In early February, the CDC released the 2012 childhood vaccination schedule with an important addition – the recommendation that both boys and girls be routinely immunized against human papillomavirus with the quadrivalent HPV vaccine (Gardisil, Merck).
This week, the American Academy of Pediatrics endorsed the recommendation, a move that many health insurers were anticipating before making decisions about how the vaccine would be covered. Now that this technicality is completed, we as primary care providers need to do our part to encourage HPV vaccination. Unfortunately, my personal experience tells me this may be easier said than done.
When the HPV vaccine first received an indication for males, I strongly encouraged my own sons, who were both in the recommended 18- to 26-year age range, to go out and get vaccinated. But neither was persuaded by my arguments. They were both in long-term relationships and did not feel they were going to be at risk in the future. Their predictions have thankfully been accurate, but this is no guarantee that they are protected against HPV and associated cancers.
HPV vaccine coverage rates need to be at 80% to confer herd immunity, but CDC data show that only about 32% of eligible girls have received all three doses necessary to achieve protection. This is why vaccinating boys makes sense.
The gender debate in HPV vaccination to prevent cervical cancer reminds me a lot of pregnancy prevention. Just as females are affected by pregnancy at rates 100% higher than males, females also have higher rates of HPV-related cancers (albeit, not 100% higher). Just as men play an essential role in the conception of a child, they also play an important role in passing HPV along to their partners. Yet, in both circumstances women are expected to carry the burden of prevention. Is this the right attitude? Shouldn’t both parties be responsible?
There are approximately 7,000 cases annually of anal, penile and oropharyngeal cancers caused by high-risk HPV strains, and these rates are increasing. So let’s get out there and advocate for uptake of the first vaccine available to prevent cancer in both sexes by promoting vaccination among both boys and girls at ages 11 and 12, and even down to 9 years of age.
This is a three dose series, so be diligent in your advocacy. As with many vaccine series, it is not just about the first dose, but also about follow up and completion in order to achieve the highest levels of protection.
Julee B. Waldrop, DNP, FNP, PNP, is the Director of the MSN-DNP Program and an associate professor at the University of Central Florida. She provides health care to children at a local community health center.
1. CDC. “National and sate vaccination coverage among adolescents aged 13 through 17 years — United States, 2010.” MMWR. 2011; 60(33):1117.
2. Saraiya M. “Burden of HPV-associated cancers in the United States.” Presentation at: Advisory Committee on Immunization Practices (ACIP) Meeting, February 24, 2011. Atlanta, GA: US Department of Health and Human Services, CDC; 2011.