How Does the New 2-Dose HPV Vaccine Improve Delivery in Primary Care? - Clinical Advisor

Although the vast majority of pediatricians recommend the human papillomavirus (HPV) vaccine starting at age 11 to 12 years, there is a lag among family physicians who recommend vaccination starting at that age, according to survey results published in Pediatrics.¹ The survey results suggest, however, that physicians believe the new 2-dose HPV vaccine schedule is raising HPV completion rates.

Routine HPV vaccination has been recommended by the Advisory Committee on Immunization Practices (ACIP) for girls and boys starting at age 11 to 12 years. Until 2016, HPV vaccination required 3 doses given over 6 months. In 2016, ACIP recommended a 2-dose regimen, scheduled 6 to 12 months apart for children as young as age 9 years.²

To determine the delivery practices, delivery experiences, and overall attitude toward the new 2-dose HPV vaccination schedule, investigators conducted a survey of nationally representative networks of family physicians and pediatricians.

A total of 302 pediatricians and 228 family physicians were included in the analysis. Pediatrician recommendations for HPV vaccination ranged from 83% for 11- to 12-year-old boys to 99% for girls aged ≥15 years. Family physician recommendations ranged from 66% for 11- to 12-year-old boys to 90% for girls aged ≥15 years. Overall, a larger percentage of pediatricians recommended vaccination for each age group compared with family physicians.

Among pediatricians and family physicians who discussed HPV vaccines, a presumptive style was used by 65% and 42%, respectively, while a conversational style to introduce the subject of vaccination was used by 16% and 24%, respectively. “Physicians were classified as using a presumptive [or announcement] style if they reported almost always or always introducing the HPV vaccine by saying, “We’ve got 3 vaccines today: Tdap, HPV and meningococcal vaccines,” said the researchers. Physicians were classified as using a conversational style if they introduced the topic by asking: “Are you interested in getting the HPV vaccine for your child today?”

Pediatricians reported a ≥50% rate of refusal of deferral of HPV vaccination of 19% and 23% among 11- to 12-year-old girls and boys, respectively; family physicians reported 27% and 36% refusal rates for girls and boys of the same age group, respectively. Factors associated with these results included the clinician not strongly recommending vaccination to 11- to 12-year-old patients, not using a presumptive recommendation style most or all of the time, strongly agreeing that they experience less patient resistance to vaccination from 13-year-old compared with 11-year-old patients, and expecting an uncomfortable conversation when recommending the vaccine to younger patients.

Other barriers to vaccination included “misinformation parents receive from the Internet or social media, parental concerns about the safety of the HPV vaccine, parents not thinking the HPV vaccine was necessary for their daughters or sons, and opposition to vaccination for moral or religious reasons,” the researchers reported.

Now that the HPV vaccine schedule only contains 2 doses, 89% of pediatricians and 79% of family physicians claim that more patients age <15 years are completing the HPV vaccinations series.  

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“Our data are encouraging in revealing substantial increases over the past 5 years in the percentage of physicians who report strongly recommending the HPV vaccine to 11- to 12-year-old patients,” the investigators noted. “The findings also reveal that according to primary care physicians, the 2-dose schedule could result in meaningful increases in HPV vaccination initiation and completion among adolescents, leading to greater protection against HPV associated cancers in the United States.”

References

1. Kempe A, O’Leary ST, Markowitz LE, et al. HPV vaccine delivery practices by primary care physicians. Pediatrics. 2019;144(4):e20191475.
   
2. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination–updated recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2016;65(49):1405-1408.

Topics:

Human Papillomavirus Infectious Diseases Primary Care

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