HPV vaccine update
Immunization rates low despite excellent effectiveness, safety profile
- Copyright © 2013 by the American Academy of Pediatrics
While vaccination coverage with more than one dose of human papillomavirus (HPV) vaccine has increased from 25% in 2007 to 53% in 2011, no appreciable increase in vaccination coverage was observed in females between 2011 and 2012 (54%), according to the Centers for Disease Control and Prevention (CDC).
Each year, the CDC tracks vaccination coverage among adolescents using the National Immunization Survey-Teen. HPV vaccination coverage levels among adolescent girls from 2007-’12 as well as post-licensure vaccine safety monitoring are summarized in a Morbidity and Mortality Weekly Report article released on July 25, “Human Papillomavirus Vaccination Coverage among Adolescent Girls and Post-Licensure Vaccine Safety Montoring — United States, 2007-2012.” http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm?s_cid=mm6229a4_w.
Data show that completion of the three-dose HPV series is far below the Healthy People goals. Meanwhile, coverage rates of other recommended adolescent vaccines have increased steadily since their routine recommendations (see figure).
If the three-dose HPV vaccine series had been initiated during health care visits when another vaccine was administered, vaccination coverage for more than one dose could have reached over 90%.
Parents lack knowledge about HPV
Nearly all sexually active men and women will acquire at least one type of HPV — through any type of intimate sexual contact — at some point in their lives. Every year in the United States, 14 million people, mostly young adults, become infected with HPV, leading to 26,000 HPV-related cancers. There are more than 8,000 HPV-related cancers in men and 17,000 HPV-related cancers in women; of these, 4,000 women will die from cervical cancer.
While HPV itself may be widespread, knowledge of the disease and understanding of the need for vaccination is not. For parents who did not intend to vaccinate their daughters in the next 12 months, the top five main reasons included:
vaccine not needed;
vaccine not recommended;
lack of knowledge about the vaccine or the disease; and
teen is not sexually active.
Research indicates that most of these concerns or lack of knowledge by parents could be addressed quickly and easily by a strong recommendation from their pediatrician and other health care providers.
Recently published studies should help boost clinicians’ confidence in recommending HPV vaccine.
A study examining the prevalence of HPV infections in girls and women before and after introduction of the HPV vaccine shows a significant reduction in vaccine-type HPV in U.S. teens (Markowitz LE, et al. J Infect Dis 2013;208:385-393OpenUrl). Since the vaccine was recommended routinely for females in 2006, vaccine-type HPV prevalence decreased 56% among females 14 through 19 years of age.
Studies conducted in several other countries show significant declines in quadrivalent HPV vaccine type prevalence and anogenital warts. These countries include Australia and Denmark, which have high vaccine coverage, as well as Germany and New Zealand, where coverage has been much lower and closer to that in the United States. In Australia, dramatic decreases in genital warts among young heterosexual males suggest indirect protection through herd immunity.
In addition to conferring protection, data confirm that HPV vaccine has a similar safety profile as other vaccines recommended for this age group.
In the United States, post-licensure vaccine safety monitoring and evaluation are extensive. From June 2006 to March 2013, approximately 56 million doses of HPV4 vaccine were distributed in the United States. For that same period, the total number of reports to the Vaccine Adverse Event Reporting System (VAERS) from females following receipt of HPV4 peaked in 2008 and decreased each year thereafter; the proportion of serious reports also decreased.
Among the 21,194 reports in females following HPV4 administration, 92% were classified as “non-serious.” Among non-serious adverse events, the most commonly reported generalized symptoms are syncope (fainting), dizziness, nausea, headache, fever and urticaria (hives); the most commonly reported local symptoms are injection site pain, redness and swelling. Among the 8% of HPV4 VAERS reports coded as “serious,” headache, nausea, vomiting, fatigue, dizziness, syncope and generalized weakness are the most frequently reported symptoms.
No serious safety concerns have been identified in large post-licensure observational studies. The CDC’s Advisory Committee on Immunization Practices and the AAP Committee on Infectious Diseases recommend that vaccine providers observe adolescent patients for 15 minutes after they are vaccinated.
For AAP resources, visit www2.aap.org/immunization/illnesses/hpv/hpv.html.
Speaking tips for AAP members, www.aap.org/en-us/my-aap/advocacy/workingwiththemedia/speaking-tips/Pages/HPV-Vaccine.aspx (login required).
For resources on how to talk about HPV vaccine with parents and patients, visit www.cdc.gov/vaccines/who/teens/for-hcp.html.
Information for parents is available at www.cdc.gov/vaccines/teens.
Dr. Wharton is deputy director of the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.