United States Sees Drop in Rate of HPV Vaccination Course Completion

Too many girls and women are not completing the recommended course of the human papillomavirus (HPV) vaccine, a new study from researchers at the University of North Carolina’s Gillings School of Global Public Health suggests.

Today, HPV is the most common sexually transmitted infection in the United States, according to the Centers for Disease Control and Prevention (CDC). From 2013 to 2014, the prevalence of genital infection with any of the 40 types of HPV 42.5% among US adults aged 18 to 59 years. While most HPV infections are asymptomatic and pass on their own within a few years, HPV types 16 and 18 are the cause of 66% of cervical cancers in the United States, while HPV 6 and HPV 11 cause about 90% of all genital warts. An estimated 19,200 women and 11,600 men are diagnosed with HPV-related cancer each year.

Since 2006, the quadrivalent HPV vaccine has been available to prevent HPV types 6, 11, 16, and 18 and recommended as a 3-shot course for females and males aged 11 to 12 years. In 2014, a 9-valent HPV vaccine became available to protect against 9 strains of the virus. Since 2016, the CDC has recommended the vaccine as a 2-shot course to be administered at least 6 months apart for females and males aged 11 to 12 years. Earlier this year, researchers found that HPV vaccination rates among males in the United States is on the rise.

In a new study published online on May 17, 2018, in the American Journal of Public Health, researchers aimed to determine the rate of adolescents and young adults receiving the full recommended course of the HPV vaccine, and not just the first dose.

The study authors note that HPV vaccine uptake rates remain below the Healthy People 2020 target levels of 80% completion for all 15-year-old males and females, with one 2016 survey showing that only 32% of boys and 43% of girls aged 13 to 17 years had received the full 3-dose series. Examining insurance claims data for more than 1.3 million privately insured individuals aged 9 to 26 who received the first of 3 doses of the HPV vaccine from 2006 to 2014, the researchers found that vaccination follow-through had declined in that time. With an outcome measure of individuals receiving a third dose of the vaccine within 12 months of the first, researchers found that vaccination follow-through fell from 67% to 38% in females. The drop was less dramatic in males, falling from 36% in 2011 to 33% in 2014.

The researchers found that the rate of follow-through was highest among individuals who began their HPV vaccine course with an obstetrician/gynecologist, and lowest among those who received the first dose from a physician’s assistant or nurse practitioner. In addition, patients with HMO insurance plans had lower rates of follow-through than those with other kinds of plans. Race and income data were not included in the study.

“The HPV vaccine shows a lot of promise, but uptake has been really low,” said the study’s lead author, Jennifer C. Spencer, MSPH, in a recent statement. Since the HPV vaccine became available, this study has been one of the largest to examine the rate of completion. “We’ve focused a lot on ways to increase initiation of the vaccine, but this work really shows that’s only part of the story. We need to make sure patients and providers understand the importance of completing the full series.”