HPV vaccine recommendations
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Human papillomavirus (HPV) vaccination rates remain low among teenagers in the United States despite the HPV vaccine recommendations issued by the Advisory Committee on Immunization Practices and the American Cancer Society.

Human papillomavirus is largely responsible for many different cancers including cervical cancer in women, anal cancers, mouth and throat cancers, and penile, vaginal, and vulvar cancers. These cancers can be prevented with vaccination. Healthcare providers began recommending vaccination with the HPV vaccine in 2007. The current HPV vaccine recommendations suggest vaccinating both female and male adolescents between the ages of 11 and 12 years old. Full immunization requires two or three booster doses following the initial vaccine.

Low vaccination rates despite recommendations

Despite strong HPV vaccine recommendations by the American Cancer Society, in 2016 only 65.1% of females and 56.0% of males between 13 and 17 years of age had received the first dose of the HPV vaccine. The percent of adolescents having completed the HPV vaccine schedule was even lower. As a consequence of these low vaccination rates, the American Cancer Society set out a goal to reach a prevalence of 80% vaccination by 2026 among adolescents before their 13th birthday.

Stacey A Fedewa Ph.D., from the American Cancer Society, conducted a study to determine how many adolescents need to initiate vaccination in order to reach an 80% HPV vaccination prevalence. The investigators also determined how many adolescents are required to receive the second or third dose of the HPV vaccine to reach the 2026 target of 80% up to date HPV immunization. The study also included an analysis of the barriers to vaccination that are preventing parents from vaccinating their children against HPV. The results of this analysis were published in Cancer.

Millions of teenagers need to be vaccinated to reach 80% prevalence

In 2016, 48.9% of female adolescents and 44.3% of male adolescents had initiated the HPV vaccine schedule by their 13th birthday. To reach an 80% HPV vaccination prevalence in 2026, an additional 3.95 million females and 4.78 million males between 11 and 12 years old must received their first HPV vaccine. The researchers suggest that 1.34 million females and 1.63 million males must be vaccinated in 2026 in order to reach an 80% HPV vaccination prevalence.

In 2016, only 35.5% of female adolescents and 31.5% of male adolescents were up to date with their HPV vaccinations by their 13th birthday. To reach the American Cancer Society’s ambitious goal of 80% vaccination prevalence, an additional 6.77 million females and 7.62 million males need to receive their second HPV vaccine. The total number of HPV vaccine doses required to reach 80% up to date HPV vaccination among adolescents is 57.62 million.

The reason for the low rates of HPV vaccination in 2016 was also investigated. More males, whites, and families with private medical insurance were not up to date with their HPV vaccination. Most of the adolescents who did not initiate or complete the HPV vaccine schedule were above the poverty line. Costs do not seem to be a significant barrier.

Strategies to improve vaccination rates are in progress

Strategies to improve HPV vaccination rates are currently in progress. Improving healthcare professionals’ knowledge of the importance of HPV vaccination and the benefits and risks of immunization is a top priority. Some healthcare professionals would like to recommend vaccination but hesitate to bring up the HPV vaccine to parents because of the relation to sexually transmitted diseases. A recent study concluded that parents who vaccinated their children considered the prevention of many different cancers as very influential in their decision to vaccinate their children.

HPV vaccine recommendations by the American Cancer Society have yielded very low rates of vaccination among adolescents. The Society has come up with a goal of reaching an 80% prevalence of HPV vaccination by 2026. In order to reach this target, the researchers have estimated how many additional adolescent males and females require to start and complete the vaccination schedule. Strategies to improve vaccination rates include, improving healthcare provider knowledge and working with parents to resolve the stigma around vaccinating their child against a sexually transmitted virus.

Written by Jessica Caporuscio, PharmD

Reference: Fedewa SA, Preiss AJ, Fisher-Borne M, et al. Reaching 80% human papillomavirus vaccination prevalence by 2026: how many adolescents need to be vaccinated and what are their characteristics? Cancer. 2018.

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