HPV vaccine trends point to failures in patient education, vaccine programs

(Press-News.org) Completion rates for the human papillomavirus (HPV) vaccine series across both genders continue to remain alarmingly low nearly seven years after its introduction, suggesting that better patient education and increased public vaccine financing programs are needed, according to new research from the University of Texas Medical Branch (UTMB).

The researchers report "startling" trends in a series of three separate studies published in Cancer, Human Vaccines & Immunotherapeutics and Vaccine.

Using data from the 2010 National Health Interview Survey, an annual cross-sectional survey tracking more than 27,000 adults in the US., researchers found: More than three-quarters of nearly 2,000 women ages 18-26 did not receive the HPV vaccine; another 10% were incompletely vaccinated (three doses required); and two-thirds said they did not want the vaccine, an attitude the researchers attribute to inadequate knowledge, lack of physician recommendation or negative beliefs about vaccines.

Just two percent of nearly 3,000 males ages 9-17 initiated the vaccine and fewer than half of those (0.5%) completed the three-dose series during 2010, the first full year when the vaccine was formally recommended for boys.

Analyzing private insurance claims from 2006-2009: Of 514 privately insured males ages 9-26 who initiated the HPV vaccine series, only 21% completed the series on an off-label basis within the recommended 12 months, and rates decreased over the period – a surprising result, the researchers said, as they surmised that the patient and/or their parents were motivated to obtain the vaccine before the FDA approved it for male use.

"This is the first generation with the opportunity to be vaccinated against the devastating cancers associated with HPV, but the majority are missing the opportunity," said lead author Dr. Abbey Berenson, professor, Department of Obstetrics and Gynecology and director of UTMB's Center for Interdisciplinary Research in Women's Health (CIRWH). "We cannot overstate the public health importance of vaccinating girls and boys. The HPV vaccine is one of the few proven ways to quickly and dramatically decrease our cancer burden."

While cost was a barrier for completion, lack of awareness and understanding about the vaccine continue to be the biggest hindrances. These obstacles were especially pertinent for low-income and/or uninsured families and minority women. The researchers recommend better educational interventions; new physician-patient communication methods, including email and text message; increased physician recommendations; and public vaccine financing programs to increase uptake and completion rates across the board.

This latest research provides a broader picture of HPV vaccine acceptance and builds on a growing body of knowledge at UTMB in this area. Previous studies led by Berenson have focused on completion rates among females ages 9-27 and differences in parents' willingness to vaccinate their sons and daughters.

An estimated 20 million Americans ages 15-49 are currently infected with HPV, and at least 50% of sexually active men and women will contract it at some point in their lives. The virus is the cause of nearly all cases of cervical cancer and nearly 90% of genital warts. HPV is also associated with vulvar, vaginal, penile, anal, and oropharyngeal cancers.

"These results underscore the critical need for better educational interventions and improved communication methods – for patients, parents and physicians – about the importance of initiating and completing the HPV vaccine to save our children from serious disease," said Berenson. "It is especially important to reach parents, who need to understand that this vaccine will help them do what all parents want most – protect their children from harm."

### Other contributing authors include: Dr. Mahbubur Rahman, associate professor, Department of Obstetrics and Gynecology; Dr. Tabassum H. Laz, postdoctoral fellow at CIRWH; Dr. Jacqueline Hirth, assistant professor at CIRWH; Dr. Alai Tan, assistant professor, Department of Preventive Medicine and Community Health; and Dr. Gregg Wilkinson, professor of epidemiology, Department of Preventive Medicine and Community Health and senior fellow, CIRWH. Funding support came from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).