Vaccination rates for human papillomavirus are lagging for teens, and a complicated web of confusion and misinformation may be to blame, according to public health leaders.
Several strains of HPV can cause cervical cancer, and two vaccines, Gardasil and Cervarix, have been shown conclusively to defend against those strains. The Food and Drug Administration recommended in 2006 that girls receive the vaccine before they become sexually active so that they are protected at the outset. In 2009, FDA approved the use of the vaccine for boys as well.
According to the Centers for Disease Control and Prevention, about 6 million people in the U.S. become infected with HPV each year and each year about 12,000 women are diagnosed with cervical cancer, leading to about 4,000 deaths.
Studies have shown the vaccine to be overwhelmingly safe, CDC said. As of June 2011, about 35 million doses of Gardasil had been distributed in the United States. CDC’s adverse event tracking mechanisms reported about 18,000 adverse events, 92 percent of which were nonserious events, such as fainting, swelling at the injection site and headache. Sixty-eight deaths were reported, but there is “no unusual pattern or clustering to the deaths that would suggest that they were caused by the vaccine, and some reports indicated a cause of death unrelated to vaccination,” CDC said.
And yet, fed perhaps by misinformation or squeamishness about the idea of their children becoming sexually active, some parents are opting not to vaccinate, and the vaccination rates are lagging, according to CDC.
Lauren Fant receives an HPV vaccination from nurse Stephanie Pearson at a doctor’s office in Marietta, Ga., in 2007.
Photo by John Amis, courtesy AP Images
“I think that this whole issue is tangled up because this is a sexually transmitted infection that you’re preventing,” said Alina Salganicoff, PhD, vice president for women’s health policy at the Kaiser Family Foundation. “But we also know enough about HPV to know that the majority of women, once they become sexually active, are exposed.”
According to an Aug. 26 study in Morbidity and Mortality Weekly Report, fewer than half of girls ages 13–17 get one dose of the three-dose vaccine, and only 32 percent get all three doses. In comparison, the meningitis and pertussis vaccines, which are also administered to adolescents, have uptake levels of nearly 63 percent and 69 percent, respectively. Coverage varies by state, with just 17.6 percent of girls in Idaho receiving three doses of the vaccine, compared to 55 percent of girls in Rhode Island. Among boys, for whom the vaccine is approved but not explicitly recommended by CDC, the coverage rate nationwide was 1.4 percent for those ages 13–17.
Salganicoff also said misinformation may be leading some parents to be overcautious and delay giving the vaccine to their children.
Political leaders are partly responsible for some of that misinformation, including Rep. Michele Bachmann, R-Minn., who publicly related a story in September that implied that the vaccine could cause intellectual disabilities. Health officials, including the American Academy of Pediatrics, quickly responded, noting there is no evidence that the vaccine causes serious health issues.
“Facts are very important,” wrote the American Congress of Obstetricians and Gynecologists in an open letter to the 2012 presidential candidates. “Especially when discussing the health of the American public.”
Another possible reason for lagging vaccinations is that preteens usually do not have the regularly scheduled wellness doctor visits that babies have, according to Vanessa Cullins, MD, vice president for medical affairs at Planned Parenthood Federation of America. Getting them to medical offices to complete the HPV vaccination schedule can be difficult, she said.
“Anything that requires more than one dose that is not part of a children’s schedule of vaccines tends to be more difficult for people to stay on schedule for,” she said.
But recent studies may provide a way forward.
Gardasil and Cervarix are given in three doses over six months. But a study published Sept. 9 in the Journal of the National Cancer Institute, which looked at two doses of Cervarix, found that two doses might be sufficient.
Mandates requiring vaccination are one way to increase the number of people getting the HPV vaccine, experts noted.
“The experience with immunizations is that when there’s a requirement that a child be vaccinated before he or she can attend school, that is a huge incentive for parents to get kids immunized,” Salganicoff said.
When the HPV vaccine was approved by the Food and Drug Administration in 2006, there was an effort from some in both the public health community and pharmaceutical industry to encourage mandates.
“There was pushback on many levels as a result,” said Salganicoff, an APHA member.
Today, only Virginia and the District of Columbia mandate the vaccine as a condition for students to attend school, and both permit parents to opt out of vaccination, according to the National Conference of State Legislatures.
The comparatively high vaccination rate in Rhode Island is likely due to a combination of factors, said Patricia Raymond, MPH, RN, chief of the Office of Immunization in the Rhode Island Department of Health.
First, Rhode Island is a universal vaccine state, meaning the vaccine is available to providers for all children, regardless of whether they are insured. The state added the vaccine to its list of those covered in November 2006 for girls and July 2010 for boys. The state also covered adolescents who were beyond the recommended age for the vaccine by allowing them to catch up.
The state also has a program called Vaccinate Before You Graduate, a school-based immunization program that up until last year focused on seniors in high school.
“The idea was to catch up kids on vaccines they might have missed,” Raymond told The Nation’s Health, explaining that many colleges or jobs might require vaccines that can cost up to $1,000, so the idea was to vaccinate teens before they entered college or the workforce.
Last year, that program expanded to offer the vaccines to adolescents in grades nine through 12.
“We definitely recommend a school-based program,” Raymond said. “Even though we focused on seniors, there’s still information going home to parents, so that’s another way of getting information to them.”
Both Salganicoff and Cullins see hope for increasing uptake of the vaccine in the coming years. Vaccination rates are slowing climbing, and the Affordable Care Act makes the vaccine available without co-pay, which will make it more accessible.
Cullins told The Nation’s Health there is more that public health professionals can do to improve the HPV vaccination rate. She said in some cases, health care providers are not equipped to give the vaccine and so patients of those providers either go elsewhere or go without. She said while most pediatricians are vaccinators, not all obstetricians and gynecologists are.
“We at Planned Parenthood feel it’s part of primary care that we should all have the vaccine available,” she said.
This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.