April 19, 2023

In The News: Why 9 Is Not Too Young for the HPV Vaccine

Medscape details frustrated efforts to promote uptake of vaccination against human papillomavirus. Data published by the CDC in 2022 found that 89.6% of teenagers aged 13-17 received at least one dose of Tdap vaccine and 89% got one or more doses of MenACWY vaccine yet only 76.9% had received one or more doses of HPV vaccine with full protection rate for HPV was 61.7%. Faced with addressing the discrepancy exacerbated by COVID, Denver Health and Hospital Authority issued a best practice alert for first HPV dose to nine and saw a 41% increase.

The strategy to begin HPV vaccination at age nine has been endorsed by the American Academy of Pediatrics and the American Cancer Society. The move intends to avoid multiple shots during a single visit and getting more children getting both doses of the vaccine. An AAP survey linked in the article showed 21% of primary care professionals seeing pediatric patients already making the offer and another 48% willing to try. The most common objection cited to attempting the new approach was the feeling that parents were not ready to discuss HPV vaccination at that age.

Additional attempts by providers to get more children covered, one of which took an “announcement” approach that informed parents of the vaccines that are due that visit. If there is hesitation, the clinicians would probe to find the cause, provide additional information, and note the interaction for any necessary follow up. The vaccine was discussed as one to prevent cancer rather than sexually transmitted infection. Each instance detailed experienced similar success in increasing HPV coverage.

Lifetime coverage was the final selling point employed by a clinician in Texas. This study emphasized there was no downside to earlier HPV vaccination whereas vaccines like MenACWY wane in coverage. The final point on the importance of the HPV vaccine is the discrepancy in potentially avoidable deaths. Meningococcus, tetanus, diphtheria, and pertussis deaths in the U.S. amount to less than 100 in a year. Cancer deaths attributable to HPV infection reach the thousands. And that, it notes, may be the best reason to start the series at nine.  

Commenting on the story, PIDS member Manika Suryadevara said, “The HPV vaccine series, recommended to be completed by 13 years of age, is safe and effective in preventing HPV infection and associated cancers. Yet adolescent HPV vaccine completion rates remain low (at just under 62% nationally). In line with current guidance from the Advisory Committee on Immunization Practice, starting the vaccine series at 9 years of age, a strategy supported by the American Academy of Pediatrics, the American Cancer Society, and the National HPV Roundtable, offers more time for vaccine completion, increases the likelihood of vaccinating prior to first exposure, decreases questions and conversations about sex, and decreases the number of shots administered per visit. As shown by the provider interventions described in the article, recommending the HPV vaccine at 9 (using the presumptive recommendation style and with a focus on vaccination for cancer prevention) is a simple and sustainable intervention that can increase on-time HPV vaccine completion rates by 13 years of age.”

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