Only 16% of teens complete HPV vaccine series by age 13 years

Amy Middleman, MD, MSEd, MPH

The article by Bednarczyk confirms what many of us have suspected for some time: despite recommendations that the HPV vaccine be given at the 11- to 12-year clinical visit, it is often being delayed. The delay in vaccination is likely related to a misguided focus — by both parents and providers — on the mode of transmission of the target disease rather than the fact that the vaccine prevents a disease that kills thousands of people annually in the U.S. alone. The CDC takes great care in making vaccine recommendations. The epidemiology of each vaccine-preventable disease is always considered in their deliberations regarding the ideal age for vaccination. As Bednarczyk points out in his article, although first sexual intercourse may occur after the age of 13 years, vaginal intercourse is not required for HPV transmission; youth may be at risk for exposure during the years of sexual experimentation that precede first sexual intercourse. In addition, we have seen the advantages of immunizing children with multiple vaccines at specific immunization platform visits; the likelihood of vaccine adherence increases when multiple vaccines are expected and given at the same visit. The immune response is more vigorous among younger patients, and those who initiate the series under 15 years of age (who are not immunocompromised) need only two doses for protection. All of these issues are carefully researched and considered by the ACIP while developing and updating vaccine recommendations. All available data — both published and unpublished — are included in their analyses. 

Additionally concerning is that some vaccine recommendations for adolescents seem to be viewed as less important and more “optional” than vaccine recommendations for younger children. In a way, that is not an issue with many vaccines against childhood diseases. Parents, providers and patients are unlikely to see the potential consequences of delayed HPV vaccination until years later if HPV-related cancers develop. Then, it will be too late to change the decision to delay vaccination. I would urge parents, providers and patients to learn more about the exhaustive data collection that informs vaccine recommendations and to trust that vaccine recommendations take into account all the best evidence available and are updated accordingly. The decision to recommend the HPV vaccine at the age of 11 to 12 years was a deliberate and well-studied one; the decision to delay HPV vaccination is an active one that carries with it its own potential risks.