In the JournalsPerspective

Only 16% of teens complete HPV vaccine series by age 13 years

Robert A. Bednarczyk

A recent analysis of data from the National Immunization Survey-Teen found that only 16% of U.S. adolescents completed HPV vaccination before the age of 13 years and only 35% before turning 15 years of age. The Advisory Committee on Immunization Practices recommends vaccination in children aged 11 to 12 years.

“This recommendation — vaccination at 11 to 12 years of age — is built off of a few key reasons. First, the immune response when adolescents are vaccinated at younger ages is stronger compared to adolescents vaccinated at older ages. Second, with two other vaccines recommended at the same ages, vaccinating against HPV at 11 to 12 years will minimize the number of visits adolescents need to complete their adolescent vaccination platform,” study researcher Robert A. Bednarczyk, PhD, of the Hubert Department of Global Health and the Rollins School of Public Health at Emory University, told Infectious Diseases in Children.

The 2016 NIS-Teen survey is a random digital dial telephone survey of parents of adolescents aged 13 to 17 years. In their study, the researchers classified adolescents based on HPV vaccine series initiation and completion before age 13 and 15 years.

The analysis focused on 20,475 parents. Of those, only 15.8% said their children had initiated and completed the HPV vaccine series before the age of 13 years, and only 34.8% said their children were fully up to date by age 15 years. In addition, 23.6% of adolescents initiated HPV vaccination after turning age 13 years, and only 7% initiated after reaching age 15 years.

“This study highlights how much room for improvement there is in HPV vaccination for U.S. adolescents. While vaccination rates have gone up in recent years, we were concerned seeing that only 16% of U.S. adolescents were fully vaccinated against HPV by their 13th birthday,” said Bednarczyk. “It is important for health care providers to strongly recommend HPV vaccination at 11 to 12 years of age as part of the full adolescent vaccine platform.”– by Erin Michael

Disclosure: Bednarczyk reports no relevant financial disclosures.

Robert A. Bednarczyk

A recent analysis of data from the National Immunization Survey-Teen found that only 16% of U.S. adolescents completed HPV vaccination before the age of 13 years and only 35% before turning 15 years of age. The Advisory Committee on Immunization Practices recommends vaccination in children aged 11 to 12 years.

“This recommendation — vaccination at 11 to 12 years of age — is built off of a few key reasons. First, the immune response when adolescents are vaccinated at younger ages is stronger compared to adolescents vaccinated at older ages. Second, with two other vaccines recommended at the same ages, vaccinating against HPV at 11 to 12 years will minimize the number of visits adolescents need to complete their adolescent vaccination platform,” study researcher Robert A. Bednarczyk, PhD, of the Hubert Department of Global Health and the Rollins School of Public Health at Emory University, told Infectious Diseases in Children.

The 2016 NIS-Teen survey is a random digital dial telephone survey of parents of adolescents aged 13 to 17 years. In their study, the researchers classified adolescents based on HPV vaccine series initiation and completion before age 13 and 15 years.

The analysis focused on 20,475 parents. Of those, only 15.8% said their children had initiated and completed the HPV vaccine series before the age of 13 years, and only 34.8% said their children were fully up to date by age 15 years. In addition, 23.6% of adolescents initiated HPV vaccination after turning age 13 years, and only 7% initiated after reaching age 15 years.

“This study highlights how much room for improvement there is in HPV vaccination for U.S. adolescents. While vaccination rates have gone up in recent years, we were concerned seeing that only 16% of U.S. adolescents were fully vaccinated against HPV by their 13th birthday,” said Bednarczyk. “It is important for health care providers to strongly recommend HPV vaccination at 11 to 12 years of age as part of the full adolescent vaccine platform.”– by Erin Michael

Disclosure: Bednarczyk reports no relevant financial disclosures.

    Perspective
    Amy Middleman

    Amy Middleman

    The article by Bednarczyk confirms what many of us have suspected for some time: despite recommendations that the HPV vaccine be given at the 11- to 12-year clinical visit, it is often being delayed. The delay in vaccination is likely related to a misguided focus by both parents and providers on the mode of transmission of the target disease rather than the fact that the vaccine prevents a disease that kills thousands of people annually in the U.S. alone. The CDC takes great care in making vaccine recommendations. The epidemiology of each vaccine-preventable disease is always considered in their deliberations regarding the ideal age for vaccination. As Bednarczyk points out in his article, although first sexual intercourse may occur after the age of 13 years, vaginal intercourse is not required for HPV transmission; youth may be at risk for exposure during the years of sexual experimentation that precede first sexual intercourse. In addition, we have seen the advantages of immunizing children with multiple vaccines at specific immunization platform visits; the likelihood of vaccine adherence increases when multiple vaccines are expected and given at the same visit. The immune response is more vigorous among younger patients, and those who initiate the series under 15 years of age (who are not immunocompromised) need only two doses for protection. All of these issues are carefully researched and considered by the ACIP while developing and updating vaccine recommendations. All available data both published and unpublished are included in their analyses. 

    Additionally concerning is that some vaccine recommendations for adolescents seem to be viewed as less important and more “optional” than vaccine recommendations for younger children. In a way, that is not an issue with many vaccines against childhood diseases. Parents, providers and patients are unlikely to see the potential consequences of delayed HPV vaccination until years later if HPV-related cancers develop. Then, it will be too late to change the decision to delay vaccination. I would urge parents, providers and patients to learn more about the exhaustive data collection that informs vaccine recommendations and to trust that vaccine recommendations take into account all the best evidence available and are updated accordingly. The decision to recommend the HPV vaccine at the age of 11 to 12 years was a deliberate and well-studied one; the decision to delay HPV vaccination is an active one that carries with it its own potential risks.

    • Amy Middleman, MD, MSEd, MPH
    • Infectious Diseases in Children Editorial Board member
      CMRI Richard Kasterke/Connie Griggs Endowed Chair
      Professor of pediatrics
      Chief of adolescent medicine
      University of Oklahoma Health Sciences Center

    Disclosures: Middleman serves as an investigator for a contract that her institution has signed with Pfizer to develop educational materials related to MenB recommendations.