Why aren’t pediatricians recommending HPV vaccination more strongly?

In a recently published essay to address this question, the authors suggest that pediatricians may present human papillomavirus (HPV) vaccine as optional or less urgent than other adolescent vaccines because they do not often read or hear about their patients’ being affected by HPV-associated cancers, which generally strike older populations. As a result, clinicians may tend to underestimate the true risk of HPV-associated disease.

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In contrast, the authors noted, pediatricians may overestimate the risk of diseases with which they are familiar and for which vaccines are recommended, such as pertussis or meningococcal disease, leading them to strongly recommend these vaccines. Whereas the prevalence of pertussis and meningococcal disease is relatively low, cases and outbreaks get substantial attention in the pediatric literature, professional circles, and the media. Given this publicity and their training and clinical exposures, many pediatricians may easily imagine the frightening scenarios that sometimes characterize these conditions, something they do not do with unfamiliar HPV-associated diseases. The authors argue that these processes result in “cognitive biases” that can lead clinicians to make errors in judgment when it comes to strongly recommending vaccines (Niccolai LM, et al. Pediatrics. 2016;138[4]:e20161537).

My take

These authors point out that tetanus, diphtheria, pertussis, and meningococcal disease cause fewer than 200 deaths per year in the United States, while more than 6,000 deaths from HPV-associated cancers occur in the same time period. It is up to pediatricians and others caring for children to make the case for this vaccine and to set the expectation that all our patients should be vaccinated for HPV just as we set that expectation for measles-mumps-rubella vaccine and others. It is a big job, but it just got a bit easier: The CDC recently stated that for patients aged between 11 and 14 years, 2 doses of HPV vaccine can be considered full immunization. -Michael G Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.