Although previous research(pediatrics.aappublications.org) has shown declines in the prevalence of vaccine-type HPV infection and genital warts among young U.S. females after introduction of the HPV vaccination program, overall infection rates in both women and men remain unacceptably high. Specifically, among adults ages 18-59 in 2013-2014, about 45 percent of men and 40 percent of women had genital HPV infection.
That's according to a recent data brief(www.cdc.gov) from the CDC's National Center for Health Statistics that provided the latest estimates of both oral and genital HPV prevalence by gender, race and Hispanic group.
The brief also noted that high-risk genital HPV infection affected about 25 percent of men and 20 percent of women. And the prevalence of any type of oral HPV infection among adults ages 18-69 in 2011-2014 was about 7 percent, while the prevalence of high-risk oral HPV infection was 4 percent.
- Among adults ages 18-59 in 2013-2014, about 45 percent of men and 40 percent of women had genital HPV infection, according to a recent CDC data brief.
- About 25 percent of men and 20 percent of women had high-risk genital HPV infection.
- The prevalence of any type of oral HPV infection among adults ages 18-69 in 2011-2014 was about 7 percent, and the prevalence of high-risk oral HPV infection was 4 percent.
Notably, said the data brief, the CDC National Health and Nutrition Examination Survey (NHANES), from which these data were drawn, doesn't include populations that may be considered at higher risk for HPV infection, such as those who are institutionalized, incarcerated or in nonhospital-based long-term care facilities, as well as injection drug users and homeless individuals. "Therefore, these data provide conservative estimates of both oral and genital HPV among U.S. adults," said the brief.
Additional Data Brief Details
Non-Hispanic Asian adults had the lowest prevalence of any and high-risk genital HPV infection among the total population, as well as among men and women, whereas non-Hispanic black adults had the highest prevalence of any and high-risk genital HPV infection among both the total population and among men and women. Men had more genital and high-risk genital HPV infection than women in the total population and also among non-Hispanic white adults.
Prevalence of any and high-risk oral HPV infection was also lowest among non-Hispanic Asian adults, and prevalence of any oral HPV infection was highest among non-Hispanic black adults. Men had a higher prevalence of oral HPV infection overall compared with women. Men also had significantly higher rates of high-risk oral HPV infection than women for every race and Hispanic group except non-Hispanic Asian adults.
The higher prevalence of oral HPV infection in men also was reported in a previous CDC NHANES for 2009-2010 that was published in JAMA in 2012.(jamanetwork.com)
Reaffirming Importance of HPV Vaccine
AAFP liaison to the Advisory Committee on Immunization Practices (ACIP) Margot Savoy, M.D., M.P.H., of Wilmington, Del., told AAFP News she wasn't surprised by the substantial prevalence of genital HPV infection among adults that was reported in the data brief.
"I've been telling folks for years that estimates are around 50 percent of adults have HPV, and even more if you consider the ones who were exposed but cleared the infection," she said.
"The trouble is you don't know which HPV you will get exposed to," Savoy said. "You could have nothing, genital warts or cancer. I don't know why anyone would want to leave their child vulnerable when two doses of the HPV vaccine before age 15 can slash that risk."
Savoy said family physicians should encourage parents to get their 11-year-olds vaccinated with the nine-valent HPV vaccine (HPV9; Gardasil 9). It's particularly important for this population to receive the vaccine, she said, because most patients this age haven't had sexual contact yet and they also have the most robust response to the vaccine, which is why they only need two doses instead of the traditional three.
Savoy's message reflects the ACIP's vote during its Oct. 19-20, 2016, meeting to recommend that patients ages 11-12 receive two doses of the HPV vaccine at least six months apart, rather than the previously recommended three doses.
Adolescents ages 13-14 also are able to receive HPV vaccine on the two-dose schedule.
Savoy said when she's explaining the value of the HPV vaccine to patients and their parents, she uses simple analogies.
"You don't wait until after the motor vehicle accident to put on your seatbelt," she said. "You don't put on a bike helmet after you fall off the bike.
"So before you begin any sexual activity, you should be immunized against HPV."
To help convince parents to have their child vaccinated, she tells them she understands they don't want to think about their kids growing up and being sexually active. "But if you intend to be a grandparent someday, your kid is going to end up having unprotected sex with someone," Savoy said. "Why wouldn't you want to protect him or her?"
Data about the impact of HPV vaccines on noncervical cancers are still being collected, according to Savoy. But overall, she said she anticipates that higher rates of HPV vaccination will result in a lower incidence of infection and correspondingly lower incidences of noncervical cancers and other health consequences of HPV infection.
"Even if you don't happen to care about cancer prevention, genital warts are stigmatizing, disfiguring and often difficult to treat," said Savoy. "HPV vaccine reduces the incidence of warts, as well."
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