Editor's note: this is an updated version of the original article which appeared in January 2016.
If you combined the number of annual deaths in America caused by meningococcus, measles, mumps, rubella, polio, diphtheria, and tetanus before the introduction of the specific vaccines, the number is approximately 6,000. Compare this to the estimated number of deaths caused by HPV-induced cancers each year—about 11,000. The CDC estimates that 75-80% of Americans have been infected with genital strains of HPV by age 50 years.1 HPV disease is both common and deadly.
Physicians blame parents
So why is our completed vaccination rate for HPV among eligible recipients (about 40%) lower than that achieved in many third world countries? If you ask health care providers the question, many would answer that parents refuse it.
► Some refuse based on fear of lasting side effects listed on anti-vaxxer web sites.
► Some refuse because they know their child will marry a virgin and not have sex until marriage.
► Some refuse it for the middle-school-aged child for whom it is recommended, but plan to get it when the child is older.
Unfortunately, most adolescents have their first sexual encounter way before the parents think they will. The result is teens with a vaccine-preventable infection that would have been prevented had the vaccine only been given earlier.
CDC blames physicians
If you ask the CDC why our completed vaccination rate for HPV is below all the other recommended vaccines in the pediatric age group, they will point a finger at us, the health care providers (aka the pro-vaxxers).
In a study by Gilkey et al2 on the quality of physician communication about HPV vaccine, 27% of surveyed pediatricians and family practice physicians did not “strongly recommend” HPV vaccination at the CDC recommended time. Is there any advantage to delaying the vaccine? No, immunity does not seem to wane. We vaccinate babies against hepatitis B, also a sexually transmitted disease. Should we wait until they are older and more likely to engage in risky behaviors? We already tried that and it didn't work when the hepatitis B vaccine was just given to those “at risk.”
I tell parents that age11 years is the perfect time to give Gardasil since it is nearly always ahead of possible exposure and that 11-year-olds produce higher antibody levels than 16-year-olds. (Not that that really matters; the protection from this vaccine is extremely good no matter when it is administered.)
1. Roush SW, Murphy TV, and the Vaccine-Preventable Disease Table Working Group. Historical comparisons of morbidity and mortality for vaccine preventable diseases in the United States. JAMA. 2007;298:2155-2163. doi:10.1001/jama.298.18.2155.
2. Gilkey MB, Malo TL, Shah PD, Hall ME, Brewer NT. Quality of physician communication about human papillomavirus vaccine: findings from a national survey. Cancer Epidemiol Biomarkers Prev. 2015 Nov;24(11):1673-9. doi: 10.1158/1055-9965.EPI-15-0326. Epub 2015 Oct 22.
3. Clark L, Kuter B. An investigation of the recommendation styles and same day vaccination rates for pediatricians discussing HPV vaccine with adolescent patients and their caregivers. Open Forum Infect Dis. 2014;(suppl 1): S36. doi: 10.1093/ofid/ofu051.97