More clinicians need to be discussing the HPV vaccination with their patients and parents, and starting early could improve vaccination rates, according to panelists at a recent National Foundation for Infectious Diseases (NFID) webinar.
Although the CDC reports that more than half of teenagers are up-to-date on the HPV vaccine (Gardasil, Merck) that is used to prevent cervical, anal and other HPV-related cancers, the public health community could be doing better.
“If there was a vaccine for breast cancer, everybody would have it,” said Kimberly Williams, the chief diversity, equity and inclusion officer for Cervivor, a nonprofit bringing cervical cancer survivors together to help raise awareness about the disease.
The CDC’s National Immunization Survey-Teen surveillance database monitors trends in vaccination coverage at the national, state and local levels, and found that for the first time in a decade, HPV vaccination coverage in 2022 did not increase among teens ages 13 to 17 years. In addition, the survey also found that teens born in 2008 have lower HPV vaccination coverage than previous birth cohorts, which Cassandra Pingali, MS, MPH, an epidemiologist with the CDC, said indicates the “COVID-19 pandemic has affected routine coverage of young teens” (MMWR Morb Mortal Wkly Rep 2023;72[34]:912-919).
“We hope that all clinicians will review adolescent immunization histories, with a particular focus on those born in 2008 and for those who are [Vaccines for Children Program]–eligible, to ensure that their patients are up-to-date with all recommended vaccines,” she said.
The CDC recommends that HPV vaccinations be given at age 11 or 12, but they can also start at age 9, while catch-up vaccination is recommended for people through age 26 who are not adequately vaccinated. Adults between the ages of 27 and 45 who are not adequately vaccinated should discuss the vaccine with their physician. They are not indicated for use in adults older than 45.
“For most patients, the benefit of the vaccine is primarily in their late adolescent, early adult life,” said Robert Hopkins Jr., MD, the medical director of NFID. (Read Dr. Hopkins’ review on adult vaccination at bit.ly/3uxRuR7-IDSE.)
Barriers
Despite these recommendations, there are specific barriers with the HPV vaccine beyond lack of awareness and vaccine hesitancy. Requiring three doses of the HPV vaccine, in addition to the recommended pertussis and meningococcal disease vaccines, can be too many appointments or shots for some parents, patients and providers. Because HPV is a sexually transmitted infection, there can be a stigma attached to HPV vaccination among parents who insist their child is not at risk. Some people do not understand that HPV has been linked to other cancers, not just cervical cancer, so it is important for male and female patients to be vaccinated.
Anecdotally, more providers should be encouraging patients to receive the HPV vaccine. Ms. Williams, a cervical cancer survivor, told the story of a pediatrician asking if she wanted the vaccine for her son.
“I asked if he needed the vaccine and she stated, ‘Not really.’ I made the decision not to vaccinate my child thinking it was not something he needed,” she said. After being diagnosed with cervical cancer and learning the importance of the HPV vaccine, Ms. Williams made sure her children were vaccinated.
Since the CDC says HPV vaccination can begin at age 9, education should start then, according to Sherri Zorn, MD, a pediatric physician–quality improvement coach with the Washington chapter of the American Academy of Pediatrics (AAP) and Washington HPV Free Task Force. She said discussions at age 9 provide four full years for vaccination and increases on-time HPV completion by age 13. It also makes the conversations with parents easier, as they focus on cancer prevention as opposed to sexual activity.
“The lovely thing about age 9 is that if they say ‘no,’ you can provide very brief counseling and give another strong recommendation next year,” Dr. Zorn said.
Dr. Zorn cited results from a survey of 34 providers in five clinics serving rural Washington communities that found that 56% said recommending HPV vaccination at ages 9 and 10 versus 11 or 12 made the process somewhat or much easier. The AAP, American Cancer Society and National HPV Vaccination Roundtable also recommend starting HPV vaccination at age 9.
Regardless of age, Dr. Zorn said a first step for providers should be discussing HPV vaccination as a presumptive announcement instead of an open-ended question, that is, “Your child is due for the HPV vaccine today” as opposed to “What would you like to do today about the HPV vaccine?” To create a culture of vaccinating at age 9, practices should assure the entire care team is on the same page, but she said that should not delay the discussions for providers.
“They can start it today with their very next 9- or 10-year-old patient,” Dr. Zorn said.
The sources reported no related financial disclosures.
This article is from the February 2024 print issue.