HPV vaccines: Additional call-to-action by healthcare providers needed
Although the quadrivalent HPV vaccine was approved for use in the US in 2006, the latest Centers for Disease Control and Prevention (CDC) data shows only 57% of females and 35% of males received at least 1 dose, with far less finishing the three dose series. In fact, the HPV vaccine has the lowest completion rates of any vaccine in the United States, including vaccines that are recommended for the same age groups. In 2013, the Director of the CDC said achieving higher HPV vaccination rates was a top public health priority. Still, achieving higher rates has been a struggle.
Healthcare provider recommendation has been shown in several studies to be the best predictor of HPV vaccine uptake in children and adolescents. While the HPV vaccine is FDA approved and recommended by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, the American Academy of Family Physicians (AAFP), the American College of Obstetrics and Gynecology (ACOG), and many other professional organizations, it is not treated the same way as other approved vaccines. At office visits, HPV vaccine recommendations tend to be given in a softer, optional manner by providers. There may be several reasons for this:
1. Sexual activity is not something that pediatricians or providers working with adolescents have had to discuss prior to the HPV vaccine. It may make them uncomfortable to bring up, as parents might think the provider recommendation assumes their adolescents are sexually active.
2. Parents may refuse the vaccine stating that their children are not yet sexually active so don’t need the protection just yet. This leads to waiting until exposure leading to disease in some of our children.
3. Parents may want more information on this particular vaccine prior to agreeing to have their children vaccinated since they may not know much about it, leading to missed opportunities.
4. HPV vaccine is seen by many parents as an STD vaccine (genital warts) rather than a cancer prevention vaccine. This is one of the only cancer prevention vaccines we have.
We must come up with a solution to ensure a provider initiated strong recommendation. Additional media information on the HPV vaccine may help increase awareness in the general population and normalize it, thus increasing comfort among providers to bring up the vaccine. Phrasing as an age based recommendation versus focusing on sexual behavior may help facilitate uptake. In addition, a new study shows that electronic health record prompts to physicians result in patients being 6 to 10 times more likely to get the vaccine. So if we remind providers to bring up the HPV vaccine during the patient visit, uptake is improved despite a strong or weak recommendation. Treating HPV vaccine the same way as other recommended vaccines and not separating it out is likely to facilitate uptake.
Several states including California have now worked to eliminate vaccine exemptions for religious and philosophical beliefs for required immunizations. This law will help nudge parents to have their children vaccinated if they remain in public school. If the HPV vaccine is made part of the required vaccine package, there will be more pressure for healthcare providers to administer it to all children. With the recent introduction of the 9-valent HPV vaccine, we have an opportunity to prevent even more HPV associated cancers. Let’s make sure that protecting our children from HPV-related diseases is a public health priority among all healthcare providers. We have a vaccine to prevent cancer, let’s use it.
We have a vaccine to prevent cancer, let’s use it.
Brandon Brown
This blog post was written by Brandon Brown. Brandon Brown is an Assistant Professor at the UC Riverside School of Medicine Center for Healthy Communities. His research interests include HIV and HPV-related disease, cancer prevention among underserved populations, use of pop culture for education, and ethical issues in outbreaks including the Ebola epidemic. He earned his bachelor's degree in applied mathematics from the University of California, Irvine, followed by a M.P.H. in epidemiology from UCLA. He then attended the Johns Hopkins Bloomberg School of Public Health to earn his Ph.D. in international health, conducting his postdoctoral work in global health at UCLA.
The opinions expressed by guest bloggers and those providing comments are theirs alone, and do not reflect the opinions of Immunize Nevada or any employee thereof.
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