Trends in HPV Vaccination

Abstract

Source: Chido-Amajuoyi OG, Talluri R, Wonodi C, et al. Trends in HPV vaccination initiation and completion within ages 9-12 years: 2008–2018. Pediatrics. 2021;147(6): e2020012765; doi:10.1542/peds.2020-012765Investigators from multiple institutions conducted a retrospective study to evaluate trends in human papillomavirus (HPV) vaccination in US children 9-12 years old during the period 2008–2018. For the study they reviewed data from the National Immunization Survey-Teen (NIS-Teen). NIS-Teen is an annual population-based survey used to collect vaccination information on US teens between the ages of 13 and 17. Random digit dialing is used to contact households to collect demographic and immunization data. Dates of vaccinations are verified using a questionnaire mailed to health care providers identified by survey respondents. Data from NIS-Teen are weighted to provide nationally representative estimates. For the current study, data on the cohort of youths who were 13 years old at the time of each survey between 2008 and 2018 were abstracted. Rates of HPV initiation between the ages of 9 and 12 years were determined, and, when full data became available in 2011, annual rates of HPV up-to-date (HPV-UTD) status calculated. HPV-UTD was defined as receipt of 3 doses of HPV vaccine, or receipt of 2 doses at least 5 months (minus 4 days) apart, before a child’s 13th birthday. Results were stratified by sex, race (white or Black), ethnicity, and state. Logistic regression was used to assess the differences in HPV initiation and HPV-UTD rates over time.During the study period, nationally representative HPV vaccination rates for children 9-12 years old were based on annual number of responses ranging from 3,455 to 4,763. Overall, HPV initiation rates rose from 17.3% in 2008 to 62.8% in 2018 (P < 0.0001 for trend), and HPV-UTD increased from 13.5% in 2011 to 32.8% in 2018 (P < 0.0001). HPV-UTD rates increased by 31.9% between 2011 and 2018 among boys, compared to a 6.6% increase in girls. Throughout the study period HPV-UTD rates were higher in Hispanic children than those in non-Hispanic white and non-Hispanic Black youths. Similarly, HPV-UTD rates were higher in non-Hispanic Black youths than in non-Hispanic whites. By 2018, HPV initiation rates were >60% in 32 US states and >70% in 16. HPV-UTD rates were <50% in all states except Rhode Island (61.6%), Colorado (58.7%), Hawaii (53.5%), and Ohio (50%), as well as the District of Columbia (53.2%). States with the lowest HPV-UTD rates were Mississippi (12.5%), Missouri (14.2%), and Utah (15.7%).The authors conclude that HPV vaccination status in US children 9-12 years old is suboptimal.Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The HPV vaccine is unique. It is the first to protect against adult cancers rather than a childhood infectious disease. Cervical cancer is the second leading cause of cancer death of women worldwide.1 Numerous studies have shown that the HPV vaccine reduces transmission of the carcinogenic strains of HPV virus in nearly 100% of individuals, as well as greatly reduces the development of cervical dysplasia.1,2 The vaccine is recommended by the AAP in both boys and girls between the ages of 9-12, before most sexual activity and when immunogenicity is high.2 Approximately 23% of parents are hesitant about the safety, efficacy, and importance of the HPV vaccine.3 To reach herd immunity, the Healthy People 2020 initiative set a goal of 80% vaccination, giving promise for the near eradication of cervical and penile cancer.4 The present rate of completed vaccination in the US is 51.1%.5The current investigators followed trends of HPV vaccination over a period of 10 years using a large national database. There was wide variation in vaccine adherence across the country—from a low of 12.5% in Mississippi to the high of 61.6%% in Rhode Island. The investigators cite several programs that improve the success of Rhode Island, such as free access to vaccines, school-based vaccine programs, and a physician-led program to assist poorly performing practices.6 The success of some state programs and failure of others suggests differences in vaccine priority and healthcare infrastructure. The downstream effects of a failed HPV vaccine policy have serious consequences to the public health. The results of the current study highlight this national failure and serves as a clarion call for health care leaders to address this shortfall.The HPV vaccination rate for US children is suboptimal.Concurrent data from the CDC reveal marked decreases in the 9 vaccine serotypes infection rates since introduction of the quadrivalent and 9-valent HPV vaccines.7 Single-dose HPV vaccines, currently being investigated, hold promise to further increase vaccination and to decrease infection rates.8