CDC Survey Outlines Sketchy Progress Made in Vaccination Effort
August 05, 2014 - Chris Crawford - AAFP News (AAFP)
The number of adolescents ages 13-17 who are receiving the HPV vaccine remains "unacceptably low," said CDC officials in a recent press release(www.cdc.gov). The announcement came as the agency released results from its 2013 National Immunization Survey-Teen (NIS-Teen),(www.cdc.gov) which appeared July 25 in Morbidity and Mortality Weekly Report (MMWR).(www.cdc.gov)
Although the HPV vaccination numbers in 2013 increased from the previous year among both girls and boys, they are still especially low compared to the number of adolescents who received the tetanus, diphtheria and pertussis (Tdap) vaccine.
The NIS-Teen report estimated that in 2013, about 57 percent of adolescent girls and 35 percent of adolescent boys received one or more doses of HPV vaccine. However, 86 percent of all adolescents had received one dose of Tdap vaccine during that period. According to the news release, such gaps in coverage indicate missed opportunities to provide the HPV vaccine to adolescents when they receive other recommended adolescent vaccines, such as Tdap and meningococcal vaccine.
The CDC's Advisory Committee on Immunization Practices (ACIP) recommends that preteens (i.e., those age 11 or 12) get one dose each of Tdap, meningococcal and HPV vaccine during a single visit.
CDC officials announced that the number of adolescents ages 13-17 who are receiving the HPV vaccine remains "unacceptably low" as the organization released its 2013 National Immunization Survey-Teen on July 25.
Last year, almost 74 percent of parents with daughters who received the HPV vaccine said that a health care professional recommended the vaccine, compared to about 52 percent of parents of unvaccinated daughters.
To address gaps in clinicians' knowledge about the vaccine and communication skills, the CDC has developed a number of resources for physicians as part of its You Are the Key to HPV Cancer Prevention campaign.
Jamie Loehr, M.D., of Ithaca, N.Y., the AAFP's liaison to the ACIP, said he thinks HPV vaccination numbers remain low because parents and physicians are still hesitant to accept the vaccine as a routine component of the adolescent immunization schedule.
"Part of the issue is that it is a relatively new vaccine, and part of the issue is that it is considered a vaccine against a sexually transmitted disease instead of a cancer-prevention vaccine," Loehr told AAFP News. "There is also the problem that when (the vaccine was) first available, several states tried to force a mandate that required this vaccine for school attendance, and that caused an uproar that has not settled down."
So, given the early controversy, physicians may still be somewhat gun-shy about recommending the vaccine, and parents may still remember that the vaccine had a bad reputation a few years ago, said Loehr. He added that the staggered vaccination recommendation process -- that it was first indicated and recommended only for girls and then later for both girls and boys -- also may have left a lingering discomfort about "changing" rules for the vaccine, leading to physicians questioning how much they really knew about it.
For physicians or patients who are concerned about the HPV vaccine's safety, the news release noted that in the eight years of post licensure vaccine safety monitoring and evaluation conducted by federal agencies and vaccine manufacturers, and after 67 million doses of vaccine have been distributed, no serious safety concerns have been linked to HPV vaccination.
According to the MMWR report, the most commonly reported symptoms after receiving HPV vaccine include injection-site reactions such as pain, redness and swelling. Other commonly reported symptoms include dizziness, fainting, nausea and headache.
Tips for Increasing Vaccine Coverage
Released in February, the President's Cancer Panel 2012-13report (deainfo.nci.nih.gov), outlined three critical goals it said must be achieved to increase HPV vaccine coverage in the United States:
Reduce missed clinical opportunities to recommend and administer HPV vaccine.
Increase acceptance of HPV vaccination among parents, caregivers and adolescents.
Maximize access to HPV vaccination services.
Loehr said that in his experience, if parents, caregivers and adolescents are receptive to receiving the HPV vaccine, they usually are OK receiving it along with the Tdap and meningococcal vaccines in one visit.
"The issue is that parents still put HPV vaccine in a different category and are still uncomfortable with the vaccine, so they get the Tdap and the meningococcal and put off the HPV for now," he said.
The good news, Loehr added, is that the three-dose schedule required for the HPV vaccine doesn't seem to be an added burden.
In 2013, almost 74 percent of parents with daughters who were vaccinated against HPV said that a health care professional recommended the vaccine, according to the MMWR report. That's compared to about 52 percent of parents who received a recommendation but did not have their daughters vaccinated.
For boys, the difference is even more exaggerated, with almost 72 percent of parents of vaccinated sons receiving a recommendation, compared to about 26 percent of parents of sons who were unvaccinated.
One of the five top reasons parents surveyed for the NIS-Teen listed for not getting the HPV vaccine was not receiving a clinician's recommendation.
Loehr said in his office, clinicians and staff start recommending the HPV vaccine at age 10, with the goal being to administer all three doses before the patient turns 13.
"If they come in at age 13 and have not had HPV, we try to bring it up at every visit and always bring it up at every well-child checkup," he added.
To physicians still hesitant to recommend the HPV vaccine, Loehr said he would encourage them to consider the vaccine a cancer-prevention drug, and present it to patients as such. He pointed to a CDC statistic that said if all girls in the targeted age group were vaccinated against HPV each year, more than 25,000 cervical cancers would be prevented. The agency has also said that if all adolescent girls were vaccinated against HPV before their 13th birthday, 91 percent of them would have some protection from the cancers caused by HPV infection.
CDC Creates Comprehensive Set of Resources
To address gaps in clinician knowledge and communication skills, the CDC has developed several resources for physicians as part of a campaign called You Are the Key to HPV Cancer Prevention(www.cdc.gov). The agency's website offers HPV vaccine resources for family physicians and pediatricians regarding the clinical impact of persistent HPV infection and the importance of vaccinating adolescents at age 11-12. These include a tip sheet for talking about the HPV vaccine with parents and handouts about the vaccine and immunization schedules.
"The whole site and (its resources) are wonderful, and I recommend them highly," Loehr said. "The CDC staff is working hard to help clinicians understand how to improve HPV vaccination rates."