"HPV vaccine is cancer prevention." That's the message the AAFP, CDC and a number of other stakeholder organizations are sending to primary care clinicians nationwide, urging them to talk earnestly with parents about the benefits of human papillomavirus (HPV) vaccination in young adolescents. It's keenly important to take advantage of opportunities to vaccinate, say the groups, because although immunization rates for other adolescent vaccines continue to improve, HPV vaccination rates have not.
"What you say, and how you say it, matters" when it comes to recommending vaccines for young patients, says a recent "Dear Colleague" letter(3 page PDF) signed by leaders of the AAFP, the American Academy of Pediatrics (AAP), the American College of Obstetricians and Gynecologists (ACOG), the American College of Physicians, the CDC, and the Immunization Action Coalition. When it comes to the HPV vaccine, the importance of delivering a strong, consistent recommendation to immunize can make all the difference, say the groups.
- The AAFP, CDC and other stakeholder organizations have reached out to the nation's primary care physicians, urging them to strongly recommend routine human papillomavirus (HPV) vaccination for 11- and 12-year-olds.
- It is essential to leverage opportunities to vaccinate because although immunization rates for other adolescent vaccines continue to improve, HPV vaccination rates have not.
- Physicians can help boost vaccination rates by assuring parents that the HPV vaccine is safe, effective and important.
"A half-hearted recommendation to a patient may not only result in the patient leaving your practice unvaccinated, but may lead the patient to believe that HPV vaccine is not as important as the other adolescent vaccines," says the letter.
Of course, nothing could be further from the truth.
Consider these statistics:
- About 79 million people in the United States currently are infected with HPV,(www.cdc.gov) and about 14 million become newly infected each year.
- More than 33,000 HPV-associated cancers(www.cdc.gov) (i.e., those that occur at anatomic sites associated with HPV) are seen each year in the United States.
- Of these, more than 26,000 cancers are attributed to HPV, with cervical cancer in women accounting for most of these cases (10,300), followed by oropharyngeal cancer in men (6,700).
The 2014 recommended immunization schedule for people ages 0 through 18 years jointly developed by the CDC's Advisory Committee on Immunization Practices, the AAFP, AAP and ACOG calls for routine administration of the three-dose HPV vaccine series in both girls and boys at age 11-12. Yet, according to a July 26 article(www.cdc.gov) in Morbidity and Mortality Weekly Report, only about one-third of teenage girls ages 13-17 had received all three vaccine doses in 2012, the first year for which coverage rates did not increase from those seen during the previous year.
CDC Expert Offers Tips on Recommending HPV Vaccine Successfully
It's likely most family physicians have encountered this scenario: Junior wants to go out for his middle school's soccer team, so Mom brings him in for a preparticipation exam. In reviewing the 12-year-old's medical record, you notice he hasn't yet received the routine adolescent immunizations, including the human papillomavirus (HPV) vaccine.
In a video commentary(www.medscape.com) Anne Schuchat, M.D., director of the CDC's National Center for Immunization and Respiratory Diseases, says the best way to ensure this opportunity to vaccinate against HPV doesn't slip by is to be direct.
"Try saying, 'Today your child needs three vaccines,'" Schuchat recommends. "'These vaccines prevent HPV cancers, meningitis, diphtheria, tetanus and whooping cough.'
"Many parents will accept this confident recommendation without question."
Schuchat also points out that just because parents ask questions about the HPV vaccine, that doesn't necessarily mean they're hesitant to have their child immunized.
"Parents of preteens and teenagers may be interested in having their child vaccinated against HPV, but before saying yes, they may need your reassurance that you feel strongly that their child should get this vaccine," says Schuchat.
Find further guidance on talking with parents(www.cdc.gov) about HPV vaccination on the CDC website.
"It's astonishing that despite a remarkable effectiveness record, only around a third of U.S. adolescent girls complete HPV vaccination," said AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., in a joint press release issued in conjunction with the letter. "Countries like Rwanda are immunizing more than four out of five adolescent girls. We have to do better in the United States.
So, what can you tell patients and their parents when they come to you with doubts about the vaccine?
- The vaccine is safe. HPV vaccine has been meticulously studied in both girls and boys. Since 2006, about 57 million doses have been distributed in the United States alone, and the vaccine has not been associated with any long-term side effects. As with other immunizations, most side effects are mild, consisting mainly of pain or redness in the arm in which the vaccine is given. These effects subside quickly.
- The vaccine is effective. Extensive clinical trials have shown HPV vaccine to be extremely effective in both boys and girls. Studies in the United States and other countries where the vaccine is used demonstrate significant reductions in the incidence of infections caused by the HPV types targeted by the vaccine.
- The vaccine is important. Simply put, HPV vaccine prevents cancer. In girls, it represents the single best defense against cervical cancer, and it is a key tool in preventing anal and oropharyngeal cancers in both men and women. To maximize the vaccine's benefits, it's essential to administer the complete three-dose series.
Finally, some parents may not understand why the vaccine -- which, after all, protects against sexually transmitted infections -- should be given to their 11- or 12-year-old child. You can remind them that, as with other vaccines, it's critical that their child receive the vaccine before he or she becomes infected. So, just as children are immunized against varicella well before they're likely to be exposed to a child with chickenpox, they should receive the HPV vaccine before they are exposed to HPV through sexual activity.
CDC: Provider Resources for Vaccine Conversations with Parents(www.cdc.gov)