Executive Summary
While the number of 13- to 17-year-old boys and girls receiving the HPV vaccine increased slightly for the second year in a row, four out of 10 adolescent girls and six out of 10 adolescent boys have not started the recommended HPV vaccine series, according to national data.
- Since 2008, the yearly national vaccination coverage estimate among female adolescents for one dose of HPV vaccine has been lower than the estimate for one dose of Tdap vaccine, another recommended adolescent vaccine, and the difference in coverage between the two vaccines remains large.
- Clinicians should look to the CDC’s “you are the key” web portal for resources to provide a strong and effective recommendation for the HPV vaccine.
While the number of 13- to 17-year-old boys and girls receiving the human papillomavirus (HPV) vaccine increased slightly for the second year in a row, four out of 10 adolescent girls and six out of 10 adolescent boys have not started the recommended HPV vaccine series, according recent national data from the Centers for Disease Control and Prevention’s (CDC’s) 2014 National Immunization Survey — Teen.1
The latest estimates indicate that 60% of adolescent girls and 42% of adolescent boys have received one or more doses of HPV vaccine. (See the CDC’s infographic at http://1.usa.gov/1NPjO0o.) These numbers are an increase of three percentage points for girls and eight percentage points for boys, according to data from the 2013 report, a random-digit-dialed survey of parents or guardians of teens ages 13-17. The 2014 survey included data for more than 20,000 adolescents.
Analysts found coverage with each HPV vaccine dose was higher among Hispanic girls than among white girls, while coverage with one and two doses of HPV vaccine higher among black girls than among white girls. Coverage with each HPV vaccine dose was higher among girls living below the poverty level compared with those living at or above the poverty level.1
Coverage with each HPV vaccine dose was higher among Hispanic boys than among white boys, and coverage with one dose of HPV vaccine was higher among black boys than among white boys, the analysis reveals. Coverage with each HPV vaccine dose was higher among boys living below the poverty level compared with those living at or above the poverty level.1
When looking at the state level, the analysis shows that for girls, state-level coverage with at least one dose of HPV vaccine ranged from 38.3% in Kansas to 76.0% in Rhode Island. For boys, state-level coverage with at least one dose of HPV vaccine coverage ranged from 23.2% in Indiana to 69.0% in Rhode Island.
Some large increases
While there was a three percentage point overall increase nationally for first-dose HPV vaccine coverage among adolescent girls, a handful of state and local areas achieved much larger increases in coverage, notes Anne Schuchat, MD, assistant surgeon general and director of the CDC’s National Center for Immunization and Respiratory Diseases.
A handful of geographic areas made significant progress, with increases ranging from 13% to 23%, said Schuchat in a press conference. For example, four states saw notable increases in first-dose coverage: Illinois, Montana, North Carolina, and Utah. Chicago and Washington, DC, two of the six local areas surveyed by the CDC, also saw significant increases from 2013 to 2014; Philadelphia, which already had among the highest HPV first-dose coverage rates in 2013 at 77.5%, increased its rate to 80.3% in 2014.
“The large increases in these areas show us that it is possible to make real progress in a variety of settings,” said Schuchat. “But the areas that saw significant improvements had conducted a number of activities aimed at raising coverage, and their experience suggests a combination of strategies is needed, since different approaches may reinforce each other.”
What approaches work?
The Advisory Committee on Immunization Practices recommends that preteens (ages 11 or 12) receive one dose of quadrivalent meningococcal conjugate vaccine, one dose of HPV vaccine, and one dose of tetanus-diphtheria-acellular pertussis (Tdap) vaccine during a single visit. A persistent gap in coverage between HPV vaccination and other vaccinations recommended for adolescents is a sign of missed opportunities to protect adolescents from cancers caused by HPV infections, notes the CDC.
Since 2008, the yearly national vaccination coverage estimate among female adolescents for one dose of HPV vaccine has been lower than the estimate for one dose of Tdap vaccine, and the difference in coverage between the two vaccines remains large, according to CDC data. For example, Tdap coverage in 2014 increased 2.9% to 87.6%. From 2013 to 2014, HPV vaccination coverage for girls increased 3.3 percentage points from 56.7% to 60% in 2014; for boys, HPV vaccination coverage increased from 33.6% in 2013 to 41.7% in 2014, a growth of 8.1%.1
“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,” noted Schuchat. “High Tdap and quadrivalent meningococcal conjugate vaccine rates show it is possible to achieve rates with the current infrastructure, and that starts with reducing missed opportunities to give HPV vaccine.”
What is the CDC doing to increase vaccination rates? The agency’s approaches include establishing links between cancer groups and immunization groups, educating clinicians, adopting practice-based quality improvement efforts, providing feedback on how to improve coverage, conducting public communication campaigns, and using registries and immunization information systems to send reminders to parents about upcoming shots.
Clinicians should look to the CDC’s “You Are the Key” web portal (http://1.usa.gov/1eGPIdM), which includes several resources to give clinicians guidance on how to provide a strong and effective recommendation for the HPV vaccine, says CDC spokesperson Ian Branam. The website also includes patient education resources that clinicians can share with parents, he notes. The CDC recently issued additional guidance online for providers regarding 9-valent HPV vaccine use among persons who previously received HPV vaccination in an effort to address issues that might arise during the transition to 9-valent HPV vaccine. (See guidance at http://1.usa.gov/1J24idk. Also see Contraceptive Technology Update’s coverage of the new vaccine, “New HPV vaccine covers 9 types of HPV, March 2015 STI Quarterly supplement.)
Focus on males
To enhance health services to young men, including HPV vaccination, the Washington, DC-based Partnership for Male Youth is leading the Young Male Well Visit Project with the Research Triangle Park, NC-based American Sexual Health Association, the Baltimore-based Healthy Teen Network, and the Washington, DC-based School Based Health Alliance.
One of the collaboration’s first efforts is the release of two groundbreaking instruments designed to encourage better communication between adolescent and adult young males and their healthcare providers during the young male well visit.
The first instrument, Your Health Is Your Power, is designed for males ages 14-18. The self-assessment tool gives the patient information on what to expect from his clinical visit and includes questions designed to help him think about how he’s feeling physically and mentally about such topics as diet and exercise, substance use, relationships, immunizations, and sexual health.
The second instrument is a provider checklist, designed as a companion piece to the self-assessment tool for young male patients. It triggers questions healthcare providers want to ask, even for patients in the office for a basic sports physical.
Covering the same topics as the patient self-assessment tool, this piece is designed so that multiple topics can be addressed efficiently during every medical visit. (Download both instruments at http://bit.ly/1TvDVYl. Select “A Patient Self-Assessment Tool” for the patient tool and “The Checklist For Healthcare Providers” for the clinician tool.)
This pair of instruments can make the most of clinical visits by prepping adolescent males on what to expect and giving their healthcare providers a concise checklist of targeted questions in several important health domains. These tools were developed through several collaborative activities, including a literature review and research with the target audiences.
Also, clinicians can now use a free health provider toolkit developed especially for adolescent and young adult males that addresses HPV vaccination among other issues. The toolkit is from a multi-disciplinary team of nationally known clinicians and researchers in pediatrics, family medicine, adolescent medicine, sexual and reproductive health, psychiatry, psychology, social work, substance use, trauma, violence, and urology. The toolkit is the Partnership’s flagship effort in enhancing healthcare delivery for adolescent and young adult males.
The clinical toolkit is for healthcare providers who serve adolescent and young adult males ages 10-26. It is designed to address adolescent and young males’ unique healthcare needs. It contains four major clinical components:
- a downloadable checklist for healthcare providers that covers nine major domains where the healthcare needs of adolescent and young adult males are most pronounced and unique;
- a compilation of suggested patient interview questions for each domain;
- supporting materials for each domain consisting of background information, practice tools, and references;
- a video library of continuing medical education and patient education presentations on subjects covered by the toolkit.
The toolkit will be continually updated with suggestions from users and from focus groups of clinicians who will review the instrument, according to the Partnership for Male Youth. Comments may be submitted through the comment button at the top of each page. (Access the toolkit components at http://bit.ly/1TvEC3S.)
REFERENCE
- Reagan-Steiner S, Yankey D, Jeyarajah J, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years — United States, 2014. Morb Mortal Wkly Rep 2015; 64(29):784-792.
The latest estimates indicate that 60% of adolescent girls and 42% of adolescent boys have received one or more doses of HPV vaccine.
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