Human Papillomavirus Vaccine Recommendations Research Articles

PCN17 Predicting the Potential Cost and Effects of Prophylactic HPV Vaccination in Males in Thailand

To predict the potential cost and effects of adding males with females for HPV vaccination in Thailand. Human Papillomavirus (HPV) is the most commonly sexual transmitted virus in the United States. The American Academy of Pediatrics (AAP) recommends HPV vaccination for adolescent. Many studies show that HPV vaccination is beneficial in preventing HPV-associated diseases, such as cervical cancers, cervical intraepithelial neoplasia (CIN), genital warts and others. In Thailand, cervical cancer is the second most common cancer. The cost and effects of vaccination in males is generally considered as beneficial as vaccine coverage of females. A basic model of HPV vaccination was developed based on current literatures to estimate the economic and health effects of HPV-associated diseases in both males and females in the United States comparing to populations in Thailand. The baseline vaccination costs per case in USA and Thailand are 500 USD and 265 USD (9283 baht) respectively. The QALYs gained per case for both countries are 0.0126 in females and 0.0094 for combined males and females. Totals for combined males and females vaccination is 493,153 QALYs for USA and 13,957 QALYs for Thailand. Adding HPV vaccination in adolescent males in Thailand is certainly more costly, but still beneficial. The potential of health benefits depends more on the female HPV vaccination coverage, however, males add benefits also. If the coverage rate for females is high, the health benefits increase. Based on the total population, the benefits can be substantial.

Are there socioeconomic disparities in women having discussions on human papillomavirus vaccine with health care providers?

BackgroundHuman papillomavirus (HPV) vaccine recommendation by a health care provider (HCP) is an important predictor of vaccine receipt. We examined whether being of a minority race/ethnicity, having lower income and education, and the lack of health insurance and a regular HCP are each associated with a lower likelihood of a discussion on HPV vaccine occurring between a woman and her HCP.MethodsA sample of 1,631 women aged 18 years and older was drawn from the 2007 Health Information National Trends Survey. Given that only a subgroup of women who were aware of the HPV vaccine were asked if they had a discussion with their HCPs, we estimated a probit model correcting for sample selection.ResultsAmong those aware of the HPV vaccine, 17.3% of respondents reported having discussions on the vaccine with their HCPs. Compared with Whites, African Americans were less likely to be aware of the HPV vaccine but more likely to have discussions with their HCPs concerning the vaccine. A statistically significant association between lower income and education levels and a lower likelihood of HPV vaccine awareness was observed, but low levels of income and education did not appear to affect the probability of having HPV vaccine discussions with HCPs.ConclusionsSocioeconomically disadvantaged women did not show a lower propensity to have vaccine discussions with their HCPs, suggesting that HCPs can be a major catalyst in increasing vaccine receipt among the higher risk group. The results of the study suggest a two-pronged approach that seeks to raise vaccine awareness among socioeconomically disadvantaged women at the population level and encourages HCPs to intensify discussions about the HPV vaccine with patients.

Abstract B06: Rural women's decision making about cervical cancer prevention in South Carolina.

Abstract Objective: Despite advances in screening and prevention, cervical cancer disparities have been detected in minority, rural, and underserved women. This study explored women's knowledge, attitudes, and behavior related to human papillomavirus (HPV) and cervical cancer prevention in South Carolina, which ranks fourteenth in the United States in cervical cancer incidence and mortality. Methods: Three focus groups were conducted in two rural and urban counties as part of a community-based participatory (CBPR) project. Instrument development and participant recruitment were conducted in partnership with a community advisory board. Snowball sampling was employed to recruit twenty-eight adult women (18-70 years of age). An Institutional Review Board approved the study and informed consent was obtained. Results: Cervical cancer prevention knowledge varied, with urban women reporting greater exposure to public health campaigns. Most participants had more positive views about screening than HPV vaccination, but were less knowledgeable about current screening guidelines. Lack of health insurance, transportation, and costs were main barriers to screening. Provider recommendations for HPV vaccination also emerged as a barrier. Lack of provider recommendations and ineffective patient-provider communication were viewed as greater barriers to HPV vaccination than cost due to expanded access vaccination programs. Conclusions: Rural women view cervical cancer screening as an important health service; however, their health decisions are informed by cancer prevention knowledge, access to care, cost concerns. Providers are a trusted source of health information and present an opportunity to convey culturally-appropriate evidence-based messages about cervical cancer prevention and control. Citation Format: Jessica D. Bellinger, Whitney Millegan, Azza Abdalla, Kim Creek. Rural women's decision making about cervical cancer prevention in South Carolina. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B06.

Provider factors associated with disparities in human papillomavirus vaccination among low‐income 9‐ to 17‐year‐old girls

Many women who develop cervical cancer are eligible for or are participants of Medicaid. Providing human papillomavirus (HPV) vaccination to girls enrolled in Medicaid may reduce cervical cancer disparities in low-income and minority women. This study evaluated provider characteristics associated with HPV vaccination among 9- to 17-year-old female Medicaid enrollees. A random sample of 800 providers from the Florida Medicaid Master Provider File was mailed a survey in October 2009 that evaluated demographic and practice characteristics, HPV information and knowledge, barriers to HPV vaccination, vaccine practices, and vaccine recommendation practices. To measure HPV vaccination, Medicaid claims data were used to calculate the proportion of eligible patients who received at least 1 dose of the vaccine from participating providers within the study period. Provider factors associated with vaccination at the bivariate level were evaluated in a multiple linear regression model. The response rate was 68.3% (N = 485). After excluding ineligible respondents, the current analysis included 433 providers. HPV vaccination prevalence ranged from 0% to 61.9% (M = 20.4, standard deviation = 14.5). HPV vaccination rates were higher among providers who were pediatricians, had a private practice, practiced in a single specialty setting, were providers under the Vaccines for Children program, saw primarily non-Hispanic white patients, used 2 or more strategies for vaccine series completion, and did not refer out for HPV vaccination. Despite financial coverage for Medicaid-eligible girls, HPV vaccination rates are low. Study findings can be used to target health services interventions to providers least likely to administer HPV vaccine to female Medicaid enrollees.

Do correlates of HPV vaccine initiation differ between adolescent boys and girls?

BackgroundGuidelines now recommend that adolescents routinely receive human papillomavirus (HPV) vaccine. Because little is known about uptake among boys, we assessed HPV vaccine initiation in a population-based sample of adolescent boys and girls. MethodsWe analyzed weighted data from 751 parents who reported on an 11- to 17-year-old son or daughter for the 2010 North Carolina Child Health Assessment and Monitoring Program survey. Stratified multivariate logistic regression analyses identified correlates of HPV vaccine initiation separately for boys and girls. ResultsOnly 14% of sons had received one or more doses of HPV vaccine compared to 44% of daughters (p<0.01). For both sons and daughters, vaccine initiation correlated with age and having received meningococcal vaccine. Among sons, initiation of HPV vaccine was lower for those living in high income households (odds ratio [OR]=0.22, 95% CI, 0.09–0.53) and higher for those whose race was neither white nor black (OR=3.26, 95% CI, 1.06–10.04). When asked to give the main reason for not vaccinating their child against HPV, parents of unvaccinated sons were more likely than those of daughters to report not getting a provider's recommendation or not being aware that the vaccine was available for their child, but less likely to report concern about safety (p<0.01). At least 86% of unvaccinated children had missed an opportunity to receive HPV vaccine. ConclusionsHPV vaccine correlates and concerns varied for parents of boys and girls. To improve very low levels of uptake among boys, providers should recommend HPV vaccine concomitant with other adolescent vaccines.

Human Papillomavirus Vaccines: Where Do They Fit in HIV-Infected Individuals?

Human papillomavirus (HPV) is the etiological agent for cervical cancer and a large majority of anal cancers worldwide. In 2006 two preventive vaccines against the HPV were approved by the US Food and Drug Administration and have since been approved in over 100 countries. HIV-infected populations are at an increased risk for HPV-related cancers. None of the efficacy trials for these vaccines included HIV-infected populations. However, studies in HIV-infected children and adult men show that the vaccine is safe and highly immunogenic. Studies evaluating the vaccine in HIV-infected women are in progress. Based on these studies, the American Council on Immunization Practices recommends HPV vaccination for all HIV-infected children and young adults up to age 26 years. HPV vaccine policies in resource-limited countries, many of which have a high prevalence of HIV infection, are still being developed. Future studies should examine the role of HPV vaccination for older HIV-infected adults who likely have ongoing HPV infection.

Knowledge about human papillomavirus (HPV), and health beliefs and intention to recommend HPV vaccination for girls and boys among Korean health teachers

The human papillomavirus (HPV) vaccination rate in Korea is very low because a school-based HPV vaccination program has not yet been introduced. This study was designed to assess HPV knowledge, compare the health beliefs toward HPV vaccination and intention to recommend HPV vaccination for girls and boys, and identify the factors influencing the intention to recommend HPV vaccination for girls and boys among Korean health teachers. A descriptive cross-sectional study design was employed, in which 757 health teachers who worked at elementary, middle, high, and special schools in Korea participated via an online survey. A self-administered, structured questionnaire was applied, which included items on sociodemographics, HPV awareness, HPV knowledge, perceived benefits, susceptibility, severity, and barriers toward HPV vaccination for girls and boys, and intention to recommend HPV vaccination for girls and boys. The rate of correct HPV knowledge items ranged from 5.2% to 89.2%; 23.4% of the health teachers answered that they had ever taught about HPV, 97% answered that both boys and girls should receive HPV vaccination, and 47.6% answered that the best time for HPV vaccination is when students are at middle school. There were differences regarding the perceived benefits (Z=−7.69, p<0.001), perceived susceptibility (Z=−3.37, p=0.001), perceived severity (Z=−4.13, p<0.001), and perceived barriers (Z=−4.90, p<0.001) toward HPV vaccination, and regarding intention to recommend HPV vaccination (Z=−15.21, p<0.001) for girls and boys. Factors associated with the intention to recommend HPV vaccination for girls were the HPV vaccination status of the health teachers’ children [odds ratio (OR)=4.24, 95% confidence interval (95% CI)=1.14–15.72], and the teachers’ Pap-test experience (OR=2.50, 95% CI=1.05–5.91), perceived benefits (OR=3.30, 95% CI=1.26–7.40), perceived susceptibility (OR=3.25, 95% CI=1.58–6.68), and perceived barriers (OR=0.51, 95% CI=0.30–0.99); these factors for boys were the health teachers’ career duration (OR=1.61, 95% CI=1.12–2.32), HPV knowledge (OR=1.45, 95% CI=1.01–2.09), perceived benefits (OR=3.46, 95% CI=2.27–5.26), perceived susceptibility (OR=1.55, 95% CI=1.04–2.29), and perceived severity (OR=1.71, 95% CI=1.15–2.56). General awareness of HPV should be increased and more specific information about HPV—including that related to vaccination of boys and men—should be provided for health teachers. Although a school-based HPV vaccine program has yet to be introduced in Korea, health teachers should possess general knowledge about HPV and HPV vaccination, and differences in attitudes and intentions related to HPV vaccination between girls and boys should be reduced.

Human papillomavirus vaccine knowledge and hypothetical acceptance among women in Appalachia Ohio

ObjectiveTo assess hypothetical acceptance of the human papillomavirus (HPV) vaccine for themselves and a daughter age 9–12 years among Appalachia Ohio women. MethodsWomen with an abnormal Pap smear and randomly selected women with a normal Pap smear from 17 clinics completed an interview in 2006–2008. ResultsFrom 1131 original study participants, 807 (71%) completed a survey about the HPV vaccine for their daughters and themselves. Nearly half, 380 (47%), of the participants had heard of a vaccine to prevent cancer, and 362 (95%) of respondents had heard of HPV. The participants were then told that the FDA had approved a vaccine to prevent HPV. Only 379 (38%) participants identified girls ages 9–12 years as a group who should get the vaccine. After being given the official HPV vaccine recommendation statement, 252 (31%) wanted the vaccine; 198 (25%) were “not sure”; and 353 (44%) did not want the vaccine for themselves. With respect to giving the HPV vaccine to a daughter ages 9–12 years, participants responded “yes” 445 (55%); “not sure” 163 (20%); or “no” 185 (23%). Numerous reasons were provided supporting and opposing vaccine acceptance for themselves and for a daughter. Their physician's recommendation for the HPV vaccine increased vaccine acceptance to 86% for themselves and 90% for a daughter. ConclusionKnowledge, acceptance, and barriers about the HPV vaccine vary among women living in Appalachia Ohio. Physician recommendation is a key facilitator for vaccine diffusion in this region.

Health care provider recommendation, human papillomavirus vaccination, and race/ethnicity in the US National Immunization Survey.

Human papillomavirus (HPV) is a common sexually transmitted infection in the United States, yet HPV vaccination rates remain relatively low. We examined racial/ethnic differences in the prevalence of health care provider recommendations for HPV vaccination and the association between recommendation and vaccination. We used the 2009 National Immunization Survey-Teen, a nationally representative cross-section of female adolescents aged 13 to 17 years, to assess provider-verified HPV vaccination (≥ 1 dose) and participant-reported health care provider recommendation for the HPV vaccine. More than half (56.9%) of female adolescents received a recommendation for the HPV vaccine, and adolescents with a recommendation were almost 5 times as likely to receive a vaccine (odds ratio = 4.81; 95% confidence interval = 4.01, 5.77) as those without a recommendation. Racial/ethnic minorities were less likely to receive a recommendation, but the association between recommendation and vaccination appeared strong for all racial/ethnic groups. Provider recommendations were strongly associated with HPV vaccination. Racial/ethnic minorities and non-Hispanic Whites were equally likely to obtain an HPV vaccine after receiving a recommendation. Vaccine education efforts should target health care providers to increase recommendations, particularly among racial/ethnic minority populations.

Human papillomavirus vaccine practices in the USA: do primary care providers use sexual history and cervical cancer screening results to make HPV vaccine recommendations?: Table 1

Guidelines recommend against the use of Papanicolaou (Pap) or human papillomavirus (HPV) testing when determining eligibility for the HPV vaccine. Optimally, the HPV vaccine should be administered before sexual initiation. Guidelines recommend that age-eligible women with past exposure to HPV should still be vaccinated. Little is known about how primary care providers (PCPs) use sexual history and HPV and Pap tests in their HPV vaccine recommendations. Data from the 2007 Cervical Cancer Screening Supplement (CCSS) administered with the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to assess HPV vaccination recommendations. The CCSS investigates cervical cancer screening practices, HPV testing and HPV vaccine recommendations among PCPs. A summary measure of compliance with guidelines was defined as rarely or never using the number of sexual partners and HPV tests and Pap tests to determine vaccine receipt. A total of 421 PCPs completed the CCSS in 2007. Among NAMCS and NHAMCS providers who recommend the HPV vaccine, only 53% (95% CI 42% to 63%) reported making guideline-consistent recommendations. The majority reported sometimes to always recommending the HPV vaccine to women with a history of an abnormal Pap result (85%; 95% CI 75% to 91%) and a positive HPV test (79%; 95% CI 70% to 86%). A large proportion of providers report practices that are inconsistent with guidelines. Providers may also be recommending the vaccine to women who may receive little benefit from the vaccine. Provider and system-level efforts to improve guideline-consistent practices are needed.

Rationale for Reducing the Spread of Human Papillomavirus in Adolescents: Strategies to Improve Outcomes (CME Multimedia Activity)

As detailed in this online CME activity (http://cmeaccess.com/cme/JAH_HPV_program/index.asp?link_id=2), human papillomavirus (HPV) infection is the cause of cervical cancer and neoplasias in women, and genital warts in men and women. In addition, 35%-85% of vaginal, vulvar, anal, penile, and oropharyngeal cancers are attributable to HPV. An estimated 80% of females and 50% of males in the United States will become infected at some point in their lives; however, the incidence of this highly prevalent infection peaks in adolescents and young adults. Owing to the importance of vaccination before this elevated risk of exposure, the Centers for Disease Control and Prevention recommends HPV vaccination for girls aged 11-12 years with either the bivalent or quadrivalent vaccine. Recently, the quadrivalent vaccine, which also protects against genital warts and anal neoplasias and cancer, was approved for use in boys as well. Although the coverage rate has increased steadily in the 5 years since the vaccine's introduction, it remains below 50%. To overcome barriers to vaccination, including lack of awareness about adolescents' HPV risk and challenges associated with preventive care in this age group in general, healthcare providers must be able to educate parents/patients about HPV and the vaccine, as well as maximize opportunities to vaccinate adolescents at every office visit.

A National Survey about Human Papillomavirus Vaccination: What We Didn't Ask, But Physicians Wanted Us to Know

Study ObjectiveThe current study presents findings from a qualitative examination of free text comments from a national survey of U.S. physicians on human papillomavirus vaccine recommendation beliefs and practices. Qualitative analyses of free text physician responses may offer a more complete and physician-driven description of influences on human papillomavirus vaccine recommendation. Design and ParticipantsIn 2009, a survey assessing physicians' knowledge, attitudes, and human papillomavirus vaccination practices was conducted among a national sample of U.S. physicians practicing Family Medicine, Pediatrics, or Obstetrics/Gynecology (response rate 67.8%). Qualitative comments were analyzed using a Grounded Theory approach. ResultsOf 1008 completed surveys, 112 participants provided comments, which were organized into three primary HPV vaccine-related themes: (a) comments about cost of the vaccine, (b) comments about institutional policies and procedures, and (c) physicians' personal views and one secondary theme related to survey methodology: the parent study's use of an upfront cash incentive. Many comments pertained to issues that were queried in the closed-end survey items; however, some comments provided insight into understudied areas (e.g., physician attitudes regarding survey methodology). ConclusionPhysician respondents used the free text space to reemphasize issues that were most important to them and to offer insight about aspects of the vaccine and the survey process.

Inter-State Variation in Human Papilloma Virus Vaccine Coverage Among Adolescent Girls in the 50 US States, 2007

Human papilloma virus (HPV) vaccination could substantially reduce the burden of cervical cancer by preventing HPV infection. This study uses the 2007 National Survey of Children's Health (NSCH) to estimate HPV vaccine coverage prevalence for US girls aged 12-17, the target group for vaccination. NSCH is a population-based telephone survey of households with children younger than 18 years. The proportion of girls aged 12-17 whose parent or guardian reported receipt of a clinician recommendation for HPV vaccination, one or more does of HPV vaccine, or a complete three-dose HPV vaccine series were estimated. Multivariable models estimated adjusted associations and marginal predicted vaccine coverage prevalence for each of the 50 US states and according to race/ethnicity, household income, insurance status, parental education, and whether the girl had a 'medical home'. The NSCH sample included 17,264 girls aged 12-17. Overall 18.2 % (SE 0.8 %) of girls reportedly received at least one HPV vaccine dose and 3.6 % (SE 0.4 %) completed the series; 31 % received clinician recommendation for HPV vaccine. Girls who received a clinician recommendation to vaccinate were 23 (95 % CI 18-29) times as likely to be vaccinated as those not counseled. There was substantial interstate variation in vaccine coverage that was largely explained by variability in clinician counseling. For 2007, there was substantial variation in HPV vaccine coverage among US girls 12-17 years that was largely explained by variability in clinician counseling. Strategies aimed at increasing clinicians' counseling for HPV vaccination could substantially reduce disparities in HPV vaccine coverage.

Factors associated with human papillomavirus vaccine-series initiation and healthcare provider recommendation in US adolescent females: 2007 National Survey of Children's Health

ObjectiveTo identify factors associated with initiation of the human papillomavirus vaccine series and parental report of a healthcare provider recommendation of the human papillomavirus vaccine in adolescent females. DesignCross-sectional analysis of 2007 National Survey of Children's Health. ParticipantsParents of 12–17 year-old US adolescent females. Main outcome measuresAssociations of sociodemographic and healthcare factors with initiation of the human papillomavirus vaccine series and parental report of a healthcare provider recommendation of the human papillomavirus vaccine. ResultsData were analyzed for 16,139 adolescent females. Almost 20% of adolescent females initiated the HPV vaccine series. Significantly higher proportions of adolescent females who initiated the human papillomavirus vaccine series vs. those who did not initiate the human papillomavirus vaccine series had a parental report of their healthcare provider recommending the human papillomavirus vaccine (84% vs. 20%). In multivariable analyses, adolescent females who were American Indian/Alaska Native, were multiracial, received the meningococcal vaccine, received the tetanus/tetanus–diphtheria/tetanus–diphtheria–acellular pertussis vaccine, or were poor had higher adjusted odds of initiating the human papillomavirus vaccine series; parental report of a healthcare provider recommendation of the human papillomavirus vaccine was associated with about 18 times the adjusted odds of initiating the human papillomavirus vaccine series. In separate multivariable analyses, adolescent females who were African-American and uninsured had lower adjusted odds of a parental report of a healthcare provider recommendation of the human papillomavirus vaccine. ConclusionParental report of a healthcare provider recommendation is significantly associated with human papillomavirus vaccine-series initiation. African-American race/ethnicity and uninsurance were associated with lower odds of a parental report of a healthcare provider recommendation of the human papillomavirus vaccine. Routine healthcare provider recommendation of human papillomavirus vaccination might improve adolescent females’ human papillomavirus vaccination rates.

Recommended Adult Immunization Schedule: United States, 2012*

Recommended Adult Immunization Schedule: United States, 2012*

114. Factors Associated With Human Papillomavirus (HPV) Vaccine Acceptance Among Haitian and African-American Parents of Adolescent Sons

HPV knowledge is very low in both African American and Haitian parents, and vaccination rates are very low in their adolescent sons. Improving knowledge and vaccination rates will require culturally competent educational interventions addressing the distinct informational needs of each community. Physicians are uniquely situated to provide culturally competent education and should address patients’ vaccination preferences by routinely offering HPV vaccination to male patients. Introduction/Purpose Genital Human Papillomavirus (HPV) infection is the most common sexually transmitted infection in the US. Approximately 90 % of anal and penile cancers, 100 % of cervical cancers, 40 % of vaginal and vulvar cancers, 20-60 % of oral cancers, and 90 % of genital warts are attributable to HPV. In October 2011, the Advisory Committee for Immunization Practices (ACIP) updated their statement to recommend HPV vaccination for 11-21 year old males for the prevention of genital warts and anal cancers. Currently little data exists on parental views towards HPV vaccination in adolescent sons. As the US black community is ethnically diverse, we set out to explore cultural differences in attitudes towards HPV vaccination in African-American parents and Haitian Immigrant parents of adolescent sons. These insights will be used to create a short, practical, physicianbased, educational intervention geared toward increasing HPV vaccine acceptance. Factors associated with Human Papillomavirus (HPV) vaccine acceptance among Haitian and African-American parents of adolescent sons

Adult Immunization 2012: Politics, Process, and Progress

In this issue, the ACIP presents the recommended Adult Immunization Schedule for 2012. The editorialist discusses the rationale behind key changes between this and previous ACIP recommendations.

Human papillomavirus vaccination and the primary prevention of cancer: implications for survivors of childhood cancer.

Effective vaccination is now available to prevent human papillomavirus (HPV), the most common sexually transmitted infection and the cause of cervical cancer, the second most common cancer among women worldwide. HPV vaccine uptake is particularly important for females surviving cancer, who are at high risk for HPV-related complication due to the direct and indirect effects of cancer therapy. Thus, Version 3.0 of the Children's Oncology Group Long-Term Follow-Up Guidelines for Survivors of Childhood, Adolescent and Young Adult Cancer recommends HPV vaccination for all eligible females surviving childhood cancer. Because this vaccine was only FDA approved in 2006, little is known about the complexity of vaccination uptake among those surviving childhood cancer. This chapter describes HPV vaccination and its usefulness in survivors of childhood cancer, provides a rationale for describing survivors as being at increased risk for HPV-related complication, identifies factors that are predictive of HPV vaccination, and discusses the utilization of these predictors in designing strategies to promote adherence to the HPV vaccination recommendations among survivors.

Prevalence and predictors of human papillomavirus vaccination in adolescent girls

ObjectivesTo determine the prevalence and predictors of human papillomavirus (HPV) vaccination in adolescent girls who were recommended to receive the vaccine by their health care providers. DesignCross-sectional study. SettingUnited States in 2007–08. ParticipantsParents or guardians most knowledgeable about health and health care of adolescent girls aged 12 to 17 years participating in the 2007 National Survey of Children's Health (NSCH). InterventionNCSH was a population-based telephone survey using a complex probability sampling design. Main outcome measuresPrevalence of HPV vaccination in adolescent girls who were recommended to receive the HPV vaccine and predisposing, enabling, and need factors associated with HPV vaccination. ResultsOf 12.38 million adolescent girls aged 12 to 17 years, 3.69 million (29.76%) were recommended to receive the HPV vaccine by their health care provider. The majority who received the HPV vaccine recommendation were 13 to 17 years of age (83%), were white (71%), and had one or more preventive visits (94%). Among those for whom the HPV vaccine was recommended, 48.75% (95% CI 45.37–52.13) received the vaccine. Multivariate logistic regression analysis of those who were recommended revealed that enabling and predisposing factors were significantly associated with the HPV vaccination. Children living at 101% to 200% of the Federal Poverty Level (odds ratio 0.54 [95% CI 0.30–0.98]) and children in households with two or more adults (0.51 [0.33–0.80]) were negatively associated with HPV vaccination, whereas children with any preventive medical care visit(s) (2.28 [1.36–3.84]) in the previous year were positively associated with HPV vaccination. ConclusionNearly one-half of adolescent girls received the HPV vaccine among those who were recommended by their health care provider. The study finding emphasizes the importance of predisposing and enabling factors for HPV vaccination. Policy and education efforts can focus on these factors to improve HPV vaccination rates.

Updates on Human Papillomavirus and Genital Warts and Counseling Messages From the 2010 Sexually Transmitted Diseases Treatment Guidelines

In April 2009, experts on sexually transmitted diseases (STDs) were convened to review updates on STD prevention and treatment in preparation for the revision of the Centers for Disease Control and Prevention (CDC) STD Treatment Guidelines. At this meeting, there was a discussion of important updates on human papillomavirus (HPV), genital warts, and cervical cancer screening. Key questions were identified with assistance from an expert panel, and systematic reviews of the literature were conducted searching the English-language literature of the PubMed computerized database (US National Library of Medicine). The available evidence was reviewed, and new information was incorporated in the 2010 CDC STD Treatment Guidelines. Two HPV vaccines are now available, the quadrivalent HPV vaccine and the bivalent HPV vaccine; either vaccine is recommended routinely for girls aged 11 or 12 years. The quadrivalent HPV vaccine may be given to boys and men aged 9-26 years. A new patient-applied treatment option for genital warts, sinecatechins 15% ointment, is available and recommended for treatment of external genital warts. This product is a mixture of active ingredients (catechins) from green tea. Finally, updated counseling guidelines and messages about HPV, genital warts, and cervical cancer are included. This manuscript highlights updates to the 2010 CDC STD Treatment Guidelines for HPV and genital warts. Important additions to the 2010 STD Treatment Guidelines include information on prophylactic HPV vaccine recommendations, new patient-applied treatment options for genital warts, and counseling messages for patients on HPV, genital warts, cervical cancer screening, and HPV tests.