HPV Vaccine

HPV Updates:

1/12/2017 - Texas Health and Human Services HPV Strategic Plan Released

The Texas Department of State Health Services and the Texas Health and Human Services Commission have released their HPV Strategic Plan as required by Senate Bill 200 of the 84th Legislature, 2015. You can read the full report here

12/23/16 - DSHS Vaccine Advisory on Updated CDC Recommendations

The Texas Department of State Health Services has released a vaccine advisory regarding the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) updated recommendations regarding the three injection series of HPV vaccination in adolescents, beginning at age 11-12 years. CDC now routinely recommends two doses of HPV vaccine for 11 or 12 year olds to prevent HPV cancers.

Read the full DSHS advisory here.

Read the Updated ACIP recommendations here

About the HPV Vaccine:

Since the introduction of HPV vaccine in 2006, coverage in females has been gradual but remains low. Although one dose vaccination rates increased from 25.1% in 2007 to 54.0% in 2012, uptake of HPV vaccine has stalled despite the CDC/ACIP recommendation for routine vaccination starting at 11-12 years of age. The rate of completion for all doses of HPV vaccine remains extremely low nationwide. In 2011, Texas ranked at an unenviable position of 37th in the nation for providing 1 dose of HPV vaccine and 31st for providing 3 doses. Clearly, we have some work to do.

Missed Opportunities
Girls are missing out on HPV vaccine despite visiting a health care provider after their 11th birthday. According to recent studies, 85% of girls who are not vaccinated had at least one health care visit in which HPV vaccine could have been given, but was not - as a matter of fact, other vaccines were given…but not HPV. If all such opportunities were utilized, the estimates are that the coverage would exceed 90%. The consequences of under-vaccination are substantial: CDC estimates that 4400 women could develop cervical cancer as a result of missed opportunities for vaccination. Up to 1400 women could die as a result of these missed opportunities.

Among those who are vaccinated, the potential benefits of HPV vaccine are now being recognized: Among females aged 14–19 years, the prevalence of vaccine-type HPV (HPV-6, -11, -16, or -18) infection decreased from 11.5% in 2003–2006 to 5.1% in 2007–2010 - a decline of 56%. The vaccine effectiveness of at least 1 dose is 82%, and for 3 doses it is up to 100%. This translates into a decrease in HPV associated cervical cancer in women.

HPV vaccine is safe, effective, and it is preventing cancer. What’s the problem?

Parental Perceptions
Surveys among parents have shown the following reasons for HPV vaccine hesitancy:

  • They did not feel the HPV vaccine was necessary
  • They did not feel the HPV vaccine was recommended
  • They had concerns about the HPV vaccine’s safety
  • They lacked knowledge about vaccine or disease
  • Their daughter is not sexually active

Armed with this information and the population based experience on HPV vaccine benefits, health care providers and public health officials must improve efforts to increase immunization rates. The reasons for the low HPV vaccination rates are many, but there is a clear failure to communicate the benefits of HPV vaccination.

Tips for Providers:
  • HPV vaccine is recommended by the Advisory Committee on Immunization Practices for both male and female adolescents, and should be provided along with other routine vaccines. Review about the most recent CDC recommendations here.
  • Healthcare professionals should make strong recommendations and vaccinate all patients at 11 or 12 years of age. Missed opportunities data show that if HPV vaccine was given every time a clinician gave a Tdap or MCV4 dose, HPV vaccine coverage would be over 90 percent.
  • If not given at age 11 or 12, the HPV immunization series should be initiated in all teens and up to 26 years of age.
  • As opposed to discussing only vaccines that are required for school entry, present parents with information on all recommended vaccines for adolescents.
  • Emphasize to parents that HPV vaccine prevents cancer.
  • Discuss with parents how common HPV is and that to be most effective, it must be given before the onset of sexual activity – whenever that may be.
  • After 7 years of use since approval, data shows that the HPV vaccine is both safe and effective.
  • Don’t miss opportunities to vaccinate - vaccinate against HPV at both sick and well child visits, sports physicals, or any other vaccination visit.
  • Use the “alerts” in your EMR system to remember when vaccines are needed.
  • Use reminder recall systems to remind patients when a vaccine is due (post cards, phone calls, and text messages).
  • Ask nurses to check vaccine status as they bring the child/parent into the exam room.
  • Use standing orders specific for HPV vaccination.
  • Use educational resources available from CDC, TDSHS and other reliable sources
  • Remember that your recommendation is the strongest factor for acceptance of vaccines because parents and patients trust their physician’s advice above anyone else’s.

The Texas Pediatric Society's Committee on Infectious Diseases and Immunizations supports CDC recommendations and encourages providers to improve HPV vaccination coverage of Texas adolescents.

Resources
 
CME Webinars and Self-Study Opportunities
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