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Updated HPV Vaccine Recommendations Include 2 Doses for Some, 3 for Others

MAR 21, 2017 | LORRAINE L. JANECZKO, MPH
ACIP advises that children with a history of sexual abuse or assault be routinely vaccinated starting at 9 years of age. Men who have sex with men should receive the routine male HPV shots and should be vaccinated through age 26 if they were not sufficiently vaccinated in the past. Individuals who are transgender should receive the routine adolescent HPV shots and be vaccinated through age 26 if they were not sufficiently vaccinated in the past.
 
For 9- through 26-year-old females and males who have primary or secondary immunocompromising conditions that might reduce cell-mediated or humoral immunity, ACIP advises the 3-dose schedule.  
 
In the results of a survey of United States sexually transmitted disease (STD) clinics that was presented September 23, 2016 at the Centers for Disease Control and Prevention (CDC) STD Prevention Conference in Atlanta, Georgia, Dr. Meites wrote in her abstract, "By early 2015, in a geographically diverse group of 78 STD clinics, most offered nationally-recommended HPV vaccination, but financing remained an important barrier."
 
"Increasing participation in federally funded programs such as Vaccines for Children might reduce such barriers, at least in part. Further research could identify additional strategies for STD clinics to increase provision of HPV vaccination according to national guidelines," she proposed. 
 
The 2-dose series could be more cost-effective and help ensure that more people are adequately vaccinated. 
 
According to results of another study presented the same day at the conference, health care providers may be missing opportunities to vaccinate adolescents against HPV.
 
Kelly Jamison, MPH, a research scientist and analyst at the Bureau of Sexually Transmitted Disease Control of the New York City Department of Health and Mental Hygiene, and her colleagues reviewed the electronic medical record (EMR) data of adolescents attending STD clinics in New York City between 2010 and 2013 and the Citywide Immunization Registry (CIR) of all immunization records for city residents 18 years of age or younger.
 
The authors cross-matched the EMR with the CIR to identify all immunizations administered by any New York City provider. They included clinic patients who were eligible for the HPV vaccine and had at least one immunization event between 11 and 18 years of age recorded in the CIR.
 
Among 13- to-18-year-olds attending New York STD clinics, only around 46% of females and 12% of males received the recommended 3-dose series of HPV vaccinations over six months, lead author Ms. Jamison said in her presentation.
 
"Although the vaccine has been available for nearly a decade, HPV vaccine uptake has been slow, with estimated national three-dose coverage of adolescent females about 40% and adolescent males about 22%," she added.
 
"STD clinic patients are a group at increased risk for HPV acquisition; they also remain under-vaccinated," she noted.
 
The researchers think that their estimates are conservative. "We used registry data, but most likely, these patients actually visited the clinic more times than we were able to capture," Ms. Jamison told Contagion® in an interview.
 
"New York State has dropped the requirement that adolescents have parental consent to receive an HPV vaccination," Ms. Jamison said in the interview. "So far, we've provided at least one dose to over 800 patients."
 


Lorraine L. Janeczko, MPH, is a medical science writer who creates news, continuing medical education and feature content in a wide range of specialties for clinicians, researchers and other readers. She has completed a Master of Public Health degree through the Department of Epidemiology of the Johns Hopkins Bloomberg School of Public Health and a Dana Postdoctoral Fellowship in Preventive Public Health Ophthalmology from the Wilmer Eye Institute, the Johns Hopkins University School of Medicine and the Bloomberg School. 


DISCLOSURES: The authors did not report any conflicts of interest with the study.
 
Sources:

  • Meites, et al., Use of a 2-Dose Schedule for Human Papillomavirus Vaccination—Updated Recommendations of the Advisory Committee on Immunization Practices. (http://onlinelibrary.wiley.com/doi/10.1111/ajt.14206/full dated February 27, 3027; and https://www.cdc.gov/mmwr/volumes/65/wr/mm6549a5.htm#contribAff dated December 16, 2016; and https://www.cdc.gov/mmwr/volumes/66/wr/mm6605e2.htm dated February 10; and https://www.cdc.gov/mmwr/volumes/66/wr/mm6608a8.htm?s_cid=mm6608a8_w dated March 3, 2017)
  • 2016 CDC STD Prevention Conference p 88 (https://www.cdc.gov/stdconference/2016/STD_Conference_2016_Program_Book.pdf). Abstract 5A1: HPV Vaccination Offered By 78 Sexually Transmitted Disease Clinics—United States, 2014–2015. (https://cdc.confex.com/cdc/std2016/webprogram/Paper37588.html)
  • ​Abstract 5A2: Adolescents Attending New York City Sexually Transmitted Disease Clinics Have Missed Opportunities for Receiving HPV Vaccine with Primary Care, and Other Providers. (https://cdc.confex.com/cdc/std2016/webprogram/Paper37494.html)
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