Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elle Meisner
Nereyda Ochoa
Landon J. Kunzelman
James DotimasFA16 Immunization Module’s Updates
Barriers to Increasing HPV Vaccination Rate: Gender and Followthrough on 3-Injection Series
The CDC cites Human papillomavirus (HPV) as the most common sexually transmitted infection in the United States. Noncancerous HPV types cause over 90% of genital warts, and there are at least 250,000 cases of genital warts in U.S. males. The recommendation is that all boys and girls be vaccinated. Unfortunately, coverage for females in the United States is only around 30% while coverage for males hovers around 10%.
Papillomaviruses infect keratinocytes in the basal layers of stratified squamous epithelium (shoutout to CTB). The HPV vaccine utilizes virus-like particles (VLPs) that are expressed on the surface of virally infected cells. The vaccine is not infectious because it contains no viral DNA. It has proven to be highly efficacious with minimal risk.
Gender: HPV causes almost all cases of cervical cancer. This drove the vaccination outreach to focus on young girls even though HPV can cause cancer and infertility in both males and females. While it is now strongly encouraged that both males and females get vaccinated, the majority of young men and their parents are unaware of the availability of an HPV vaccine for males.
Commitment to the 3-injection series: While completion of the series increases with age, there is a significant percentage of patients who initiate the 3-dose vaccination but fail to complete it.
http://www.tandfonline.com.proxy.cc.uic.edu/doi/abs/10.1080/21645515.2016.1141158
http://www.sciedu.ca/journal/index.php/jer/article/view/9643
https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet#q6
https://www.cdc.gov/mmwr/preview/mmwrhtml/su6302a10.html
https://www.ncbi.nlm.nih.gov/pubmed/26453270
https://www.ncbi.nlm.nih.gov/pubmed/25992782
One of the best threads I've read so far. What a sad statistic, we have a vaccine that works against a common cancer but our coverage is horrible. I would bet there are many reasons for the poor coverage including health policy (which varies by State), insurance, scientific literacy, social perception and probably others. The CDC believes that males should be vaccinated as well to prevent other HPV-related cancers.
I think another obstacle in the utilization of the HPV vaccine that is worth note is the stigma that unfortunately surrounds it. Because HPV is technically a sexually transmitted infection, parents may employ the excuse that their child need not be vaccinated because he or she is not sexually active, or because he or she will be smart about sex. The problem here, however, is that teenagers are rarely smart, and even when they are, their partners might not be. It is frustrating because we have a vaccine against cancer, and people shy away for reasons that are not necessarily backed by logic, reason, or science.
After reading this article, my immediate thoughts went to the thing our world revolves around, money. I did a tiny bit of a searching around to see if insurance covers those who want to get this vaccination voluntarily. According to most places that I looked, it seems that Gardisil is covered by many insurance plans. However, these insurance plans typically have an age range; something like 9-26 years old for women. Unfortunately, there was no mention of males in these statistics. This leaves me wondering if the problem goes beyond people's reluctance to voluntarily receive a vaccination.
I was wondering the same thing as @Angelina Kim. What accounts for the differences in vaccination rates in the different countries? Why is it so low in the US compared to Australia and the UK. Are these differences due to differences in the health care system?
Drawing an interesting tidbit from an earlier post by @Madeline Bell, it seems strange that despite the noted safety of the HPV vaccine, the importance of including it among other mandatory vaccinations, and national goals to increase vaccination, the CDC still recommends that we vaccinate for HPV after 9 years old.
I wonder why this is - and what improvements could be made to align it with other regular vaccination schedules.
A 3-shot series seems arduous. It is not surprising that the level of commitment is so low. This is unfortunate since the benefits of this vaccination helps so many. I wonder if getting just one dose provides some minute level of protection. Either way, I hope a better vaccination is in the works.
I like the first figure you included and the topic in general. It's really interesting to see that other countries are having more success. I wonder why vaccination rates for HPV are much higher in Australia and the UK than the US. Have those countries made these vaccinations mandatory? I'm also curious about how they got the message out to people to get vaccinated.
This is such an interesting topic, especially since we all remember the drama that surrounded introduction of the HPV vaccine. Since HPV immunization isn't part of the required vaccine series, it is our job as future physicians to stress the importance of this vaccine for both boys and girls.