Rates of vaccination against human papillomavirus (HPV) continued to lag far behind national goals, including just a small bump in the rate since 2012, the CDC reported.
A study reported in the July 25 issue of Morbidity and Mortality Weekly Report showed that 57.3% of girls, ages 13 to 17, received at least one dose of HPV vaccine in 2013, increasing from 53.8% in 2012. The proportion of girls who received all three doses increased from 33.4% to 37.6%. The national goal is 80% coverage with the vaccine.
A greater increase in HPV vaccination rates occurred among boys the same age but remained well below rates for girls. The proportion of boys who received at least one dose rose from 20.8% in 2012 to 34.6% in 2013, and 13.9% of boys in the target age range received all three doses of vaccine in 2013, up from 6.8% in 2012.
"I wish I had good news, but what I need to report is a small increase in HPV vaccination," Anne Schuchat, MD, assistant surgeon general and director of CDC's National Center for Immunization and Respiratory Diseases in Atlanta, said during a conference call with the media.
Schuchat attributed the low rate of HPV vaccine coverage to "missed opportunities" during visits with healthcare providers. If every girl born in 2000 had received the HPV vaccine at the same time as other routinely administered vaccines, more than 90% of them would have been immunized against HPV by the end of 2013. Uptake of the meningococcal and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines reached 77.8% and 86.0%, respectively in 2013.
Data for the study came from the National Immunization Survey-Teen (NIS-Teen), a telephone survey of a representative sample of more than 18,000 13- to 17-year-olds living in all 50 states and the District of Columbia. NIS-Tenn has accumulated vaccination information on adolescents since 2006. Self-reported vaccination is corroborated by the participants' healthcare providers. Parents also provide information as part of the survey.
Though small, the increases in vaccination rates restored the upward trend that was disrupted between 2011 and 2012, as rates remained unchanged or declined in some cases.
"It is a relief that we did not continue to have flat-lining HPV coverage in 2013," Schuchat said. "There was absolutely no improvement from 2011 to 2012."
A mention of the vaccine or recommendation by a physician or other healthcare provider continued to be the single most important factor in HPV vaccination. Three-fourths of parents whose daughters were vaccinated recalled getting a recommendation from a healthcare provider, as compared with about half of parents who chose not to vaccinate their daughters. Among boys, the difference was 72% versus 26%.
The CDC has been working with the American Academy of Pediatrics and the American Academy of Family Physicians to promote HPV vaccination. Schuchat said the cooperation will continue and possibly expand to include other medical and health professions groups.
Despite the overall disappointment with vaccination rates, five states substantially outperformed the national average with increases of 12 to 18 percentage points compared with 2012. The states are geographically, politically, socioeconomically, and ethnically diverse (Illinois, Michigan, New Hampshire, South Carolina, and New Mexico). Even so, CDC officials hope to glean information about the success in the five states to apply to the other 45 states and DC, said Schuchat.
Concern about vaccine safety has diminished somewhat as healthcare providers and parents have learned more about the vaccines, including their favorable safety profile. More than 30% of the patients cited lack of knowledge or the belief that the vaccination was unnecessary.
Post-marketing surveillance of vaccine safety showed that 67 million doses of the quadrivalent vaccine and 719,000 doses of the bivalent vaccine were distributed from June 2006 through March 2014. During that time, the Vaccine Adverse Event Reporting System received 25,176 averse event reports related to the quadrivalent vaccine. More than 92% of the reports were classified as nonserious, according to the MMWR report.
The most commonly reported symptoms in girls and boys receiving the HPV vaccine have been injection-site reactions, dizziness, syncope, nausea, and headache.
The authors disclosed no relevant relationships with industry.
Morbidity and Mortality Weekly ReportSource Reference: Stokley S, et al "Human papillomavirus vaccination coverage among adolescents, 2007-2013, and postlicensure vaccine safety monitoring, 2006-2014 -- United States" MMWR 2014; 63: 620-624.