CDC: HPV vaccination rates unsatisfactory among teens

Issue: August 2014

HPV vaccination coverage is unacceptably low among adolescents, despite a slight increase in coverage since 2012, according to data presented in a telebriefing today.

Laurie D. Elam-Evans, PhD, of the immunization services division at the CDC’s National Center for Immunization and Respiratory Diseases, and colleagues analyzed data from the 2013 National Immunization Survey-Teen to determine vaccination coverage among adolescents in the United States. National estimates for 2013 were based on responses from 18,264 adolescents aged 13 to 17 years.

Analysis indicated vaccination coverage increased from 84.6% to 86% for at least one dose of Tdap; from 74% to 77.8% for at least one dose of MenACWY; from 53.8% to 57.3% for at least one dose of HPV among females; and from 20.8% to 34.6% for at least one dose of HPV among males. No statistically significant differences were observed in coverage for at least two doses of measles-mumps-rubella vaccine or at least three doses of hepatitis B vaccine. Coverage for at least two doses of varicella vaccine increased from 74.9% to 78.5% among adolescents with no history of disease.

Older adolescent females, aged 15 to 17 years, had higher HPV vaccination rates compared with younger adolescent females. HPV coverage did not differ by age among males. Most vaccination rates were similar between sexes, although females had greater vaccination coverage than males for all three doses of HPV and three-dose HPV series completion.

Shannon Stokley, MPH, also of the immunization services division at the NCIRD, and colleagues evaluated HPV vaccination coverage among adolescents from 2007 to 2013 using data from the 2013 National Immunization Survey-Teen.

Data was analyzed by birth cohort to determine receipt of at least one dose of HPV by age 13 years among females. Receipt of at least one dose of HPV by age 13 years increased an average of 5.9% (95% CI, 2.8-9) with each new birth cohort, reaching 46.8% (95% CI, 41.2-52.5) for the 2000 birth cohort.

Missed opportunities to receive HPV vaccine also were evaluated. A missed opportunity was defined as a health care encounter occurring on or after the 11th birthday and before the 13th birthday in which the adolescent received at least one vaccine but not the HPV vaccine. The number of unvaccinated females at age 13 years with at least one missed opportunity ranged from 9.3% among the 1994 birth cohort to 83.7% among the 2000 cohort. Researchers predicted vaccination coverage for at least one dose of HPV could have reached 91.3% (95% CI, 87.9-93.8) if missed opportunities among the 2000 cohort were eliminated.

“The high coverage rate of Tdap vaccine shows us that it is certainly possible to reach our goal of vaccinating 80% of adolescents against cancers caused by HPV. … Pediatricians and family physicians are uniquely situated to prevent missed opportunities by giving HPV vaccine during the same visit they give Tdap and meningococcal vaccines,” Anne Schuchat, MD, assistant surgeon general and director of the NCIRD, said in a press release.

Anne Schuchat

The number of parents who reported receiving a recommendation for the HPV vaccine from their clinician significantly increased from 2012 to 2013 for parents of male and female adolescents. Parents of vaccinated adolescents were more likely to receive a recommendation compared with parents of unvaccinated adolescents.

One of the top five reasons parents did not vaccinate their child was because it had not been recommended to them by their child’s doctor. More than 30% of parents said lack of knowledge or belief that the vaccine was not needed was their main reason was for not vaccinating their child.

Safety concerns also were a reason for not having a child vaccinated against HPV. Of the estimated 67 million doses of HPV4 distributed from June 2006 to March 2014, the Vaccine Adverse Event Reporting System (VAERS) received 25,176 adverse event reports for HPV vaccination. No new safety concerns have arisen since the post-licensure reporting to VAERS was published in 2009.

“Our system is clearly missing many opportunities to vaccinate against HPV-related cancers. We are urging clinicians to strongly recommend HPV vaccine the same way and the same day they recommend and administer meningococcal conjugate and Tdap vaccines. The data show a recommendation from a HCP is strongly associated with teens getting vaccinated,” Schuchat said during a telebriefing.

For more information:

Elam-Evans LD. MMWR 2014;63:625-633.

Stokley S. MMWR. 2014;63:620-624.

Disclosure: The researchers report no relevant financial disclosures.