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HPV Vaccination Recommendation
1. HPV Vaccine Recommendations & Current
Issues
Gregory Zimet, PhD
Professor, Department of Pediatrics
Section of Adolescent Medicine
Indiana University School of Medicine
2. Disclosures
Investigator on HPV-related research grants funded by
Merck’s Investigator-Initiated Science Program
3. Outline
Current status of HPV vaccine
recommendations
HPV vaccine safety
HPV vaccination rates
Summary & recommendations
5. HPV Vaccine Licensure: FDA
Quadrivalent Vaccine
Females 9-26 years old (licensed in 2006)
Males 9-26 years old (licensed in 2009)
Bivalent Vaccine
Females 9-26 years old (licensed in 2009)
6. ACIP HPV Vaccine
Recommendations for
FEMALES
Quadrivalent (licensed 2006):
For prevention of vaginal, vulvar, and cervical precancers and
cancers, genital warts, and anal precancers (AIN 2/3)
Bivalent (licensed 2009):
For prevention of vaginal, vulvar, and cervical precancers and
cancers
Both vaccines:
Routine administration for 11-12 year old girls
Administration for 9-10 year old girls at provider’s/parental
discretion
Administration for 13-26 year old females not previously
vaccinated
7. ACIP HPV Vaccine
Recommendations for
MALES
Quadrivalent vaccine only:
2009 – permissive recommendation; 2011 – routine
recommendation
For prevention of genital warts & anal precancers (AIN 2/3)
Routine administration for 11-12 year old boys
Administration for 9-10 year old boys at provider’s/parental
discretion
Administration for 13-21 year old males not previously
vaccinated
Males 22-26 may get vaccinated by not strongly recommended
Men who have sex with men (MSM) should be immunized up to
8. Other Recommendations
Previous sexual activity not a contraindication
No testing for prior HPV exposure necessary
HIV-infected males and females 9-26 should get
3-dose quadrivalent vaccine series
HPV vaccines can be co-administered during
same visit with other recommended vaccines
(e.g., MCV4; Tdap)
9. Other Recommendations
Though no known danger exists, HPV vaccine is
not recommended for pregnant women
Cervical cancer screening recommendations
should be followed regardless of vaccination
status
No evidence for prevention of penile
cancers, oropharyngeal cancers, or RRP
11. HPV Vaccines are Safe
Safety continues to be closely monitored by
several different systems*
VAERS data to date show no concerns about
safety**
Study based on over 600,000 doses of vaccine
found no increased risk for***:
Stroke
Seizures * Markowitz et al. Vaccine 2010.
** Slade et al. JAMA 2009.
Allergic reactions *** Gee et al. Vaccine 2011.
Many other conditions
12. HPV Vaccines are Safe
Examination of multiple studies that compared
vaccine recipients to placebo recipients*:
About 22,000 persons in each of the 2 groups
Severe adverse events examined included: adverse
pregnancy outcomes, immune system
problems, heart problems, and nervous system
problems
Severe adverse events occurred rarely in both
groups
NO DIFFERENCE FOUND *Lu et al. BMC Infect Dis 2011.
BETWEEN THE
VACCINE GROUP AND THE CONTROL GROUP
13. HPV Vaccines are Safe
All of the evidence to date indicates that HPV
vaccination is much safer for children &
adolescents than:
Playing soccer
Taking Tylenol (acetaminophen)
Riding in or driving a car
Mowing the lawn
15. Indiana: Cervical cancer
summary
Hispanic women have higher incidence of
invasive cervical cancer compared to other
women
Black women have higher cervical cancer
incidence and mortality than white women
Indiana and national rates of cervical cancer
incidence and mortality are roughly equivalent
Lake county has a cervical cancer death rate
that is nearly twice the national rate
From: Swanson, Weathers, Rakowski. “Cancer Disparities in Indiana:
An Epidemiologic Profile”. IUSCC, IU Public Health, ACS.
16. From: Swanson, Weathers, Rakowski. “Cancer
Disparities in Indiana: An Epidemiologic Profile”.
IUSCC, IU Public Health, ACS.
17. From: Swanson, Weathers, Rakowski. “Cancer
Disparities in Indiana: An Epidemiologic Profile”.
IUSCC, IU Public Health, ACS.
18. 2010 HPV Vaccination Rates for 13-17
year old girls*
80%
70%
60%
73%
50%
58%
40% 49% 1st Dose
3 Doses
30%
34% 37%
20% 29%
10%
0%
U.S. Indiana Rhode Is.
*CDC MMWR 2011.
19. 2009 Indiana HPV Vaccination Rates
for 13-17 year old girls*
60% 1st Dose
50%
40%
52%
30% 37%
31%
20%
10%
0%
Indiana Marion Cty Lake Cty
*CDC MMWR 2010.
20. 2010 Vaccination Rates: Other
findings*
Indiana is 4th from the bottom in HPV
vaccination
Male vaccination: Nationally,1%-2% received 1
or more doses
Meningococcal vaccine
63% nationally
71% Indiana
2007-09 U. Mich. Health Systems
18% of 19-26 yr old women vaccinated*
*CDC MMWR 2011
2008 North Carolina Survey Dempsey et al. Vaccine 2011
Reiter et al. Sex Trans Dis 2010
19% of 10-12 yr old girls vaccinated*
24. Summary: The good, the bad, and the
ugly
The good
HPV vaccines are very effective
HPV vaccines are very safe
All 11-12 year olds should be receiving HPV vaccine
The bad
The U.S. in general has not done well with HPV
vaccination, particularly with targeted age group
Indiana is 4th from the bottom of all states in HPV vaccination
rates for 13-17 year old girls
The ugly
Completion rates for non-Hispanic Blacks, Hispanics, and those
who fall below the poverty line are unacceptably low
25. Recommendations
Develop and test new and creative strategies to
increase acceptance of vaccine and reduce
disparities in series completion
Focus on Lake County
Look to Rhode
Island, Massachusetts, Washington State, and
South Dakota as examples of fairly successful
HPV vaccination programs