HPV immunization lags

Pharmacists can play a substantial role in improving HPV vaccination rates among adolescents

Recent data released by CDC show that human papillomavirus (HPV) vaccination rates trail behind other teen vaccines. These data are alarming given the fact that HPV affects 20 million people in the United States, with an estimated 6.2 million new cases annually.

When asked why this may be the case, Melinda Wharton, MD, MPH, Deputy Director of the CDC National Center for Immunization and Respiratory Diseases, told Pharmacy Today, “It appears providers aren’t making as strong a recommendation for the HPV vaccine compared with other adolescent vaccinations such as the meningococcal and tetanus, diphtheria, and pertussis [Tdap] vaccines.” She noted that a strong provider recommendation truly makes a difference for parents and caregivers considering the HPV vaccine for their adolescent child.

“Parents tend to have questions about the HPV vaccine, and some think they can wait for their children to be older before administering the vaccine,” Wharton added. She explained that some parents have a difficult time accepting the fact that the vaccine targets the prevention of a virus that is spread through sexual contact, and many parents think the recommended age of 11 years to 12 years for the HPV vaccine is too young because many girls are not sexually active yet. Parents and caregivers need to understand that immunizing children against HPV and the development of cervical cancer in the future is most effective when the vaccine is given before any sexual contact occurs, noted Wharton.

HPV vaccination rates remain low

CDC released teen vaccination data from 2010 that showed improvements in the number of teens receiving the meningococcal and Tdap vaccines; however, HPV vaccination rates remained low, with many failing to complete the three-dose series.

Compared with increases reported for the meningococcal (9.1%) and Tdap vaccines (13.3%), coverage increases for HPV were less than half of the increases seen with the other two vaccines. CDC reported that 49% of girls received one dose of the vaccine in 2010, which was up 4.4% from the previous year, and only 32% of girls had received the series. Completion of the three-dose series was noted to be lower among black and Hispanic patients compared with white patients and among patients living below the poverty line.

Legislative actions

Many states have granted pharmacists the ability to administer the HPV vaccine to adolescents via a protocol or prescription. According to data from APhA, as of June 2012, 43 states or territories have granted authority to pharmacists to administer the HPV vaccine, with most having specific age limitations. Nine states or territories were listed as not allowing pharmacists to administer the vaccine.

Other legislative actions aimed at improving HPV vaccination rates include state bodies adding the vaccine as part of school vaccination requirements or requiring funding and/or education of the public about the HPV vaccine.

Practice opportunities

“The HPV vaccine series can be started in the physician’s office, but pharmacists who have the legislative authority in their state to administer the HPV vaccine to adolescents can play a substantial role in improving HPV vaccination rates by completing the series in the community,” Wharton told Today. She noted that it may be easier for parents to take their teens to visit the local community pharmacy to receive additional doses instead of returning to the providers’ office.

Once the series is complete, documentation of completion can be sent to the provider’s office. Wharton explained that pharmacists are in an ideal position to educate parents and caregivers of adolescents about HPV, its role in the development of cervical cancer, and the three-dose HPV vaccine series, especially when filling prescriptions for teens with chronic conditions such as asthma.

Educating parents, caregivers

Parents should be educated about the primary vaccines recommended for adolescents, which include the meningococcal conjugate vaccine at 11 years to 12 years of age with a booster at 16 years; a Tdap booster between 11 years and 18 years; a three-dose series of the HPV vaccine given to girls at 11 years to 12 years and boys between 9 years and 26 years; and an annual influenza vaccination.

In terms of the HPV vaccine, CDC has developed patient-related educational materials that can be accessed at no charge from its website at www.cdc.gov/vaccines/vpd-vac/hpv/downloads/PL-dis-preteens-hpv.pdf and www.cdc.gov/vaccines/vpd-vac/hpv/downloads/dis-HPV-color-office.pdf. In addition, for those who are unable to pay for recommended vaccinations, the Vaccines for Children program provides vaccines at no cost to uninsured individuals younger than 19 years.