV vaccine strongly with other routine vaccines

Issue: February 2015

To increase HPV vaccine uptake, the National Foundation for Infectious Diseases recommends physicians make stronger recommendations to parents and include HPV vaccine in all other routine vaccine conversations.

In 2013, 57% of girls aged 13 to 17 years received one dose of HPV vaccine, and 37.6% received the full three-dose series, according to data published in MMWR. Although HPV vaccine uptake increased among adolescent males in 2013, only 34.5% received one dose of HPV vaccine and 13.9% received the full three-dose series.

“This is a public health problem,” Joseph A. Bocchini Jr., MD, an Infectious Diseases in Children Editorial Board member, said during an NFID webcast. “We have a safe, effective vaccine that can prevent the majority of cancers associated with HPV, and we are allowing children to get through our practices unimmunized.”

Joseph A. Bocchini. Jr.

More than 95% of study participants who received HPV vaccine in clinical trials had significant immune responses and evidence of protection against various pre-cancer endpoints caused by HPV types 16 and 18 and genital warts caused by HPV types 6 and 11, according to Bocchini, chairman of the department of pediatrics at Louisiana State University Health Sciences Center.

“Post-licensure studies show the same degree of effectiveness and a very large impact of vaccination on the prevalence and incidence of genital warts,” he said.

Currently, no state is close to achieving the national Healthy People 2020 goal to immunize 80% of teens against HPV, Bocchini said.

This is partly due to challenges physicians face when discussing HPV vaccination with patients and their parents.

One hurdle to HPV vaccine uptake is the varying quality of vaccine recommendations, according to Noel T. Brewer, PhD, an associate professor at the University of North Carolina, who also spoke during the webcast.

Noel T. Brewer

Data show that some pediatricians and family physicians are not recommending HPV vaccine in a timely matter, ie, giving recommendations after ages 11 and 12 years or not recommending HPV vaccine at all, or not strongly endorsing the HPV vaccine within their recommendations, according to Brewer.

“Your HPV vaccine recommendation is uniquely influential,” Brewer said, addressing physicians. “You have the ability to change this health behavior quickly in your own practice.”

As a result of the commonness of HPV infection and its link to a range of cancers, the NFID recommends the following steps to physicians to increase HPV vaccine uptake:

recommend HPV vaccine with the same strength and conviction used to recommend other adolescent vaccines
be knowledgeable about HPV and HPV vaccines
inform colleagues and staff so the entire practice is delivering the same HPV messages
communicate vaccination benefits to parents and adolescents at every opportunity
make vaccination procedures routine and focus on ways to reduce missed opportunities

The NFID also recommends administering HPV vaccine to patients aged 11 or 12 years.

“Modeling shows we will have a greater impact if this vaccine is given universally before the onset of sexual activity. We really want to give this vaccine before anybody is at risk for acquiring HPV,” Bocchini said. “Antibody response to HPV vaccines is much greater in 11- to 15-year-olds than it is in 16- to 26-year-olds, and antibody persists, as indicated by more than 8 years of data in ongoing studies. The vaccine is well tolerated in this age group. Additionally, we have an implementation advantage in that the 11- to 12-year-old visit is designed as an immunization visit. This makes it very easy to include HPV amongst the other vaccines given at this age.”

For more information:

Visit http://www.nfid.org/homepage/additional-offerings/hpv-call-to-action.pdf.

Disclosure: Bocchini reports no relevant financial disclosures. Brewer reports financial ties with Merck, GlaxoSmithKline and Pfizer.