HPV Vaccination Rates Fall Short in Adolescents

United States adolescents have fallen behind recommended schedules for human papillomavirus (HPV) vaccinations, according to a study published in the Journal of Infectious Diseases.

While approximately 60% of 13-to 17-year-old adolescents had initiated the HPV vaccine series in 2016, only 16% of adolescents had completed the series by age 13, and 35% by age 15, according to the study, which examined 2016 data from an annual US Centers for Disease Control and Prevention survey of parents on teen immunizations.

"What we really see is that adolescents are getting the vaccine, they're just tending to get it at slightly older ages," Robert A. Bednarczyk, PhD, assistant professor in the Hubert Department of Global Health Emory University Rollins School of Public Health and lead author of the study, told Contagion®.

The Advisory Committee on Immunization Practices recommends HPV vaccination before age 13. Only 2 doses of the vaccine are needed if completed before age 15.

In addition to fewer required doses, benefits to administering the vaccine at younger ages include a stronger immune response, and the convenience of combining administration of the vaccine along with tetanus, diphtheria, and acellular pertussis vaccines recommended for ages 11 to 12.

"The biggest thing that doctors can do is to recommend this vaccine just like any other vaccine," Dr. Bednarczyk said.

He said negative perceptions about the vaccine could be contributing to the lag in vaccination rates.

"I think the biggest take-home message for this is we have a safe and effective vaccine that can prevent cancer that has been recommended for use for over a dozen years in the [United States]. That information should really be reassuring for parents," Dr. Bednarczyk said.

Clinicians also may hesitate to bring up concerns about sexually transmitted diseases among children so young.

"This is a vaccine for prevention. It's going to be most effective when it's given before there's any possibility of exposure to the virus," Dr. Bednarczyk said. "I think that's how we need to start thinking about this vaccine. It is something that we hope is not necessarily going to be needed for a long time, but we want to make sure that our adolescents are protected should it be needed."

Reports on the rates of HPV vaccinations have been mixed. A study by investigators at Johns Hopkins University School of Medicine published in March found that HPV vaccination among males ages 9 to 26 increased between 2011 and 2016.

In October, the US Food and Drug Administration expanded approval for the use of recombinant human papillomavirus (HPV) vaccine, Gardasil 9, for adults ages 27 to 45.

A study published in the American Journal of Public Health in May 2018 found that HPV vaccination follow-through fell between 2006 and 2014.

Interventions such as training sessions, prompts to improve communication, and learning collaboratives should be implemented to improve the rate of rate of HPV vaccinations completed within the recommended schedule, Melissa B. Gilkey, PhD, and Marjorie A. Margolis, MPSH, of the University of North Carolina at Chapel Hill wrote in an editorial commentary related to the new study.

"Given the sheer magnitude of the problem, interventions that engage healthcare providers and systems offer our best chance of improving the timeliness of HPV vaccination nationally, and recent research has identified a small number of evidence-based interventions for doing so," the authors wrote.