HPV vaccination safe, effective for mid-adult patients at risk for future infection
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Including mid-adults in HPV vaccination efforts is safe and effective, while remaining cost effective, according to a narrative review of existing data.
“The 9-valent vaccine (9vHPV) against human papillomavirus (HPV) has been FDA-approved for use in mid-adults aged 27 to 45 years since 2018,” Laura M. King, MPH, clinical instructor in the University of California’s School of Public Health division of epidemiology, told Healio.
“The U.S. Advisory Committee on Immunization Practices recommends HPV vaccination in mid-adults based on shared clinical decision-making (SCDM) — a process by which clinicians and patients together decide on a clinical course of action based on the risks and benefits of a treatment or preventative measure and patient preferences,” she said.
However, King explained that SCDM for vaccination against HPV in mid-adults may be difficult to operationalize and clinicians may face challenges in identifying which mid-adult patients could benefit from HPV vaccination — or, she added, even which factors may be important in considering whether HPV vaccination could benefit an individual patient.
“Although five models have estimated the population-level impacts and cost-effectiveness of mid-adult HPV vaccination, translating the disparate findings from these models to individual-level considerations for patients may be challenging,” King said.
To better describe the available evidence and considerations in SCDM for HPV vaccination in mid-adults, King and colleagues performed a narrative review to determine safety and efficacy, describe clinical rationale for mid-adult vaccination, summarize public health impacts, review cost effectiveness and assess patient and clinician knowledge.
Overall, existing studies used for the review demonstrated that HPV vaccination is safe and effective in mid-adults and may provide greater protection than naturally acquired immunity against future infection by 9vHPV types.
Modeling studies assessed in the review also estimated that universal mid-adult vaccination could prevent anywhere from 20,934 to 37,856 HPV-associated cancer cases, 102,691 to 1,743,461 anogenital warts cases and 421 to 8,688 cases of recurrent respiratory papillomatosis over 100 years, while costing approximately $141,000 to $1,471,000 per quality-adjusted life-year gained — demonstrating cost effectiveness.
Despite this positive data, King said the review revealed gaps in knowledge related to HPV vaccination among clinicians and mid-adult patients.
According to the review, studies of patient knowledge and attitudes have shown that many mid-adult patients were unaware of their eligibility for HPV vaccination. However, once they were made aware of their eligibility for vaccination, many indicated interest in learning more.
Likewise, surveys of clinicians showed that many are aware that SCDM for HPV vaccination was recommended in mid-adults. However, more than half were unsure of what to focus on or emphasize in SCMD. They were also more likely to recommend HPV vaccination to female patients than to male patients (26% vs. 17%), despite a noted increase in HPV-associated cancers in men, according to the study.
“HPV vaccination is safe and efficacious and may benefit mid-adult patients at risk of future HPV acquisition,” King said. “Shared clinical decision-making for HPV vaccination should be considered for a wide range of mid-adult patients.”
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