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Two-Dose HPV Vaccination Series Now Recommended for Adolescents, 11-14 Years

Monday, November 14, 2016   (0 Comments)
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Audrey Fine, American Cancer Society


The Centers for Disease Control and Prevention (CDC) recently revised its recommendation for the HPV (human papillomavirus) vaccination series. For children ages 9 through 14, only two doses instead of three is now recommended; the two shots should be administered at least six months apart. The CDC continues to recommend that most children get the vaccine at age 11 or 12 to protect against cancer-causing HPV infections. Debbie Saslow, PhD, Senior Director of HPV Related and Women’s Cancers at the American Cancer Society, said the new recommendation will make it easier for people to get protection from HPV.  “It’s a burden on parents to get teenagers to the provider’s office. The new recommendations not only cut down on repeated trips, but also spread out the recommended interval. This adds the flexibility that allows the second injection to be given at a time when the child may already be at the provider’s office for something else – an annual checkup, a sports physical, or even an acute visit like a strep test,” she said.




The new recommendations come from the Advisory Committee on Immunization Practices, a group of medical and public health experts that develop recommendations on use of vaccines in the general population of the US. Teens and young adults who start getting the vaccination at ages 15 through 26 years will continue to need 3 doses of HPV vaccine. Children and teens ages 9 through 14 who have already received 2 doses of HPV vaccine less than 6 months apart, will require a third dose. Three doses are also recommended for people with weakened immune systems ages 9 through 26 years.


The recommendation for targeting the 11-12 year old population is because the vaccine causes a better immune response in children than during the later teenage years. Children are also likely still seeing their doctor regularly and getting other vaccinations at this age. Over 200 million doses of vaccine have been distributed worldwide – more than 67 million doses in the US along with 8 years of safety monitoring in the US. No serious safety concerns have been identified.


Why vaccinate?

Most cervical cancers are caused by HPV, and the virus has been linked to cancers of the vulva, vagina, penis, anus, and throat. HPV is also a major cause of genital warts. Vaccines are among the few medical interventions capable of achieving almost complete eradication of a disease. It is not often that we have an opportunity to prevent cancer, or in this case multiple cancers, with a single tool. HPV vaccination offers opportunities for FQHCs to focus on cancer prevention with their adolescents and families.



Despite the overwhelming evidence for its safety and effectiveness, HPV vaccination is underutilized. While vaccination rates continue to improve for other adolescent vaccines such as Tdap and meningococcal, HPV vaccination rates have not.  Only 1 in 3 girls and 1 in 5 boys in the US are fully vaccinated – far less than the Healthy People 2020 goal of 80%.


The annual direct medical cost of prevention and treatment of HPV-related disease is at least $8 billion for females alone. Of this, $6.6 billion is for cervical cancer screening and follow-up and $1 billion is for treatment of cancer, including $400 million for invasive cervical cancer and $300 million for oropharyngeal cancer. Several studies have shown that HPV vaccination of adolescent girls and boys is highly cost-effective.


Physician recommendation is the strongest predictor of receipt of vaccination. Data shows that providers are not recommending HPV vaccine with the same strength and consistency as for other vaccines. There is also a need for education of parents about the vaccine – why it's needed, the importance of vaccinating prior to the onset of sexual activity, and its excellent safety record. Health systems barriers include inadequate reimbursement for vaccine administration and lack of provider and patient reminder systems.


The Comprehensive Cancer Control National Partners named HPV vaccination as one of three nationwide priorities for all Comprehensive Cancer Control programs. CDC awarded one-year grants to a total of 18 states and 4 cities to improve vaccination rates in 2013 and 2014. The National Cancer Institute awarded 18 NCI comprehensive cancer centers a one-year grant to develop targeted approaches to increase HPV vaccine uptake in 2014-2015. CDC awarded 5-year grants to four organizations, including the American Cancer Society to increase HPV. Additionally, the President’s Cancer Panel released a report in February, 2014 calling for urgent action to increase uptake of HPV vaccination in the US and globally.


The American Cancer Society has two specific programs to help raise vaccination rates:

1)       The National HPV Vaccination Roundtable , established by the Society and CDC in 2014, is a national coalition of public, private, or voluntary organizations, and invited individuals dedicated to reducing the incidence of and mortality from HPV-associated cancer in the US, through coordinated leadership and strategic planning. 

2)       Vaccinate Adolescents against Cancers Project (HPV VACs) allows American Cancer Society staff to work with FQHCs across the nation while expanding current cancer prevention and early detection activities to increase HPV vaccination through improved provider awareness, education, and enhanced system-wide processes.


Even with low vaccination rates, HPV infections targeted by the vaccines have dropped by more than half in the US since the introduction of the vaccine. In Australia where vaccination rates are high, the number of high-grade abnormal Pap test results ("pre-cancers") has already declined in young women, and cases of genital warts have been almost eliminated.


Further Information

Audrey Fine, Primary Care Health Systems Manager, American Cancer Society





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