Applied Evidence

Bringing the HPV vaccination rate into line with other adolescent immunizations

J Fam Pract. 2019 December;68(10):E1-E7

From The Journal of Family Practice | 2019;68(10):E1-E7.

References

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16. US Department of Health and Human Services. Preventive care. www.hhs.gov/healthcare/about-the-aca/preventive-care/index.html. Accessed December 4, 2019.

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22. CDC. Luxembourg A. Program summary and new 9-valent HPV vaccine trial data. Presented at the Advisory Committee on Immunization Practices (ACIP), October 30, 2014. Atlanta, Ga. 2014. www.cdc.gov/vaccines/acip/meetings/downloads/min-archive/min-2014-10.pdf. Accessed December 4, 2019.

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24. Lowy DR, Schiller JT. Reducing HPV-associated cancer globally. Cancer Prev Res (Phila). 2012;5:18-23.

25. Rand CM, Goldstein NPN. Patterns of primary care physician visits for US adolescents in 2014: implications for vaccination. Acad Pediatr. 2018;18:S72-S78.

26. Taylor JL, Aalsma MC, Gilbert AL, et al. Perspectives of family medicine physicians on the importance of adolescent preventive care: a multivariate analysis. BMC Fam Pract. 2016;17:4.

27. Harris SK, Aalsma MC, Weitzman ER, et al. Research on clinical preventive services for adolescents and young adults: Where are we and where do we need to go? J Adolesc Health. 2017;60:249-260.

28. Gilkey MB, Moss JL, McRee AL, et al. Do correlates of HPV vaccine initiation differ between adolescent boys and girls? Vaccine. 2012;30:5928-5934.

29. Espinosa CM, Marshall GS, Woods CR, et al. Missed opportunities for human papillomavirus vaccine initiation in an insured adolescent female population. J Pediatric Infect Dis Soc. 2017;6:360-365.

30. CDC. Update: Vaccine side effects, adverse reactions, contraindications, and precautions. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 1996;45:1-35.

31. Moss JL, Reiter PL, Brewer NT. Concomitant adolescent vaccination in the U.S., 2007-2012. Am J Prev Med. 2016;51:693-705.

32. Noronha AS, Markowitz LE, Dunne EF. Systematic review of human papillomavirus vaccine coadministration. Vaccine. 2014;32:2670-2674.

33. Perkins RB, Chigurupati NL, Apte G, et al. Why don’t adolescents finish the HPV vaccine series? A qualitative study of parents and providers. Hum Vaccin Immunother. 2016;12:1528-1535.

34. Jacobson Vann JC, Szilagyi P. Patient reminder and patient recall systems to improve immunization rates. Cochrane Database Syst Rev. 2005;(3):CD003941.

35. Dempsey AF, O’Leary ST. Human papillomavirus vaccination: narrative review of studies on how providers’ vaccine communication affects attitudes and uptake. Acad Pediatr. 2018;18:S23-S27.

36. Rosenthal SL, Weiss TW, Zimet GD, et al. Predictors of HPV vaccine uptake among women aged 19–26: importance of a physician’s recommendation. Vaccine. 2011;29:890-895.

37. Gargano LM, Herbert NL, Painter JE, et al. Impact of a physician recommendation and parental immunization attitudes on receipt or intention to receive adolescent vaccines. Hum Vaccin Immunother. 2013;9:2627-2633.

38. Bonville CA, Domachowske JB, Cibula DA, et al. Immunization attitudes and practices among family medicine providers. Hum Vaccin Immunother. 2017;13:2646-2653.

39. Wilson R, Brown DR, Boothe MA, et al. Knowledge and acceptability of the HPV vaccine among ethnically diverse black women. J Immigr Minor Health. 2013;15:747-757.

40. Iversen O, Miranda MJ, Ulied A, et al. Immunogenicity of the 9-valent HPV vaccine using 2-dose regimens in girls and boys vs a 3-dose regimen in women. JAMA. 2016;316:2411–2421.

41. Haydon AA, Cheng MM, Herring AH, et al. Prevalence and predictors of sexual inexperience in adulthood. Arch Sex Behav. 2014;43:221-230.

42. Gilkey MB, Malo TL, Shah PD, et al. Quality of physician communication about human papillomavirus vaccine: findings from a national survey. Cancer Epidemiol Biomarkers Prev. 2015;24:1673-1679.

43. Gilkey MB, McRee AL. Provider communication about HPV vaccination: a systemic review. Hum Vaccin Immunother. 2016;12:1454-1468.

44. American Academy of Family Physicians. Strong recommendation to vaccinate against HPV is key to boosting uptake. www.aafp.org/news/health-of-the-public/20140212hpv-vaccltr.html. Accessed December 4, 2019.

45. Sturm L, Donahue K, Kasting M, et al. Pediatrician-parent conversations about human papillomavirus vaccination: an analysis of audio recordings. J Adolesc Health. 2017;61:246-251.

46. Malo TL, Gilkey MB, Hall ME, et al. Messages to motivate human papillomavirus vaccination: national studies of parents and physicians. Cancer Epidemiol Biomarkers Prev. 2016;25:1383-1391.

47. Kornides ML, McRee AL, Gilkey MB. Parents who decline HPV vaccination: Who later accepts and why? Acad Pediatr. 2018;18:S37-S43.

48. Reno JE, Thomas J, Pyrzanowski J, et al. Examining strategies for improving healthcare providers’ communication about adolescent HPV vaccination: evaluation of secondary outcomes in a randomized controlled trial. Hum Vaccin Immunother. 2018;15:1592-1598.

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53. CDC. Frequently asked questions about HPV vaccine safety. www.cdc.gov/vaccinesafety/vaccines/hpv/hpv-safety-faqs.html. Accessed December 4, 2019.

54. Arana J, Su J, Lewis P, et al. Post-licensure surveillance of 9-valent human papillomavirus vaccine (9vHPV) in the Vaccine Adverse Event Reporting System (VAERS), United States, 2014-2017. https://idsa.confex.com/idsa/2018/webprogram/Paper69618.html. Accessed December 4, 2019.

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The threats posed by HPV

HPV infections are the most commonly transmitted infections in the United States and nearly all men and women will be exposed to one or more types of HPV at some point in their lives. Current data show that 79 million Americans, most in their late teens and early 20s, are infected with HPV, and about 14 million people in the United States become newly infected each year.¹⁸ HPV is a DNA tumor virus that causes epithelial proliferation at cutaneous and mucosal surfaces.

There are more than 100 types of the virus,¹⁹ including more than 40 strains that infect the human genital tract. Of the latter 40 strains, there are oncogenic or high-risk types and non-oncogenic or low-risk types.²⁰ HPV infection with high-risk types causes cervical, vaginal, and vulvar cancers in women; penile cancers in men; and oropharyngeal and anal cancers in both men and women. Low-risk HPV types cause genital warts in both men and women.²¹ The current available HPV vaccine in the United States is a 9-valent vaccine (9vHPV) that replaces the former 2- and 4-valent HPV vaccines and includes immunogenic coverage against high-risk HPV types 16, 18, 31, 33, 45, 52, and 58; and low-risk types 6 and 11.²²

Centers for Disease Control and Prevention (CDC) data from 2010 to 2014 show that approximately 23,700 women and approximately 17,300 men in the United States developed HPV-associated cancer. Most common in women are cervical cancers and in men, oropharyngeal cancers (cancers of the back of the throat, base of the tongue, and tonsils). Using population-based data to genotype HPV types from cancer tissues, the CDC reports that HPV is responsible for about 90% of cervical and anal cancers, 70% of oropharyngeal, vaginal, and vulvar cancers, and 60% of penile cancers.²³ A significant percentage of these cancers could potentially be prevented by receipt of 9vHPV.^23,24

Make adolescent immunization a high priority

Anticipate opportunities to vaccinate and take steps to make your immunization and scheduling processes more prominent. With HPV specifically, you can strongly advocate for vaccination, address parental misgivings and educate them using clear communication styles, and acquire knowledge to answer concerns about potential vaccine adverse effects.

Every visit is an opportunity to vaccinate. The American Academy of Family Physicians and The American Academy of Pediatrics recommend that adolescents have annual preventive visits for screening, immunizations, and assessment and counseling for risky behaviors. However, many adolescents do not present annually for preventive visits, and fewer than half of adolescents receive regular preventive care.²⁵ In a study of 425 family physicians and pediatricians, almost all pediatricians endorsed the importance of annual well visits, while less than three-quarters of family physicians did.²⁶ An analysis of national surveillance systems shows rates for preventive health care visits range from 43% to 74% among adolescents 10 to 17 years of age, and 26% to 58% among young adults 18 to 25 years of age.²⁷ Overall, 67% of adolescent health care visits are for acute care, and 10% are for follow-up care.²⁸

Continue to: Missed opportunities for the HPV vaccine