HPV vaccine can’t wait
Immunization of younger teens is critical to preventing serious cancers later in life
- Copyright © 2012, The American Academy of Pediatrics
Administering immunizations during adolescence provides unique challenges. A recently released report from the National Immunization Survey—Teen (NIS-Teen) provides evidence that there has been more difficulty in obtaining acceptance of the human papillomavirus (HPV) vaccine compared to two other vaccines recently introduced to adolescents: tetanus, diphtheria and acellular pertussis (Tdap) vaccine and meningococcal conjugate (MCV4) vaccine.
“HPV vaccine is different.” “HPV vaccine can wait.” “I won’t go to the mat for this one.” That’s what is frequently heard from pediatricians across the country. Perhaps you have said the same things yourself.
It may seem like there isn’t any urgency to recommending HPV vaccination when speaking with 11- or 12-year-olds and their parents. The cancers that HPV causes won’t occur for decades. Sometimes, questions around vaccination can tie up a busy office visit. However, some of the statistics behind the rationale for targeting this age for immunization may surprise you.
Burden of disease
The evidence makes it clear that HPV vaccination in younger teens is critical to assuring the prevention of serious cancers later on in life.
Although some pediatricians have been delaying HPV vaccination, it turns out that HPV infections aren’t waiting. Each year, there are 6 million new human papillomavirus infections, with a majority occurring in teens and young adults. People acquire their first HPV infections soon after sexual debut. Nearly one in two high school students has had sexual intercourse (MMWR. July 24, 2012, www.cdc.gov/mmwr/pdf/wk/mm61e0724.pdf).
Research suggests parents do want to talk about the HPV vaccine. When they raise questions, this is not the same as refusal or reluctance to vaccinate. The pediatrician’s strong recommendation is the key to helping parents with their decision.
HPV vaccines are effective in preventing infection from four HPV types (6,11,16 and 18). But they do not cure an infection that has already occurred. Nearly 12,000 U.S. women get cervical cancer each year despite strong cervical cancer screening programs. About 2,000 women and men get anal cancer each year. Many of these cancers can be prevented with HPV vaccination during the teenage years before infection with one of the cancer-causing strains occurs.
HPV infection also can lead to oropharyngeal cancer, which has been increasing, and it affects both genders. Each year, nearly 7,000 cases of HPV16/18-associated oropharyngeal cancers are diagnosed. It is postulated that HPV vaccine also may prevent many of these oropharyngeal cancers.
To achieve the prevention benefit of this vaccine, young people need to get the vaccines before they are exposed to these cancer-causing viruses. The best way to assure this is to vaccinate before sexual activity starts.
Another benefit to vaccinating at the recommended age is that the antibody levels achieved after vaccination at this age are higher than after vaccination of older adolescents. At present, there is no evidence of waning protection after vaccination. The level of antibody achieved after vaccination predicts antibody titers years later. This can help parents understand why age 11-12 years is the right time to vaccinate.
The latest vaccination coverage statistics tell us that we’re failing to reach preteens with even a first dose of HPV, let alone the full series of three immunizations. Despite rising rates for Tdap and MCV4, HPV vaccination rates are stagnating, according to the 2011 NIS-Teen data. Nearly one out of two 13- to 17-year-old girls has not received a first HPV dose. Only one out of three has received all three doses., Only 8% of boys have started the HPV vaccination series.
Opportunities for vaccination
The recent data do not suggest that all the immunization news is bad. Clinicians are doing a good job with other vaccines for adolescents. The 2011 NIS-Teen found rising rates in Tdap and MCV4 coverage. National coverage with Tdap already has met the 2020 Healthy People goal of at least 80% coverage in those ages 13-15. These trends demonstrate that it is possible achieve high vaccine coverage in the preteen and teen years, just as has been achieved in infants and toddlers.
The HPV vaccine prevents a sexually transmitted infection, and sometimes a discussion pertaining to sexual activity can result in an uncomfortable conversation. However, the HPV vaccine is a cancer vaccine. That is how it should be presented to adolescents and their families.
When preteens come to their pediatrician’s office for a back-to-school visit or sports physical, the pediatrician has the chance to begin or continue the HPV vaccination series. If a dose of HPV vaccine were administered each time a clinician gave Tdap or MCV4, coverage could jump to more than 80%.
As the nation responds to unprecedented rates of pertussis, many parents are checking with clinicians about whether their children are up-to-date on vaccines. This is an opportunity to verify DTaP or Tdap receipt, and at the same time to strongly recommend HPV vaccinations for preteens and teens.
Parents need to understand that the HPV vaccine can’t wait. The HPV vaccine is different. It is a cancer vaccine. Prevention of thousands of cases of cancer each year is worth “going to the mat.”
Dr. Schuchat, RADM, is assistant surgeon general for the United States Public Health Service and director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. Dr. Brady is chair of the AAP Committee on Infectious Diseases.
Dr. Schuchat, RADM, is assistant surgeon general for the United States Public Health Service and director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. Dr. Brady is chair of the AAP Committee on infectious Diseases.