CDC says 40% of teen girls are skipping recommended HPV vaccines

http://www.theguardian.com/us-news/2015/jul/31/cdc-hpv-teens-low-vaccination-rate

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Nearly 10 years after the human papillomavirus (HPV) vaccine was introduced, uptake in the US remains low. A new report from the Centers for Disease Control (CDC) suggests the number of teenagers who got vaccinated against HPV increased only slightly last year, while coverage continues to lag far behind other teenage vaccinations.

“I am frustrated that in 2014 four out of 10 adolescent girls and six out of 10 adolescent boys had not even started the HPV vaccine series and are vulnerable to cancers caused by HPV,” said Dr Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases, during a media briefing.

HPV is a the most common sexually transmitted infection in the US, affecting roughly 80 million Americans – including teenagers. It is responsible for “almost all” cases of cervical cancer, and a majority of vaginal, vulvar, penile, anal and mouth and throat cancers, which together affect about 27,000 Americans per year. Other strains of the virus can result in genital warts in women and men.

The CDC has recommended routine vaccination against HPV at age 11 or 12 for both girls (since 2006) and boys (since 2011). But the new report, published on Wednesday, suggests that a large portion are still not getting the jab.

Currently, the full HPV vaccine requires three doses, spaced several months apart. Among teens aged 13- to 17-years-old, 60% of girls had received one dose of the vaccine in 2014, up from 56.7% the year before. Coverage among boys rose more aggressively to 41.7% from 33.6% during the same period. But just under 40% of teenage girls and 22% of teenage boys had received all three doses of the HPV vaccine last year.

For comparison, 87% of English girls aged 12-13 had completed the course of three HPV vaccines between September 2013 and August 2014, according to data from the National Health Service. More than 91% had received a single dose.

“The UK [has] done an astounding job at getting coverage high, ” said Dr. Noel Brewer, associate professor of health behavior at the University of North Carolina, though he attributed this achievement partly to the country’s different health care structure.

Nonetheless, Brewer worries that the US is “not even close” to achieving its own 80 % coverage goal for 2020, as set by the Department of Health and Human Services.

US parents have previously cited concerns about cost, lack of information and the vaccine’s effect on sexual behavior of teens as barriers to seeking the vaccine. But the biggest current roadblock to greater uptake of the HPV vaccine, according to Schuchat, has come from providers’ failure to make strong recommendations for the vaccine the way they would for other teenage immunizations, like the Tdap vaccine, which protects against tetanus, diphtheria and pertussis (whooping cough). In contrast to the HPV vaccine’s low coverage , 87.6% of US teens received a Tdap shot in 2014.

“There have been lots of missed opportunities clinically,” said Brewer, who authored a separate study published earlier this summer that came to similar conclusions.

“The main current problem is that physicians are recommending the HPV vaccine in passing, as optional, late in the visit, or maybe they don’t touch on it at all,” he said. “But clinician recommendation of the HPV vaccine is the single most important factor in parents’ decisions for whether to get the vaccine for their children.”

In Brewer’s study, a majority of doctors reported feeling greater hesitation about discussing the HPV vaccine because they perceived less parental support for it compared to other shots. A majority also reported discussing the HPV vaccine last, only after other teenage vaccinations, like Tdap and the meningitis shot.

Brewer noted there were also some concerns that “they might end up in uncomfortable conversations, perhaps around sex.”

Despite America’s low national HPV vaccination rate, the CDC report does point out that some states (Illinois, Montana, North Carolina and Utah) and metro areas (DC, Chicago and Philadelphia) have been better than others at encouraging HPV vaccination. Philadelphia, for example, reported a single-dose HPV vaccination rate of 80% among teenage girls — double the national average.

Those states and metro areas employed a combination of strategies to increase coverage, Schuchat said, including educating clinicians, conducting public immunization campaigns, and even sending out simple reminders to parents about upcoming shots.

“We have good news in this handful of areas that were using a variety of practices to strengthen HPV cancer protection. We know now it is possible to do much better, but overall there is much more we need to do.”