Adolescents need to see their doctors more often to receive the HPV vaccine

Sep 5 2007

Despite recommendations for annual preventive exams for adolescents, only 10 percent of teens have enough visits within 12 months to receive the recommended three shots needed for HPV vaccine. Ideally the three shots are delivered within six months, and only 1 percent of teens see their physicians that often.

“In order to be best protected against HPV, teens need all three shots before they are exposed to the virus,” said Cynthia Rand, M.D., M.P.H., assistant professor of Pediatrics at the University of Rochester Medical Center, and author of a study in Pediatrics today about adolescents' need for more doctor visits to receive the HPV vaccine. “Even if we stretch the shots out over 24 months instead of six and include check-up and sick visit as opportunities to vaccinate, only about a third of girls and a fifth of boys are seeing their doctors enough to receive all the shots.” This implies a high percentage of additional visits to primary care physicians are needed.

However, the introduction of this and other adolescent vaccines over the past few years presents health care providers with a new opportunity to offer preventive medicine. Adolescents as a whole do not see their physicians often enough to receive routine care and safety messages that are incredibly important for that age group.

“The HPV vaccine, along with the others, could be a draw to get these teenagers in and then we'd have more chances to talk to them,” Rand said. “We could counsel teens more on alcohol and tobacco use, safety and mental health issues, diet and exercise.

“We need parents and physicians to realize that even though these children can be very independent at this age, they still need you to encourage them to see their doctors for important preventive care even beyond the new vaccines.”

Rand 's study showed that the adolescents who are male, black, Hispanic, uninsured and poor are the most at risk for not seeing their physicians often enough to receive the vaccine. But even teens outside those categories aren't getting to the doctor enough. According to the study's analysis of 2,900 11 to 21 year olds' primary care visits to pediatricians, family physicians, obstetrician/gynecologists and internists in 2002-2003, more than 50 percent of both teens who had insurance and who are not poor needed two or more visits to complete the series of HPV shots.

The national Medical Expenditure Panel Survey from which the data was pulled predates the recommendations for the HPV vaccine as well as two other recent additions to the immunization schedule for adolescents. The Centers for Disease Control and Prevention funded this study.

HPV or the human papillomavirus is the most common sexually transmitted infection in the United States . Two of the four strains the new HPV vaccine, Gardasil®, manufactured by Merck & Co., Inc., protect against cause 70 percent of cervical cancers (the other two protect against 90 percent of genital warts). The vaccine was recommended earlier this year by the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices and the American Academy of Pediatrics for girls 11 and 12 and those 13 to 26 who had not yet received the vaccine. Studies are ongoing to determine whether the vaccine is effective for boys, and it is expected the vaccine will be recommended for adolescent boys in coming years.

In addition to the HPV vaccine, two other vaccines have been added to the immunization schedule for adolescents: Tdap to protect against tetanus, diphtheria and pertussis (whooping cough) and meningococcal vaccine for viral meningitis, in addition to a new recommendation for a varicella (chicken pox) booster. Each of these vaccines are given in a single shot each and don't require subsequent visits.

A team of scientists, not including Rand , at the University of Rochester Medical Center played a role in the creation of the HPV vaccine and the University is receiving royalties for its contributions.