From CDC Expert Commentary
by Eileen F. Dunne, MD, MPH
Hi. I am Dr. Eileen Dunne, a physician and medical epidemiologist at the Centers for Disease Control and Prevention. I am pleased to speak with you today as part of the CDC Expert Commentary Series on Medscape.
On October 25, 2011, the Advisory Committee on Immunization Practices (ACIP) recommended routine use of quadrivalent human papillomavirus (HPV) vaccine in boys aged 11 or 12 years. The ACIP also recommended HPV vaccination for males aged 13 through 21 years, who have not initiated or completed the 3-dose series. Men aged 22 through 26 years may also be vaccinated. For men who have sex with men, as well as for immunocompromised males, including those with HIV infection, HPV vaccine is recommended through age 26 years if they did not get the vaccine when they were younger. These recently published recommendations replace the permissive guidance published in 2009, which stated that HPV vaccine may be given to males aged 9 through 26 years to prevent acquisition of genital warts.
The HPV vaccine is a strong weapon in cancer prevention. Quadrivalent HPV vaccine prevents infection with the HPV types that cause many anal, penile, and oropharyngeal cancers, as well as genital warts, in men. Each year in the United States, about 7000 cancers in men are caused by these HPV types. Clinical trials have shown the quadrivalent HPV vaccine to be very effective in preventing anal precancers and genital warts. The vaccine will likely prevent HPV-associated penile cancers, as well as oropharyngeal cancers, but no studies have yet demonstrated efficacy against these outcomes.
In addition to the direct protection against certain HPV-related conditions and cancers in males, vaccination of males may also provide indirect protection of females by reducing transmission of HPV. Currently, the HPV vaccine is not being used to its maximum potential; the uptake has been disappointing among teenage girls. HPV vaccination of males offers an opportunity to reduce the important burden of cancers and disease in both males and females.
More than 40 million doses of HPV vaccine have been distributed in the United States since it was first licensed in 2006. The evaluation of this vaccine in clinical trials and in postlicensure studies has demonstrated that the vaccine is very safe for both females and males. The most common adverse events that can occur following HPV vaccination include injection-site reaction, headache, fever, and syncope. Those reactions have tended to be mild or moderate in intensity.
Clinicians are the key to guiding parents on vaccination decisions by providing parents with information about the HPV vaccine’s benefits and risks and the optimal timing of vaccination. The clinical visit at age 11 or 12 years is an excellent opportunity to initiate or complete all recommended adolescent vaccinations on schedule.
So what can you do as a provider? You can make a strong recommendation for HPV vaccination when patients are 11 or 12 years old, just as you would for Tdap or meningococcal conjugate vaccine. Studies have consistently shown that provider recommendation is the strongest predictor of vaccination. Parents trust your opinion more than anyone else’s when it comes to immunizations.
If parents are concerned about vaccinating at this age, explain to them the many reasons for doing so. First, remind them that HPV vaccination is a 3-dose series over 6 months, and you want their child to have the full protection provided by the vaccine, well before they are exposed to HPV. In addition, the immune response to the vaccine is better when it is given at ages 11 or 12 years compared with older ages.
Remind parents of the strong safety record of the HPV vaccine and review the common side effects. If parents express concern about syncope, reassure them that syncope is common for adolescents, and to avoid serious injury from fainting, adolescents should always sit or lie down when receiving vaccinations, remain so for 15 minutes, and be observed during this time. Going over the vaccine information statement can also be helpful for some parents.
Reinforce series completion with parents and encourage them to schedule an appointment for the next dose before they leave the office. Encourage them to participate in the reminder/recall system that your office provides so that they are sure to bring their child in for all 3 doses in the series.
I would like to share resources with you designed for both healthcare professionals and parents. CDC’s Vaccines for Preteens and Teens Website includes materials designed specifically for use in your practice. Links to this and other resources can be found below.
Thank you for your commitment to improving HPV vaccine coverage in all adolescents.
CDC Vaccines for Preteens and Teens
CDC Vaccines for Preteens and Teens: For Health Care Professionals/Providers
CDC Vaccines for Preteens and Teens References and Publications Adolescents’ Vaccine Preventable Diseases
CDC Human Papillomavirus
CDC Vaccine Safety: Human Papillomavirus (HPV) Vaccine
Children’s Hospital of Philadelphia: Prevent HPV
Schuchat A. CDC Expert Commentary: Increasing HPV Vaccine Coverage
Dr. Eileen F. Dunne is a medical epidemiologist in the Epidemiology and Surveillance Branch of the Division of STD Prevention (DSTDP) at the Centers for Disease Control and Prevention (CDC) and a Captain in the Commissioned Corps of the US Public Health Service. Dr. Dunne obtained her medical and public health degrees from the Tulane University School of Medicine and School of Public Health. Dr. Dunne completed a residency in internal medicine at Oregon Health Sciences University, followed by an infectious diseases fellowship at University of Colorado. Dr. Dunne came to CDC in 1998 as an Epidemic Intelligence Service Officer and joined DSTDP in 2001 where she now focuses on HPV and HPV vaccine research, policy, and implementation issues. Dr. Dunne is a member of the Advisory Committee on Immunization Practices (ACIP) HPV Vaccines Working Group, which formulates policy for new and existing HPV vaccines. Dr. Dunne helped develop the ACIP recommendations for the quadrivalent and bivalent HPV vaccines and she has coauthored more than 50 publications.