BE PREPARED TO ENCOURAGE HPV VACCINATION


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“Human papillomavirus (HPV) vaccination coverage lags behind coverage for the other vaccines recommended for preteens,” according to the Centers for Disease Control and Prevention (CDC).1 A recent report about vaccination coverage in the United States among adolescents aged 13 to 17 found that rates of vaccination have increased since the HPV vaccine was introduced for females in 2006 and for males in 2011.2 Still, coverage remains substantially lower than for tetanus, diphtheria, and acellular pertussis vaccine and for meningococcal conjugate vaccine.

To help close that gap, the CDC “encourages clinicians to recommend HPV vaccination in the same way and on the same day that they recommend other routinely recommended vaccines for patients at age 11 or 12 years.” In addition, the CDC “suggests effectively recommending HPV vaccination by bundling the recommendation for all vaccines for preteens, with HPV vaccine in the middle.”

Safe for Most Young People

The CDC recommends routine HPV vaccination for girls and boys aged 11 and 12, although vaccination can be started as young as 9 years old. HPV vaccination is also recommended for females aged 13 through 26 years and males aged 13 through 21 years not adequately vaccinated earlier. Gay, bisexual, and other men who have sex with men, transgender people, and persons with certain immunocompromising conditions and who are aged 22 through 26 years and have not been adequately vaccinated when younger should also receive the HPV vaccine. 

HPV vaccines can be safely administered to most young people. This includes those with minor acute illnesses, women who are breastfeeding, patients with immunocompromising conditions (although the immune response and vaccine efficacy may be reduced) and women with unclear or abnormal Pap test results, a positive HPV test, or genital warts (although it would not affect already present infections or warts). 

Patients who should not be given HPV vaccines, according to CDC guidelines, include those who have had a life-threatening allergic reaction to any ingredient of an HPV vaccine or to a previous dose of HPV vaccine. People who have an allergy to yeast should not be given Gardasil or Gardasil 9. Patients with moderate or severe illnesses are advised to “wait until the illness improves before getting vaccinated.”

Disclosure: As part of Dr. Lowy’s U.S. government–supported research at the National Cancer Institute/National Institutes of Health, he is an inventor of technology that underlies the L1-based prophylactic virus-like particle (VLP) HPV vaccine and technology that underlies an L2-based candidate prophylactic HPV vaccine. The NIH has licensed the technology for the L1 VLP vaccine to Merck, the manufacturer of Gardasil, to GlaxoSmithKline, the manufacturer of Cervarix, and to Indian Immunologicals Ltd. The L2-based vaccine technology is the subject of a cooperative research and development agreement between the NCI, Johns Hopkins University, and Shantha Biotech, and has been licensed to Shantha, PaxVax, Acambis Inc, and GSK. U.S. Federal law entitles Dr. Lowy to a limited share of royalties the NIH receives for these technologies. ■

REFERENCES

1. Centers for Disease Control and Prevention: Human papillomavirus (HPV) vaccination information for clinicians. December 15, 2016. Available at www.cdc.gov/vaccines/vpd/hpv/hcp/index.html. Accessed October 5, 2017.

2. Walker TY, Elam-Evans LD, Singleton JA, et al: National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years—United States, 2016. MMWR Morb Mortal Wkly Rep 66:874-882, 2017

3. Centers for Disease Control and Prevention: HPV Vaccine Information for Clinicians. December 20. 2016. Available at www.cdc.gov/hpv/hcp/need-to-know.pdf. Accessed October 5, 2017.


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