Self-reported HPV vaccination rates ‘low,’ but increase over time
Self-reported HPV vaccination rates among young men and women aged 18 to 21 years were “low” but rose over time, researchers wrote.
Data also showed that overall HPV vaccination rates among men trailed behind women.
“HPV is the most common sexually transmitted infection in the United States and associated with several malignancies including oropharyngeal, cervical, vaginal, vulvar, penile and anal cancers,” Michelle M. Chen, MD, MHS, a clinical lecturer in the department of otolaryngology and head and neck surgery at the University of Michigan, told Healio Primary Care. “In 2020, the FDA expanded the indications for HPV vaccination to include the prevention of oropharyngeal cancer, which is the most common HPV-associated malignancy and about 80% of oropharyngeal cancer patients are male.”
Chen and colleagues analyzed unweighted data from 6,606 women and 6,038 men who participated in the National Health Interview Survey at some point from 2010 to 2018 to assess HPV vaccination rates and determine the differences in vaccination rates between the sexes.
The researchers reported in JAMA that after data weighting, 41.6% (95% CI, 40%-43.2%) of women and 16.2% (95% CI, 14.8%-17.7%) of men said they received at least one dose of HPV vaccine at any age. The vaccination receipt rate for the women rose from 32.2% (95% CI, 27.9%-36.7%) in 2010 to 55.2% (95% CI, 49.4%-60.9%) in 2018 (P = .001). For men, this rate rose from 1.6% (95% CI, 0.6%-4.1%) to 34.1% (95% CI, 28.5%-40%) during the same time span (P < .001).
In addition, among all the women in the study, 3.8% (95% CI, 3.4%-4.3%) received their first HPV vaccine dose while aged 18 to 21 years; among all the men, 2.7% (95% CI, 2.3%-3.1%) received their first dose while aged 18 to 21 years. A total of 46.3% (95% CI, 37.6%-55.2%) of these women and 29.1% (95% CI, 20.4%-39.7%) of these men received the entire three-dose vaccination series.
“In recent years, the vaccination rates for adolescent boys have increased to be close to the rate for adolescent girls,” Chen said. “However, overall vaccination rates still lag for men and we could be doing a better job of providing the catch-up vaccination to men.”
Chen and colleagues suggested several ways to increase vaccine uptake among young adults, such as ascertaining HPV vaccination status when providing the influenza vaccine and removing cost barriers. To improve HPV vaccination rates in men, the researchers recommended leveraging university or community vaccination campaigns and providing adult primary care clinicians with information regarding the risk for HPV-associated cancers.
Perspective
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Chen and colleagues measured HPV vaccination receipt for men and women aged 18 to 21 years over the period 2010 through 2018. Their findings are similar to self-reported data from young adults in the National Center for Health Statistics data brief published by CDC in January 2020.
Given the dramatic decrease in adolescent vaccinations due to COVID-19, as well as the overwhelming evidence for high effectiveness of HPV vaccination at the recommended ages of 9 to 12 years and for low effectiveness for HPV cancer prevention in persons aged 17 years and older, strategies to improve vaccination uptake should focus on preteens.
It is critical that we prioritize adolescent vaccination and reverse the declines created by the pandemic. This means ensuring that all preteens receive provider recommendations and that physicians increase opportunities to vaccinate and use evidence-based interventions such as reminder/recall. Intensive efforts are needed to reach the national’s goal of 80% of adolescents fully vaccinated against HPV cancers.
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The results of the study by Chen and colleagues are consistent with what we are seeing here in California and nationwide since 2018, the last year these researchers compiled data for their study.
It is a public health policy failure that HPV vaccination coverage remains far too low in this country, considering we have a very safe and effective vaccine to prevent the disease. To improve upon the trends that Chen and colleagues found, doctors can advocate for policy change, such as requiring HPV vaccination upon entering school. Places like Rhode Island and District of Columbia have done this and have witnessed a tremendous increase in the proportion of the population, adolescents and young adults who have been vaccinated against HPV.
Former deputy health officer and director, STD prevention and control services, San Francisco Department of Health
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