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Increase in HPV vaccination requires addressing physician, parent concerns

Better communication with physicians, parents and adolescents about the benefits of HPV vaccination during early puberty is critical to removing barriers that have prevented wider use of the vaccine, says a public health expert at Emory University's Rollins School of Public Health. The commentary by Robert A. Bednarczyk, PhD, was published this week in the journal JAMA Internal Medicine.

HPV vaccine coverage has been lower than that of other routinely administered adolescent vaccines, with only 57 percent of adolescent females and 35 percent of adolescent males beginning the three-dose HPV vaccine series. One of the primary reasons cited by parents for not vaccinating their children relates to the vaccine's role in preventing a sexually transmitted disease and fears that adolescents will view HPV vaccination as approval for sexual activity. The vaccine is recommended for 11- and 12-year olds, or for older adolescents or young adults who have not been vaccinated.

In his commentary, Bednarczyk also responded to a study published in the same issue that found no evidence that HPV vaccination leads to higher rates of sexually transmitted infections (STIs). That research adds to a growing body of research that has found HPV vaccination does not lead to increased sexual activity.

Additional factors cited by some parents for not having children vaccinated and by some physicians for not recommending the HPV vaccine are (1) the vaccine is unnecessary because the Pap test screens for cervical cancer; (2) 11- and 12-year olds who are not yet sexually active could wait until later to be vaccinated; and (3) physicians should not need to discuss sexual activity with young teenagers.

"However, just as we do not wait until we have been in the sun for 2 hours to apply sunscreen, we should not wait until after an individual is sexually active to attempt to prevent HPV infection," notes Bednarczyk.

He also points out that these concerns overlook the three main reasons why HPV vaccine is recommended for young adolescents. First, the antibody response in younger adolescents is greater for all HPV types in the quadrivalent HPV vaccine than it is in older adolescents and young adults. Second, 27 percent of U.S. adolescents have had sexual intercourse by 15-17 years of age and 63 percent of U.S. adolescents 18-19 years old have had intercourse. Third, with the Tdap and MCV4 vaccines also recommended for 11- and 12-year-olds, the visit for those vaccines provides a convenient opportunity to begin HPV vaccination.

Addressing this knowledge gap through the development and delivery of information to adolescents, their parents, and their health care professionals will be critical to removing the stigma of HPV vaccine, Bednarczyk says. These materials should also address other fears about vaccine safety.

"In the meantime, the commentary concludes, "physicians should recommend the HPV vaccine as part of the adolescent vaccination platform, as is done for the Tdap and MCV4 vaccines, and highlight the reasons that support early vaccination: better immune response, importance of vaccinating before sexual activity, and consistent evidence that HPV vaccination does not lead to increased sexual activity."

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