Push the HPV vaccine
To reduce human papillomavirus (HPV)-related cancers, pediatricians must strongly recommend the underutilized HPV vaccine in preteens, said Joseph Bocchini Jr, MD, FAAP, in his session "Safe and effective: HPV vaccine—the pediatrician's critical role” at the American Academy of Pediatrics 2016 National Conference and Exhibition.
Among vaccines recommended for 11- to 12-year-olds, over 80% of children receive the tetanus, diphtheria, and pertussis (Tdap) vaccine and the first dose of the meningococcal conjugate vaccine by age 17 years, according to the Centers for Disease Control and Prevention (CDC) 2015 National Immunization Survey (NIS)-Teen. However, with the 3-dose HPV vaccine that is also recommended at that age, the figures are significantly lower:1
- 62.8% of girls have started the series by age 17 years;
- 49.8% of boys have started by age 17 years; and
- 34.9% of 13- to 17-year-olds have completed the series.
The FDA has recently licensed a 2-dose HPV vaccine series (0, 6 to 12 months) for 9- to 14-year-olds. In late October, the CDC Advisory Committee on Immunization Practices (ACIP) recommended using the 2-dose series for healthy persons who initiate the HPV vaccine series before their 15th birthday. This new recommendation should help improve vaccine series completion figures.
The HPV vaccine is designed to prevent HPV-related cancers that affect both men and women. About 30,000 cases are diagnosed annually in the United States—two-thirds of them in women.
It is crucial to educate parents that this vaccine prevents cancer, and it is best given at age 11 to 12 years—before children are likely to be exposed to HPV. There is no way to estimate when an adolescent will become exposed to and infected with HPV. Modeling indicates that giving the vaccine at age 11 or 12 years has the best likelihood of preventing HPV-related cancers.
Rather than making as strong a recommendation for HPV vaccination as they do for the Tdap and meningococcal vaccines, some pediatricians are presenting the timing of the HPV vaccine as a choice. When parents ask questions about the HPV vaccine, pediatricians may feel that the parents are hesitant to give the vaccine, and so the pediatricians do not pursue the issue or provide the information to make parents aware of the importance of giving the vaccine at the recommended age. They are willing to defer the vaccine until the child is older. This creates the potential that the adolescent will be infected with an HPV type that could have been prevented.
Evidence shows that a strong recommendation emphasizing that the vaccine is designed to prevent HPV-related cancers significantly increases the likelihood that parents will accept this vaccine in children.2 Pediatricians are in a unique position to protect their patients against HPV-related cancers by immunizing them before exposure to HPV is likely to occur.
1. Reagan-Steiner S, Yankey D, Jeyarajah J, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years—United States, 2015. MMWR Morb Mortal Wkly Rep. 2016;65(33):850-858.
2. Moss JL, Reiter PL, Rimer BK, Brewer NT. Collaborative patient-provider communication and uptake of adolescent vaccines. Soc Sci Med. 2016;159:100-107.