The human papillomavirus (HPV) vaccination, first introduced in the U.S. more than 10 years ago was designed to protect young women from cervical cancer. Since that time, the Centers for Disease Control & Prevention (CDC) reports that HPV cancers and genital warts have decreased by 71% among teen girls. The vaccine’s success has led to research identifying new opportunities for protection against HPV among other patient populations that can help further drive down infection rates.
Early Immunization Success
In 2006, the Advisory Committee on Immunization Practices (ACIP) first recommended the HPV vaccine be given in three doses to girls aged 11 and 12 years old, with additional suggestions for girls and women aged 9 through 26. Three years later, referencing vaccine efficacy and safety, ACIP expanded its recommendations to cover boys and men ages 11 through 21.
Just a few years after its introduction, the HPV vaccine proved to be successful in decreasing HPV infections nationwide. A study in The Lancet found that after five to eight years of immunization in the U.S., the prevalence of HPV 16 and 18, which account for 70% of all cervical cancers, decreased by 83% among girls aged 13-19 years. Among teenage boys, identification of HPV-related genital warts decreased by nearly 50%.
Expanded and Updated Recommendations
The HPV vaccine’s early success has led to revised and expanded immunization recommendations in the last decade. Just before the 10-year anniversary of the HPV vaccine, the Food and Drug Administration (FDA) approved a new and improved version of the vaccine – Merck’s Gardasil 9 – for use in accordance with CDC recommendations. The new vaccine, now the only distributed HPV vaccine in the U.S., provides protection against more strains than the previous quadrivalent version.
With the expanded protection, ACIP replaced the three-dose recommendation with a two-dose recommendation in 2016 for children between 9 and 14 years of age, making it simpler for parents and children to complete the immunization series.
Citing the success of Gardasil 9, ACIP recently approved several new recommendations for the HPV vaccine in June 2019. The committee extended the “catch-up” immunization age range for males to 26, bringing it into alignment with the catch-up recommendation for women and reducing confusion. Additionally, ACIP voted to recommend vaccination of patients aged 27 through 45 based upon “shared clinical decision-making” between the patient and their clinicians, aligning with earlier approval from the FDA for people in older age groups.
Tailored Advice for Improving Uptake
With new and evolving HPV immunization guidelines, patients of all ages will look to providers for guidance and a recommendation about the HPV vaccine. Clinicians can offer tailored guidance to patients according to their ages and needs.
Ages 11-12: When making a recommendation to a young patient, the CDC suggests providers should bundle the HPV vaccine with other vaccines the patient needs. Parents may have questions about the impact HPV has on sexual activity, however research published in Pediatrics found that patients who received the HPV vaccine did not have higher incidence of sexual activity-related outcomes such as pregnancy and sexually transmitted diseases compared to their unvaccinated peers. Focusing on the goal of cancer prevention will help to properly frame conversations.
Ages 13-26:Patients who receive the HPV vaccine at 15 or older should receive three doses to ensure full immunity, according to the CDC. Research shows that by scheduling the next vaccine dose before the patient leaves the doctor’s office, providers can increase the likelihood that patients will complete the vaccination series.
Ages 26+:Providers can help patients over the age of 26 determine whether they should receive the HPV vaccine. The American College of Obstetricians and Gynecologists notes that providers should discuss a patient’s sexual history and their potential exposure to HPV in the future before deciding what is best for the patient.
The HPV vaccine is the only way to protect patients from HPV-related cancers long before infection appears. By understanding how to implement the vaccine and discuss it with patients, providers can help boost the vaccination rate and protect more of their patients.