An update on barriers to adolescent human papillomavirus vaccination in the USA

Abstract

Human papillomavirus is the most common sexually transmitted infection in the USA. It is the primary cause of almost all cervical cancers as well as several other cancers that affect both men and women. Adolescents of both genders can now prevent transmission of the most common oncogenic strains of human papillomavirus by obtaining a safe, three-dose vaccine series. However, despite its potential to save lives and reduce severe morbidity, many US adolescents have not been vaccinated. This is in contrast to other countries where high rates of vaccination are already reducing rates of cervical intra-epithelial neoplasia and genital warts. This article describes barriers recently reported among families in the USA and concludes with suggestions for improving uptake.

Keywords:

• awareness
• barriers
• cancer prevention
• HPV vaccine
• human papillomavirus
• provider recommendation
• vaccination

Acknowledgements

SY Rojahn (Center for Interdisciplinary Research in Women’s Health, University of Texas Medical Branch at Galveston) assisted with drafting this review.

Financial & competing interests disclosure

The author is supported by the Center for Interdisciplinary Research in Women’s Health, University of Texas Medical Branch at Galveston (UTMB). The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Many girls and most boys in the USA have not received the human papillomavirus (HPV) vaccine, leaving them vulnerable to several cancers caused by this common infection.

• The vaccine requires three doses, each of which costs US$121–US$147, which creates a financial barrier for many families as well as providers. Some families who are eligible for free vaccines are not aware of the opportunity.

• Families that receive a recommendation from a physician or other provider are more likely to vaccinate their child; however, providers do not always recommend the vaccine due to lack of awareness (especially regarding the need to vaccinate males), the awkwardness of discussing a sexually transmitted infection with parents and lack of time.

• Among families in the USA, awareness and knowledge about HPV and the HPV vaccine vary by community. Many parents are unaware that boys are at risk for HPV-related cancers.

• Some parents who do not have their child vaccinated report that they are concerned with the potential for negative side effects and other consequences of vaccination. However, this vaccine has been administered to millions of patients worldwide and has been proven safe by several studies.

• The need for three doses of the vaccine administered over 6 months is a challenge for families. Alternative settings for vaccination, such as school-based clinics, could help.

• I anticipate growing attention to the risks that HPV presents to boys and men and therefore an improvement in the low male vaccination rate (only 21.6% completion among 13- to 17-year-old boys).

• A new HPV vaccine that protects against more cancer-causing strains was recently approved in the USA. It is not yet clear how this additional vaccine will affect vaccination rates nor is it clear whether re-vaccination will be recommended by providers.

Notes

HPV: Human papillomavirus.