Study: Improvements needed in how the HPV vaccine is recommended

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AUSTIN (Nexstar) — Improvements are needed in the way physicians recommend the Human Papillomavirus vaccination, according to a new study published in Pediatrics Monday.

The study, “HPV Vaccine Delivery Practices by Primary Care Physicians,” was conducted by researchers from the University of Colorado and the National Center for Immunization and Respiratory Diseases. They surveyed 588 pediatricians and family physicians by internet and mail between July and September 2018.  

HPV is a common sexually transmitted disease. The Centers for Disease Control and Prevention says based on data from 2012 to 2016, about 44,000 HPV-associated cancers occur in the U.S. each year. Cervical cancer is the most common HPV-associated cancer in women and cancers in the back of the throat are the most common among men. 

The Advisory Committee on Immunization Practices, or ACIP, routinely recommends HPV vaccination at ages 11 or 12 to protect against the potentially cancer-causing virus. ACIP also recommends vaccination for females ages 13 to 26 and males ages 13 to 21 if not adequately vaccinated before. Two doses of the HPV vaccine are recommended for those who start the series before their 15th birthday, according to ACIP. Those who begin the series at age 15 or older need three doses.

“Physicians were more likely to report high refusal rates by 11-to-12-year-old patients if physicians did not use a presumptive style, if physicians did not strongly recommend vaccination to young adolescents or if physicians anticipated less resistance to vaccination from patients older than 11 or 12 years,” researchers wrote. 

A presumptive recommendation means introducing the HPV vaccine the same way other vaccines would be recommended, with an assumption that there won’t be hesitation towards it.

“Although a majority of pediatricians do recommend the vaccine strongly when it’s to be recommended, which is at 11 to 12 years of age, even higher numbers choose to wait and strongly wait to recommend at 13 and 14 years of age,” Allison Kempe, M.D., M.P.H., of the University of Colorado School of Medicine, said. “That’s suboptimal because some adolescents are already sexually active by that time.”

Kempe was the study’s lead author.

Dr. Fredricka Barr from Baylor Scott & White Health in Austin says the biggest barrier she faces when talking to parents is cutting past the myth that the HPV vaccine doesn’t apply to boys.

“We understand why we should give it to the girls because we’re trying to prevent cervical cancer, but a lot of them are not aware that it can actually cause penile cancer as well,” Barr said. “So in both girls and boys, we have to make sure that they’re both covered.”

Barr says it’s important to address questions from parents about safety and other worries.

“We as physicians just have to not get discouraged,” she said. “If a parent is hesitant or if they’re just not as interested in getting it at this time, we just have to take every opportunity, every well visit, every visit in general to just bring it up.”

Researchers found that pediatricians who do strongly recommend the vaccine increased from 60 percent in 2013, when the survey was last conducted, to 85 percent in 2018 among 11 or 12-year-old females and increased from 52 percent to 83 percent in 11 to 12-year-old males.

From 2011 to 2015, there were a total of 15,353 cases of HPV-associated cancers in Texas. According to the Texas Department of State Health Services, cervical cancer incidence rates were highest compared to other HPV-associated cancers in women.

A 2017 National Immunization Survey shows there was an increase in 2017 from 2016 in HPV coverage rates, but the Lone Star State still lagged the national average.  

The DSHS website says that in 2019, it’s estimated that 1,395 Texas women will be diagnosed with cervical cancer and about 447 will die from it. 

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