Study shows low uptake of HPV vaccination among patients with autoimmune diseases

The number of children and young adults with autoimmune diseases receiving the HPV vaccination is profoundly low despite studies showing the vaccine to be safe and effective, according to research presented this week at the American College of Rheumatology Annual Meeting in San Diego. Given the increased incidence of HPV in people with autoimmune diseases, this research suggests that increased public health efforts are needed.

Autoimmune diseases, such as lupus and inflammatory bowel disease, are associated with increased rates of persistent infection with human papillomavirus (commonly called HPV) - the most common sexually transmitted disease and the primary cause of cervical cancer. In 2006 and 2009, the U.S. Food and Drug Administration approved two different HPV vaccines for use in people ages nine to 26 (both females and males). Studies show the HPV vaccine to be safe and effective in people with autoimmune diseases, and researchers in Boston recently investigated whether those with autoimmune diseases receive the vaccine more or less often than the general population.

"Our study demonstrated striking low uptake of HPV vaccination among patients both with and without autoimmune diseases," explains Candace Feldman, MD, MPH; rheumatology fellow; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital in Boston and lead investigator in the study. "While increased efforts are necessary for the entire population, a particular focus should be paid to those at high risk for persistent infection. Further studies are needed to better understand this low uptake and to determine strategies for improved access."

Using a U.S. commercial insurance claims database, Dr. Feldman's team identified 29,255 children and young adults with autoimmune diseases and 117,020 without and reviewed their health care records. The average age of those studied was 19 years, and 59 percent were female. The team excluded patients with a history of malignant cancers or organ transplants. Those with autoimmune diseases were matched (based on age, sex and date they received an autoimmune diagnosis) and compared to those without. The team accounted for patients' characteristics, including co-existing diseases, use of health care treatments and geographic regions when assessing the vaccine uptake.

Dr. Feldman's team noted that those with autoimmune diseases had a higher number of physician visits, abnormal pap smears and sexually transmitted diseases when compared to those without autoimmune diseases. Few people in both groups actually received one or more of the three doses of HPV vaccination (8.5 percent in those with autoimmune diseases and 9.1 percent in those without). When looking specifically at females, the researchers noted 13.1 percent with autoimmune diseases and 14.1 percent without received at least one of the three doses, but less than five percent in both groups received all three of the doses - the full vaccination. In a subgroup of female patients who had at least two years of follow-up, 20.6 percent with autoimmune disease and 23.1 percent without autoiummune disease received at least one dose. And of those, 53.1 percent and 51.4 percent - respectively - completed the series.

Additionally, the researchers noted that vaccinations were equally distributed geographically, with the exception of the Northeast, which had a higher percent of those with autoimmune diseases receiving at least one dose.

"Despite the high efficacy of HPV vaccine in preventing cervical cancer and clinically acceptable safety profile, the vast majority of patients aged nine to 26 in our study cohort with and without autoimmune diseases did not receive the HPV vaccine," says Seoyoung C. Kim, MD, MSCE; assistant professor of medicine; Division of Pharmacoepidemiology & Pharmacoeconomics; Division of Rheumatology, Immunology and Allergy at Brigham and Women's Hospital in Boston; and senior investigator in the study. "Patients at high risk of persistent HPV infection should be encouraged to receive the vaccine, although future study is needed to determine the effectiveness of HPV vaccine in patients with autoimmune diseases, particularly those on immunosuppressive drugs."

SOURCE American College of Rheumatology