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14 million additional adolescents needed to reach HPV vaccination goal

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November 19, 2018

HPV vaccination rates among adolescents must increase substantially for the American Cancer Society to achieve its goal of 80% prevalence by 2026, according to study results published in Cancer.

Extensive data support HPV vaccination as a cancer prevention strategy. The CDC recommends routine vaccination — administered in two shots 6 to 12 months apart — for all boys and girls aged 11 or 12 years old. Researchers noted that more than 90% of adolescents who had not initiated HPV vaccination by their 13th birthday had a wellness checkup between the ages of 11 and 12 years.

“Most adolescents presumably had an opportunity to be vaccinated during this time frame. Why it is not happening is a critical question,” Stacey A. Fedewa, MPH, PhD, epidemiologist and strategic director of risk factors and screening surveillance at the American Cancer Society, said in a press release. “While we could not determine whether a provider recommended the vaccine during these visits, previous studies show that only about half of parents reported that they had ever received a recommendation to vaccinate their child against HPV.”

The American Cancer Society set a goal that by 2026, 80% of all U.S. adolescents will be up to date with HPV vaccinations by their 13th birthday.

Fedewa and colleagues pooled data from the 2016 National Immunization Survey for Teens to estimate baseline HPV vaccination prevalence and determine the number of additional vaccinated adolescents needed to reach the goal. The researchers also sought to inform programs aimed at increasing vaccination uptake by identifying the characteristics of those who had not initiated or completed vaccination.

Data from the 2016 survey showed 48.9% of girls and 44.3% of boys had initiated HPV vaccination, and 35.5% of girls and 31.5% of boys were up to date with vaccination by their 13th birthday.

Of the 80.3% of adolescents who had not initiated HPV vaccination, more than 90% reported a recent wellness visit with a health care provider.

For the American Cancer Society goal to be achieved, an additional 7.62 million boys (95% CI, 6.78-8.4) and 6.77 million girls (95% CI, 5.95-7.55) would need to receive two doses of the vaccine between 2018 and 2026.

That would require an additional 18.27 million doses beyond the current vaccination levels, for a total of 57.62 million doses needed.

“To reach this goal, improvements in facilitators of HPV vaccination initiation, including physician recommendations and parental acceptability, are needed,” Fedewa and colleagues wrote.


Adolescents who had not initiated or completed vaccination were more likely to be boys (51.9%), white (56.7%), and have private insurance (56.5%). More than 80% of adolescents who had not initiated or completed vaccination resided in households above the poverty level and had mothers with more than 12 years of education.

“Our findings and others suggest that broader implementation of evidence-based approaches is needed to improve uptake among unvaccinated adolescents,” the researchers wrote. – by Jennifer Southall

Disclosures: Fedewa and other study authors report employment with American Cancer Society’s Surveillance and Health Services Research Program, which received a grant from Merck for intramural research. Please see the study for all other authors’ relevant financial disclosures.

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