Human papillomavirus (HPV) is the most common sexually transmitted virus in the United States.1 According to the Centers for Disease Control and Prevention, 1 in 4 persons in the United States is currently infected with the virus, which is about 79 million people. Approximately 14 million individuals, including teenagers, are infected every year. Another shocking statistic is that almost every person who is sexually active will get HPV at some point in their lives if they don’t receive the vaccine,1 and although 9 of 10 infections resolve on their own within 2 years and cause no symptoms or health problems, 1 in 10 infections persists and can progress to cancer.2
The HPV virus can cause cancer of the cervix, vulva, and vagina in women, cancer of the penis in men, and cancer of the anus and back of the throat, including the base of the tongue and tonsils, in both women and men.1 Every year in the United States, HPV causes 33,700 cases of cancer in women and men despite the fact that HPV vaccination can provide nearly 100% protection against cervical precancers in women.3 If vaccination of both girls and boys can prevent the vast majority of these cancers, why are so many more girls than boys receiving the vaccine, and what can be done to increase vaccination rates?
Currently, the CDC and the Advisory Committee on Immunization Practices (ACIP) recommend that all girls and boys who are aged 11 or 12 years should get the recommended series of HPV vaccine, which is “2 doses for persons starting the series before their 15th birthday.”3 This has a 2-fold advantage. The earlier age is associated with a more robust immune system capable of mounting a protective immune response. The CDC also says studies have shown that 2 doses of HPV vaccine given at least 6 months apart to adolescents at age 9 to 14 years worked as well or better than 3 doses given to older adolescents starting the series at age 15 or older. Two vaccines instead of 3 also makes it more likely that children will complete the recommended schedule. Children aged 15 to 26 years still need the 3-dose regimen, as do children aged 9 to 26 years who are immunocompromised and would benefit from an extra dose. As of June 26th, 2019, the ACIP recommends “catch-up” vaccination4 for males through age 26 years (previously through age 21 years), in order to make sure that the vaccine is offered equally to both genders.
Vaccination rates and the gender gap
According to the CDC, most parents are choosing to get the HPV vaccine for their children, which is good news. In 2017, nearly half (49%) of adolescents were up-to-date on the HPV vaccine, and approximately two-thirds (66%) of adolescents aged 13 to 17 years received the first dose to start the series.5 On average, the percentage of adolescents who started the vaccine series increased by 5 percentage points each year over the past 5 years (2013-2017).
Despite the progress, there are several serious problems that cannot be ignored. For one, the 66% refers to the number of persons getting at least 1 dose.5 Only 49% of teenagers are up-to-date on all recommended doses, which means that only these 49% and not the 66% are actually protected against HPV infection and related cancers. Additionally, even though these numbers improve every year, there is still a long way to go, both in initially getting individuals vaccinated and in making sure they get the full 2- or 3-dose regimen for maximal protection.
1. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV): HPV fact sheet. Available at: https://www.cdc.gov/std/hpv/stdfact-hpv.htm. Reviewed November 16, 2017. Accessed August 5, 2019.
2. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV): About HPV. Available at: https://www.cdc.gov/hpv/parents/about-hpv.html. Reviewed April 29, 2019. Accessed August 5, 2019.
3. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV) Questions and answers. Available at: https://www.cdc.gov/hpv/parents/questions-answers.html. Reviewed August 23, 2018. Accessed August 5, 2019.
4. Immunization Action Coalition. Ask the Experts. Human papillomavirus (HPV). Available at: http://www.immunize.org/askexperts/experts_hpv.asp. Accessed August 5, 2019.
5. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV): HPV coverage data. Available at: https://www.cdc.gov/hpv/hcp/vacc-coverage/index.html. Reviewed August 23, 2018. Accessed August 5, 2019.
6. American Cancer Society. HPV vaccination rates are rising among American teens. Available at: https://www.cancer.org/latest-news/hpv-vaccination-rates-are-rising-among-american-teens.html. Published August 14, 2017. Accessed August 5, 2019.
7. Thomas TL, Snell S. Ask the expert: Vaccinate boys with the HPV vaccine? Really? J Spec Pediatr Nurs. 2013;18(2):165-169. Erratum in: J Spec Pediatr Nurs. 2014;19(1):101.
8. Centers for Disease Control and Prevention (CDC). Chapter 11: Human papillomavirus. In: The Pink Book. Epidemiology and Prevention of Vaccine Preventable Diseases. Available at: https://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html. Reviewed May 16, 2018. Accessed August 5, 2019.
9. American Journal of Managed Care (AJMC) 2006-2019 Clinical Care Targeted Communications Group, LLC. Dr. Anna Beavis discusses gender differences in HPV vaccination. Presented at: Society of Gynecologic Oncology (SGO) 2018 Annual Meeting on Women’s Cancer; March 24-27, 2018; New Orleans, LA. Available at: https://www.ajmc.com/conferences/sgo-2018/dr-anna-beavis-discusses-gender-differences-in-hpv-vaccination. Published March 25, 2018. Accessed August 5, 2019.
10. Kaiser Family Foundation. The HPV vaccine: Access and use in the US. Available at: https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in/. Published October 9, 2018. Accessed August 5, 2019.
11. Centers for Disease Control and Prevention (CDC). CDC Newsroom: Many adolescents still not getting HPV vaccine. Available at: https://www.cdc.gov/media/releases/2015/p0730-hpv.html. Reviewed July 30, 2015. Accessed August 5, 2019.