Dr. Daron Ferris often sees the consequences of human papillomavirus infection in the form of cancer and precancerous changes among women and girls at Georgia Regents University Cancer Center.
Despite the presence since 2006 of a vaccine against HPV, “It’s not getting better, as far as we’re concerned,” said Ferris, of the Gynecologic Oncology clinic.
“It’s even to the point where I’ve had mothers come in with daughters who have severe precancerous changes and they’re young enough that they could have received the vaccine and it could have been prevented.”
Still, the rate of vaccination against HPV, the most common sexually transmitted virus that can lead to cancer, did not increase last year, which was “a huge disappointment,” said Thomas Frieden, the director of the Centers for Disease Control and Prevention.
If the vaccine were administered when teenage and pre-teen girls got other vaccines, however, nearly all of them would get coverage, Frieden said Thursday.
The president of the American Academy of Pediatrics said his group was ready to help educate parents and recommend the vaccine more.
The rate of girls ages 13-17 who had received at least one dose of the HPV vaccine remained stuck at 53.8 percent in 2012, virtually unchanged from 53 percent in 2011, the CDC reported Thursday. In fact, the percentage of girls receiving all three recommended doses declined from 34.8 percent to 33.4 percent last year. If the vaccine were administered at the same time girls were getting other recommended vaccines, the coverage rate would climb to 92.6 percent, according to the report.
“We’re dropping the ball,” Frieden said. “We’re missing opportunities to give HPV vaccine, and that needs to change. This is a huge disappointment, but I am confident we will turn it around.”
In a survey of teens’ parents, about 19 percent of those who did not intend for their daughters to get the vaccine said it wasn’t needed, 14 percent thought it was not recommended, 13 percent thought the vaccine was unsafe and 10 percent refused because the child was not sexually active.
Pediatricians should address those concerns with parents to encourage HPV vaccination, which is recommended now for both boys and girls, said academy president Thomas K. McInerny.
“It is up to doctors to have open and honest and frank discussions with parents about the importance of this vaccine and to ensure their adolescents get vaccinated,” he said.
The vaccine is against the four HPV strains most commonly linked to cervical cancer and other problems such as genital warts. If the U.S. vaccination rate were to reach 80 percent – a level already achieved in other countries, such as Australia and Rwanda – there would be 53,000 fewer cases of cervical cancer in the future among girls now age 12 and younger, the CDC report notes.
There had been concerns from some parents that vaccinating young girls against a sexually transmitted disease would lead to higher rates of promiscuity, but studies have found that did not happen, Frieden said.
“HPV vaccine does not open the door to sex,” he said. “HPV vaccine closes the door to cancer.”
The recommended age to start vaccinating girls is 11.
About 79 million people in the U.S. are already infected with HPV and about 14 million are infected each year, the CDC noted. Within the first four years of the HPV vaccine being administered, the rate of infection dropped by more than 50 percent in girls ages 14-19 and the rate of genital warts also declined. In Australia, where there is a much higher coverage rate among females, the incidence of genital warts has also decreased in males, the CDC report noted.
With more than 57 million doses administered, there has not been a significant rate of serious adverse events, said Dr. Anne Schuchat, the director of the National Center for Immunization and Respiratory Diseases.
“We don’t have safety concerns about the vaccine,” she said. “So far, we have very reassuring news.”
Part of the problem might be that primary care providers feel uncomfortable talking about the subject with the parents of adolescents but they might not know the consequences of doing nothing, said Ferris, who conducted clinical trials on the vaccine and is working on the potential new vaccine.
“A lot of them don’t see what we see as far as the disease,” he said. “They never actually see what happens. It’s not difficult to have somebody roll up their sleeve and get a shot. That’s easy. But it is difficult to tell them, ‘You’re not going to have children and potentially you could die from it.’ ”