“We need to approach this as a cancer-preventing vaccine, not as an STI-preventing vaccine.”
Advisory Committee on Immunization Practices (ACIP) recommends a three- dose series of vaccine injections within a six-month period for 11- and 12-year-old boys and girls. ACIP guidelines state vac- cination can begin as early as age 9 and should be completed by age 26. The National Immunization Survey
reports that in 2012 about 30 percent of Texas females aged 13 to 17 had re- ceived all three doses of HPV vaccine. The national rate is only slightly higher at 33 percent for the same year. The fact that the vaccine is voluntary
is a major barrier, says Lisa Swanson, MD, a Mesquite pediatrician and mem- ber of the Texas Medical Association Committee on Child and Adolescent Health.
“It’s been a very tough sell,” she said. Dr. Swanson says she administers
most required vaccinations to patients at age 12, before the patient enters seventh grade. Those adolescent patients often receive two or three shots per visit. “It’s difficult for patients to talk them- selves into an extra shot that’s not re- quired,” she said. Gov. Rick Perry signed an executive
order in 2007 that would have required HPV vaccination of all sixth-grade girls in Texas. The Texas Legislature over- turned the order.
HPV is the most common sexually
transmitted infection (STI) in the United States, with about 40 different strains of the genital virus, according to CDC. The vaccine has made an impact
36 TEXAS MEDICINE April 2014
since it hit the market in 2006. A study in the Aug. 1, 2013, issue of The Journal of Infectious Diseases shows preventable strains of HPV decreased 56 percent in girls aged 14 to 19 in the four years fol- lowing the vaccine’s introduction. But physicians say it’s difficult to immunize patients in the ACIP-recommended tar- get age range. Dr. Swanson says that in her experi- ence, by age 12, most adolescents stop visiting the doctor regularly. Of those who do visit regularly, only about one in five agrees to HPV immunization. “It’s just hard to talk people into get- ting it,” she said. “Teenagers don’t like vaccines; they don’t like shots.” TMA can help physicians deliver the HPV vaccine to more adolescents through its Be Wise — ImmunizeSM
cam-
paign. Be Wise provides education and funding resources for physicians who want to help improve vaccination rates in Texas. (See “TMA Program Helps Doc- tors Spread the Word,” opposite page.)
Physician recommendation matters ACIP modified its HPV vaccine recom- mendation in January, stating the third dose should be administered at least 12 weeks after the second dose and at least 24 weeks after the first dose. The committee recommends only the quad- rivalent HPV vaccine for boys; girls can receive either the bivalent or quadriva- lent version. For more information, visit
www.cdc.gov/vaccines.
A health care professional’s recom- mendation to vaccinate against HPV is a powerful motivator for patients, accord- ing to CDC. Keller pediatrician Jason Terk, MD, past chair of the TMA Council on Sci- ence and Public Health and a member of the Be Wise — Immunize Advisory Panel, says the most significant limitation on administering the vaccine is the lack of broad affirmative promotion on the part of physicians. “We know that a strong physician en- dorsement of this vaccine will increase adoption and provision of HPV vaccine more broadly,” Dr. Terk said. “As long as it is stated or implied to be merely op- tional, the full promise of this important cancer-preventing vaccine will remain unfulfilled.”
A 2008 TMA survey and a study pub- lished this year in the American Journal of Preventive Medicine (AJPM) show phy- sicians recommend HPV vaccination only about half of the time. TMA’s statewide survey, conducted by the former Physician Oncology Edu- cation Program and published in the Au- gust 2009 issue of Cancer Epidemiology, Biomarkers & Prevention, revealed fewer than half of 1,122 participating Texas physicians always recommended the vaccine to 11- and 12-year-old girls. Six- ty-eight percent of physicians surveyed said they were likely to recommend the vaccine to 11- and 12-year-old boys, and about 42 percent agreed vaccination should be mandatory. “Physicians’ Human Papillomavirus
Vaccine Recommendations, 2009 and 2011,” a study in the January 2014 issue of AJPM, shows similar results nationally, and the instance of doctors recommend- ing the vaccine to patients rose only slightly over a two-year period. Of the physicians who participated in
the survey reported in AJPM, 35 percent in 2009 said they always recommended the vaccine to 11- and 12-year-old boys and girls. In 2011, the rate jumped to 40 percent. The recommendation rate for patients aged 13 to 17 was 53 percent in 2009 and 55 percent in 2011. For patients aged 18 to 26, the recommendation rate increased from 50 percent in 2009 to 52
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68