Who should get the HPV vaccine?

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Applied Evidence

Who should get the HPV vaccine?

J Fam Pract. 2007 March;56(3):197-202

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References

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Dramatic reductions expected. The model predicts that with current screening and vaccination against HPV, low-grade cervical abnormalities associated with HPV-16 and HPV-18 infections would be reduced by 15% and high-grade lesions by 49%. Vaccination would decrease the number of cases of cervical cancer by about 66% in conjunction with screening. The vaccine, however, would not prevent cancers caused by other high-risk HPV types.

According to the model, HPV vaccination would produce health gains that are well worth the cost. Specifically, the cost per additional quality-adjusted life-year gained with vaccinating only females was estimated to be $21,000. This ratio compares favorably with many adult and pediatric vaccines currently used in the US.

What makes FPs recommend the HPV vaccine?

A recent survey of attitudes about HPV vaccination among members of the American Academy of Family Physicians (AAFP) found that survey respondents would be more likely to administer an HPV vaccine to girls than to boys and to older rather than younger adolescents.⁴ Female gender, knowledge about HPV, and attitudes about vaccination were independently associated with family physicians’ intentions to recommend HPV vaccination.

It will take decades to see cervical cancer rates drop, but we will soon see fewer CIN 2/3 lesions once HPV 16/18 vaccination is routine.

HPV types 6 and 11 cause 90% of genital warts

Looking forward

FAST TRACK

We will continue screening long after the advent of HPV vaccination, in part, to protect the unvaccinated

The long-term efficacy of HPV vaccines remains to be determined. Sustained efficacy up to 4.5 years has been documented²⁹ but it could be that boosters will be needed.

Research has shown that adolescents and parents, and even some providers of adolescent health care, may have a significant misunderstanding about HPV infection and its possible sequelae,³⁰ suggesting the need for educational programs about the disease and its prevention. Education and vaccine advocacy from professional organizations such as the AAFP, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists will be essential to foster acceptance of HPV vaccination.

CORRESPONDENCE
Michael E. Pichichero, MD, Elmwood Pediatric Group, 601 Elmwood Avenue, Box 672, Rochester, NY 14642. Michael_pichichero@urmc.rochester.edu