9-Valent Human Papillomavirus Virus (HPV) Vaccine
The first HPV vaccine, Gardasil®, entered the U.S. market in 2006. Its introduction was lauded as the first vaccine for cancer and its use was anticipated to significantly reduce the rates of cervical cancer as well as the more than $1 billion dollars spent annually for HPV prevention and treatment. Nearly a decade later, these goals have yet to be realized. In spite of ACIP recommendations for routine immunization of both girls and boys at 11 to 12 years of age, immunization rates remain low. The percentage of girls between 13 and 17 years of age who had received at least one dose of the vaccine rose from 25% in 2007 to 57% in 2013, but has remained at that level. Completion of the three-dose series in 2013 was only 38%. In comparison, series completion rates in the UK and Australia are 60% and 71%, respectively.
Two recent papers have been published that focus on issues related to the low uptake of the HPV vaccine. Rahman and colleagues at the University of Texas examined the regional differences in vaccination rates using the Behavioral Risk Factor Surveillance System 2012 data from 8 states. Data from 3,727 adults between 18 and 26 years of age were used to determine the percentage who had received at least one dose of the HPV vaccine as well as the percentage who had completed the three-dose series. The percentages of women and men who had received at least one dose were highest in the Northeast (58.7% and 8.5%, respectively), with rates of 39% and 6.7% in the West and 30.4% and 4.9% in the South. Vaccine series completion rates showed similar regional differences, with the highest rates in the Northeast, 45.6% and 2.2%, compared to rates of 24.8% and 1.6% in the West and rates of 17.7% and 1.4% in the South.
The disparity in vaccine uptake remained even after adjustment for income and education. These numbers are particularly striking when viewed in light of the regional differences in invasive cervical disease. The South continues to experience the highest rates of cervical cancer in the United States. Based on their findings, the authors suggested two approaches to improve vaccination rates: utilizing visits for the influenza vaccine to initiate the HPV vaccine schedule and increasing insurance coverage or extending the Vaccines for Children program to include young adults from 19 to 26 years of age.
Roberts and colleagues explored the concept of parental vaccine hesitancy in an article published ahead of print in Vaccine. More than any other vaccine, the HPV vaccine has been the focus of parental and societal concerns regarding its association with a sexually transmitted disease. The authors used a modified version of the Parent Attitudes about Childhood Vaccines (PACV) survey to evaluate the issues surrounding parental hesitancy to accept HPV vaccination for their teenage children. The results of 363 surveys were analyzed from parents of adolescents between 11 and 17 years of age in six pediatric clinics at either the University of Oklahoma Health Sciences Center or the Medical University of South Carolina. Vaccination status was assessed for the HPV vaccine as well the quadrivalent meningococcal vaccine and Tdap. At the time of the visit when the survey was completed, the overall vaccination coverage rate was 45% for ≥ 1 dose of the HPV vaccine, 73% for the meningococcal vaccine, and 84% for Tdap.
Thirty-nine percent of parents noted that they had concerns about the HPV vaccine efficacy and 41% had concerns about adverse effects. Nearly half of the parents (45%) disagreed with the statement "Teens can get all of the vaccines that are due at a single visit." Agreement with the question "Have you ever delayed a vaccine for reasons other than illness or allergy?" was associated with a higher rate of HPV vaccine refusal than acceptance (8.7% versus 5%, p = 0.048). Disagreement with the statement "I am able to openly discuss concerns about vaccines with my teen's doctor." was also associated with a higher rate of HPV vaccine refusal (6% versus 1.2%, p = 0.046). The overall score on the modified PACV score failed, however, to predict which adolescents would be vaccinated at that visit. While the survey was useful in identifying reasons for parental vaccine hesitancy, it did not predict HPV vaccine uptake. The authors acknowledge that additional methods are needed to better illuminate vaccine-specific parental concerns.
HPV Vaccination Rates
The first HPV vaccine, Gardasil®, entered the U.S. market in 2006. Its introduction was lauded as the first vaccine for cancer and its use was anticipated to significantly reduce the rates of cervical cancer as well as the more than $1 billion dollars spent annually for HPV prevention and treatment. Nearly a decade later, these goals have yet to be realized. In spite of ACIP recommendations for routine immunization of both girls and boys at 11 to 12 years of age, immunization rates remain low. The percentage of girls between 13 and 17 years of age who had received at least one dose of the vaccine rose from 25% in 2007 to 57% in 2013, but has remained at that level. Completion of the three-dose series in 2013 was only 38%. In comparison, series completion rates in the UK and Australia are 60% and 71%, respectively.
Two recent papers have been published that focus on issues related to the low uptake of the HPV vaccine. Rahman and colleagues at the University of Texas examined the regional differences in vaccination rates using the Behavioral Risk Factor Surveillance System 2012 data from 8 states. Data from 3,727 adults between 18 and 26 years of age were used to determine the percentage who had received at least one dose of the HPV vaccine as well as the percentage who had completed the three-dose series. The percentages of women and men who had received at least one dose were highest in the Northeast (58.7% and 8.5%, respectively), with rates of 39% and 6.7% in the West and 30.4% and 4.9% in the South. Vaccine series completion rates showed similar regional differences, with the highest rates in the Northeast, 45.6% and 2.2%, compared to rates of 24.8% and 1.6% in the West and rates of 17.7% and 1.4% in the South.
The disparity in vaccine uptake remained even after adjustment for income and education. These numbers are particularly striking when viewed in light of the regional differences in invasive cervical disease. The South continues to experience the highest rates of cervical cancer in the United States. Based on their findings, the authors suggested two approaches to improve vaccination rates: utilizing visits for the influenza vaccine to initiate the HPV vaccine schedule and increasing insurance coverage or extending the Vaccines for Children program to include young adults from 19 to 26 years of age.
Roberts and colleagues explored the concept of parental vaccine hesitancy in an article published ahead of print in Vaccine. More than any other vaccine, the HPV vaccine has been the focus of parental and societal concerns regarding its association with a sexually transmitted disease. The authors used a modified version of the Parent Attitudes about Childhood Vaccines (PACV) survey to evaluate the issues surrounding parental hesitancy to accept HPV vaccination for their teenage children. The results of 363 surveys were analyzed from parents of adolescents between 11 and 17 years of age in six pediatric clinics at either the University of Oklahoma Health Sciences Center or the Medical University of South Carolina. Vaccination status was assessed for the HPV vaccine as well the quadrivalent meningococcal vaccine and Tdap. At the time of the visit when the survey was completed, the overall vaccination coverage rate was 45% for ≥ 1 dose of the HPV vaccine, 73% for the meningococcal vaccine, and 84% for Tdap.
Thirty-nine percent of parents noted that they had concerns about the HPV vaccine efficacy and 41% had concerns about adverse effects. Nearly half of the parents (45%) disagreed with the statement "Teens can get all of the vaccines that are due at a single visit." Agreement with the question "Have you ever delayed a vaccine for reasons other than illness or allergy?" was associated with a higher rate of HPV vaccine refusal than acceptance (8.7% versus 5%, p = 0.048). Disagreement with the statement "I am able to openly discuss concerns about vaccines with my teen's doctor." was also associated with a higher rate of HPV vaccine refusal (6% versus 1.2%, p = 0.046). The overall score on the modified PACV score failed, however, to predict which adolescents would be vaccinated at that visit. While the survey was useful in identifying reasons for parental vaccine hesitancy, it did not predict HPV vaccine uptake. The authors acknowledge that additional methods are needed to better illuminate vaccine-specific parental concerns.