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HPV vaccination rates rising, but lag behind other routine vaccines

CDC. MMWR. 2011;60(33):1117-1123.

Increases in vaccination rates for human papillomavirus are trailing increases in rates compared with two other vaccines recommended for adolescents, according to data from the CDC.

Coverage rates with the meningococcal vaccine and tetanus-diphtheria-acellular pertussis vaccines are climbing, but vaccination rates for HPV vaccine remain low, according to data from the 2010 National Immunization Survey: Teen.

“More US teens are being protected against these serious, and sometimes deadly, diseases,” Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a press release. “However, the HPV results are very concerning. Our progress is stagnating, and if we don’t make major changes, far too many girls in this generation will remain vulnerable to cervical cancer later in life. Now that we have the tools to prevent most cervical cancers, it is critical that we use them.”

The Advisory Committee on Immunization Practices recommends HPV vaccine for 11- or 12-year-old girls to protect against the types of HPV that cause cervical cancer and also recommends teenage girls who have not yet been vaccinated with HPV vaccine complete the vaccination series. HPV vaccines are given in three doses during a 6-month period. To ensure optimal protection, girls must complete all three vaccinations.

However, the survey found coverage for one or more doses of HPV vaccine was only 49%. For girls who received the recommended three doses of HPV vaccine, coverage increased to 32% compared with 27% in the previous year. Those rates were less in blacks and Hispanics compared with whites, however.

Coverage increases for HPV were about four percentage points less than half of the increases seen for Tdap (13.3 points) and meningitis (9 points).

The CDC data also revealed that coverage for the three adolescent vaccines was significantly lower among adolescents living in the southeastern United States compared with adolescents living in other regions.

Schuchat said any visit to the doctor — such as annual health checkup or physicals for sports, camp or college — can be a good time for preteens and teens to get the recommended vaccinations. By making sure all recommended vaccines are given at every opportunity, coverage for all the teen vaccines could increase substantially.

Disclosure: The researchers report no relevant financial disclosures.

More than half of sexually active adolescents acquire an HPV infection within 3 years of the onset of sexual activity, and the vast majority of adults have serologic evidence of a past infection. Every young woman who becomes sexually active during adolescence or adulthood is at risk, and persistent infection with an oncogenic HPV type increases a woman's likelihood of developing cervical cancer. Two vaccines are available that are highly efficacious in preventing persistent infection with the two most common oncogenic HPV types, thereby significantly lowering this risk. As described in this report, the rate of vaccination against HPV continues to increase, but uptake appears to be plateauing, and most adolescent females remain at risk. In contrast, vaccination rates for the meningococcal conjugate vaccine are higher and appear to be increasing steadily, even in populations not considered high risk for meningococcal infection - a devastating, but relatively rare disease.

Providers of pediatric and adolescent health care must intensify our efforts to protect our patients from vaccine-preventable HPV infection and its potentially fatal effects. We must educate ourselves, be prepared to answer questions, and give the vaccine our full and unambiguous endorsement. Adolescents often fail to seek routine preventive health care, and are more likely to present for sports physicals, work physicalsand acute health care needs. Completion of a three-dose vaccine series presents a particular challenge. HPV vaccination status must therefore be assessed at every adolescent encounter, including those for acute injuries or illnesses, exceedingly few of which would present contraindications to vaccination. Since one-third of high school freshmen and two-thirds of high school seniors have engaged in vaginal intercourse (and far more have engaged in sexual contact sufficient for transmission of HPV), we place our patients at risk by delaying initiation of the HPV vaccine series.

Cynthia Holland-Hall, MD, MPH
The Ohio State University College of Medicine Nationwide Children's Hospital
Columbus, Ohio

Disclosure: Dr. Holland-Hall reports no relevant financial disclosures.

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