Accelerate HPV vaccine uptake: Time to move
Executive Summary
A new report emphasizes the need to energize efforts to reach the potential of human papillomavirus (HPV) vaccines to save lives and prevent millions of avoidable cancers and HPV-related conditions in men and women.
• Vaccine uptake for HPV has not kept pace with that of other adolescent shots. In 2012, only about one-third of girls ages 13-17 received all three recommended doses, and less than 7% of males ages 13-17 completed the shot series.
• The report outlines three goals to increase vaccine uptake: reducing missed clinical opportunities to recommend/administer HPV vaccines; increasing parents’/adolescents’ acceptance of HPV vaccines; and maximizing access to HPV vaccination services.
Human papillomavirus (HPV) vaccine uptake has not kept pace with that of other adolescent shots. In 2012, only about one-third of girls ages 13-17 received all three recommended doses, and less than 7% of males ages 13-17 completed the shot series.1 (Contraceptive Technology Update reported on the statistics. See "Boost HPV vaccination numbers — next generation is at risk," October 2013, p. 109.)
A new report released by the President’s Cancer Panel emphasizes the need to energize efforts to reach the HPV vaccines’ potential to save lives and prevent millions of avoidable cancers and HPV-related conditions in men and women.2 (Read the full report at http://1.usa.gov/1cAVkYN. Select "Download Full Report.")
Barbara Rimer, DrPH, dean of the Gillings School of Global Public Health and member of the Lineberger Comprehensive Cancer Center, both at the University of North Carolina at Chapel Hill, serves as chair of the President’s Cancer Panel. Rimer says she hopes the report will result in more resources available for clinicians to use in talking with adolescents and their parent/caregivers about HPV vaccines.
ACIP makes its recommendations
The vaccines are recommended by the U.S. Advisory Committee on Immunization Practices (ACIP) for males and females ages 11-12 with "catch-up" doses for females up to age 26 and for males up to age 21 who were not vaccinated earlier in adolescence. Various medical specialty recommendations support vaccination of age-eligible adolescents, notes Rimer.
"Clinicians should view the prevention of cervical and other HPV-associated cancers as one of the most powerful forms of prevention in their arsenals," states Rimer. "It is time to bring HPV use in line with other adolescent vaccines."
The report outlines three critical goals that must be achieved to increase HPV vaccine uptake. They include reducing missed clinical opportunities to recommend/administer HPV vaccines; increasing parents’/adolescents’ acceptance of HPV vaccines; and maximizing access to HPV vaccination services, with the ultimate goal being completion of the full three-dose series by all age-eligible adolescents.
According to data from the Centers for Disease Control and Prevention (CDC), missed clinical opportunities are the most important reason why the U.S. has not achieved high rates of HPV vaccine uptake. As many as two-thirds of 11- and 12-year-old vaccine-eligible girls might not be receiving HPV vaccines at healthcare visits during which they receive at least one other vaccine.3 Targeted efforts, including communications strategies for physicians and other relevant health professionals, are recommended to increase the proportion of health providers who strongly recommend HPV vaccines for age-eligible adolescents, the report states.
Use of electronic health records and immunization information systems can help to avoid missed opportunities for HPV vaccination and facilitate completion of the three-dose regimen.
Get men in the picture
As part of the goals outlined in the report, experts outlined two key factors in boosting male uptake of the vaccine: expanding the current Healthcare Effectiveness Data and Information Set (HEDIS) quality measure for HPV vaccination of adolescent females to include males, and create a Healthy People 2020 HPV vaccination goal for males. Both factors would place emphasis on encouraging providers to recommend HPV vaccine to adolescent boys and their parents.
More than 90% of U.S. health plans use HEDIS to measure performance, the report notes. Health plan purchasers often use HEDIS data when selecting plans, the report notes. Plans have an incentive to change practices and make improvements to optimize their HEDIS scores. In 2012, a HEDIS measure was created to assess the percentage of age 13 female adolescents who had had three doses of HPV vaccine by their 13th birthdays. Having a similar measure for boys would boost vaccine uptake, the report notes.
Current Healthy People 2020 objectives include increasing HPV vaccine completion rates for females ages 13-15 to 80%. These objectives should be updated to include an HPV vaccination goal for males equivalent to that for females, states the report. Noel Brewer, PhD, associate professor of health behavior at the University of North Carolina at Chapel Hill Gillings School of Global Public Health, says, "Males have a disease burden themselves. They get genital warts, they get anal cancer, and this vaccine will prevent both."
Brewer sees men as the "vectors" of HPV disease, as women are getting HPV primarily from men. Given the current U.S. vaccination rates, herd immunity (reached when a critical portion of a community is immunized against a contagious disease) cannot be reached until males are vaccinated, says Brewer, who co-chaired of one of four workshops that informed the report.
"To be able to get the vaccine to work the way we need it to, we really need males vaccinated, both to help women, but to also help men as well," Brewer states.
- Centers for Disease Control and Prevention (CDC). Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and postlicensure vaccine safety monitoring, 2006-2013 — United States. MMWR 2013; 62(29):591-595.
- National Cancer Institute. Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer. A Report to the President of the United States from the President’s Cancer Panel. Bethesda, MD; 2014.
- Centers for Disease Control and Prevention. National and state vaccination coverage among adolescents aged 13-17 years — United States, 2012. MMWR 2013; 62(34):685-693. n
