‘Presumptive Style’ Increases HPV Vaccination Rates

A new cancer prevention study from the University of Colorado School of Medicine shows that physicians' communication practices have improved, boosting Human Papolivirus (HPV) vaccinations.

And, since the 2-dose HPV vaccination schedule came out for adolescents 11 to 12-years-old, overall acceptance has increased.

"A physician recommendation is one of the most important factors in vaccine acceptance by parents," said Allison Kempe, M.D., MPH, lead author and professor of pediatrics at the University of Colorado School of Medicine, in a September 16, 2019, press release. 

"However, the (HPV) vaccine is underutilized, with less than half of American adolescents completing the vaccination.” 

“We need to maximize methods of introducing the vaccine that we know to be more effective, as well as the use of reminder and delivery methods at the practice in order to improve this rate."

This study published in Pediatrics surveyed 588 pediatricians and family physicians and found that refusal rates from parents remain high, especially for 11 to 12-year-olds, the target population for vaccination.

In the USA, HPV vaccines have been licensed for use among women since 2006 and among men since 2010.

Furthermore, this study’s findings indicate physicians who use a `presumptive style' approach have higher acceptance rates. 

Presumptive style means physicians introduce the HPV vaccine and recommend it in the same manner and as strongly as the other recommended adolescent vaccines for meningitis and Tdap.

For example, a doctor could say, "We've got three vaccines today: Tdap, HPV and Meningitis," rather than isolating HPV as an option that is not as important.

Still, the survey found some encouraging signs:

• Pediatricians who strongly recommend the vaccine increased from 60% in 2013 to 85% in 2018 for 11 or 12-year-old females and from 52% to 83% for 11 to 12-year-old males.
• Some 89% of pediatricians and 79% of family pediatricians reported more adolescents under age 15 are completing the HPV series, now that only 2 doses are recommended.

Along with improving physician communication styles, HPV delivery could also be optimized by increased use of standing orders and alert systems in the medical record to remind providers of the need for vaccination at the point of care, reported these Colorado researchers.

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HPV vaccination rates are increasing, as more children are up to date on HPV vaccination, reports the US Centers for Disease Control and Prevention (CDC).

In 2017, 49 percent of adolescents were up to date on the HPV vaccine, and 66 percent of teenagers ages 13-17 years received the first dose to start the vaccine series.   

On average, the percentage of adolescents who started the HPV vaccine series increased by 5 percentage points each year over the past 5 years (2013-2017) in the USA. 

On June 26, 2019, the Advisory Committee on Immunization Practices (ACIP) approved two new recommendations for HPV vaccine:

• "Catch-up" vaccination for males is recommended through age 26 years (previously through age 21 years). This harmonizes the catch-up recommendation for males with the catch-up vaccination recommendation for females.
• Vaccination of persons 27 through 45 years of age based on "shared clinical decision-making" between the patient and the clinician. This means that the decision to vaccinate persons 27 through 45 years of age should be based on a discussion of benefits and risks between the patient and the clinician.

HPV is the most common sexually transmitted infection in the United States. In the United States, an estimated 79 million persons are infected, and an estimated 14 million new HPV infections occur every year among persons aged 15 through 59 years.

The CDC says HPV is a group of more than 150 related viruses. There are 2 categories of HPVs -- low-risk HPVs, which do not cause cancer, and high-risk HPVs, which can cause cancer.

The HPV high-risk causes genital warts and several types of HPV cancers, including cervix, vulva, vagina, penis, or anus. 

Merck's Gardasil 9 HPV vaccine is currently available in the USA.

The study was supported by a grant from the Centers for Disease Control and Prevention.

The University of Colorado Anschutz Medical Campus is a world-class medical destination at the forefront of transformative science, medicine, education, and healthcare. For more information, visit the University of Colorado Anschutz Medical Campus.

These researchers did not disclose any conflicts of interest.

Published by Vax Before Cancer