Should HPV vaccination be required for school age children?

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Human papillomavirus (HPV) affects nearly all sexually active individuals. There is no cure for HPV and the virus is associated with many different cancers including cervical and oropharyngeal cancers.

HPV vaccination is not being administered to meet the national coverage goal of 80% for females 13-15 years old. The number of adolescent girls who received at least one of the three doses of the vaccine increased from 25% in 2007 to 53% in 2011, but remained at 53.8% in 2012. If the vaccine was administered at the same time as other scheduled vaccinations, it is estimated that approximately 93% of children would receive at least one dose of the HPV vaccine.  Legislation has been introduced in 41 US states to require the vaccine, funding of the vaccine or to educate the public.

Due to the high HPV transmission rate and increased vaccination coverage enforced by the Patient Protection and Affordable Care Act (ACA), we need to intervene more on the side of prevention to reduce the growing rates of HPV. It is important for providers to discuss the potential risks and benefits of the HPV vaccine with parents of school age children. Every state should have legislation that requires HPV vaccination for all children during scheduled age appropriate vaccinations. Exceptions may be granted to parents with substantial arguments against vaccination. Currently, the National Advisory Committee on Immunization Practices, American Academy of Pediatrics, American Academy of Family Physicians and American Academy of Obstetricians and Gynecologists all recommend vaccinating girls and boys beginning at age 11 and 12. Increasing vaccine coverage will greatly benefit public health by preventing genital warts and many types of cancer.

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5 Responses to “Should HPV vaccination be required for school age children?”

  1. smalvolti Says:

    Death from cervical cancer is today preventable thanks to the availability of highly effective vaccines. The high death tolls for this vaccine preventable disease is therefore not acceptable and should be dealt with more effectively in particular when the efficacy of this intervention is widely recognised as the recent GAVI support for introduction in low income countries demonstrates.

    The access argument can and shall be easily removed with adequate level of financing aimed at granting accessibility to the entire targeted population. Such an intervention can be carried on with no delay.

    In parallel focus shall be devoted to behaviour change measures that address the growing problem of vaccine hesitancy. Interventions aimed at educating adolescents and parents should be rolled out in schools. Measures aimed at influencing the community beliefs via the use of social and traditional media should complement education creating a positive environment that recognises the value of vaccinating against HPV and does not fuel unsubstantiated doubts on the vaccine efficacy or safety. Finally policy interventions should limit to the very minimum the circumstances where vaccination will not be administered: fees proportional to the cost for the healthcare system to treat a cervical cancer patient can be considered to be levied on the parents refusing immunisation.

    Resource constraints, ignorance or false beliefs are no justification for deaths that can be otherwise avoided.

  2. ymc0214 Says:

    Thanks for your interesting posting. I think it’s great that they are rolling out HPV vaccinations for boys and girls.
    I think the two biggest hurdles to successful HPV vaccine programme are accessibility and acceptability. I agree with smalvolti in that educating both children and their parents about the benefits of HPV vaccination is very crucial in getting parents more comfortable with the programme (it would be a cue to action). The accessibility of the vaccines at schools at a reasonable price will determine whether parents move from planning stage into action stage.

  3. jjgpierce Says:

    Link to credit the image: http://www.conspiracyplanet.com/channel.cfm?channelid=55&contentid=4542

  4. morganschellenberg Says:

    Great blog!

    I think one of the most interesting things that you hint at in your posting is the importance of distinguishing between an ‘opt-in’ system and an ‘opt-out’ system. The current systems seems to be one in which people opt in – the vaccine is available, and parents decide if they want their children to receive it. You state it should be made mandatory, although exemptions may be granted for people who strongly object to the vaccine. This implies the system should be transformed to an opt out situation. Examples from the organ donation literature, for example, show that opt out programs have significantly higher rates of participation than do opt in programs, and intuitively this makes sense.

    Therefore, I agree that changing the program to opt out from opt in should greatly increase the number of school-aged girls being vaccinated against HPV, which is certainly an important public health aim.

  5. fhuang2013 Says:

    A hot topic indeed–

    Prevention is always a hard sell, especially when the very object of prevention is considered taboo for discussion. But it’s not just about engaging the health professionals, vaccine-makers, vaccine-funders, parents and children. Local circumstances (ecological model!) will dictate implementation strategies, and help uncover other important stakeholders, some of whom may require targeted education as well.

    That was the case in the province of Alberta, which was one of the last Canadian provinces to offer HPV vaccination to school-aged girls. The large and influential Catholic school boards had strong moral objections, advising parents against vaccination and refusing to facilitate this on their premises. That changed in 2008. The HPV vaccine is now available free to Grade 5 girls in the entire province, and a short-term catch-up program was instituted for girls in Grade 9. Even then, only an estimated 61% of girls aged 9-13 have received the vaccine since then (http://www.thestar.com/news/canada/2013/05/05/hpv_vaccine_alberta_may_include_boys_in_program.html), despite the free cost, government policy support, and arguably good delivery infrastructure.

    As a radiation oncologist treating cervical cancer, I see the other end of this “debate” every day. Cervical cancer is preventable with Pap smears. Now it’s even more preventable with vaccines targeting “high-yield” HPV subtypes. It’s unfathomable that yet another woman in her early 20’s walked through my door the other day with advanced cervix cancer– I think the vaccine messaging should highlight that cancer is not just an old person’s disease, and that cure, where possible, still comes at great cost (not just monetary) to individuals, families, and communities.

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