Only two states in U.S. require HPV vaccination

The JAMA Network JournalsJul 15 2015

An examination of state vaccination requirements for adolescents finds that the human papillomavirus (HPV) vaccine is currently required in only two states, many fewer than another vaccine associated with sexual transmission (hepatitis B) and another primarily recommended for adolescents (meningococcal conjugate), according to a study in the July 14 issue of JAMA.

Eight years after HPV vaccines were first recommended in the United States, vaccination coverage is substantially below the Healthy People 2020 target of 80 percent. Data from the U.S. Centers for Disease Control and Prevention (CDC) show that 38 percent of adolescent girls and 14 percent of adolescent boys had completed the 3-dose series in 2013. Recent efforts to address these deficits emphasize that HPV vaccines should not be viewed or treated differently than other routinely recommended vaccines, according to background information in the article.

Jason L. Schwartz, Ph.D., M.B.E., and Laurel A. Easterling, of Princeton University, Princeton, N.J., examined the presence and timing of state requirements for vaccines with particular relevance to adolescent health and compared those findings to the implementation of HPV vaccines. Vaccines studied were those used by the CDC to evaluate adolescent vaccination that were added to the recommended schedule since 1990 and protected against new disease targets: hepatitis B, varicella, meningococcal conjugate, and HPV. The researchers identified the earliest date that a requirement, if applicable, took effect for each vaccine in every state and the District of Columbia (D.C.) for any childhood, adolescent, or college-aged population.

Vaccination requirements were more common for hepatitis B vaccine (47 states and D.C.), varicella vaccine (50 states and D.C.), and meningococcal conjugate vaccine (29 states and D.C.) than for HPV vaccine (2 states and D.C.). Through March 2015, only Virginia and D.C. required HPV vaccination, and each includes broad, vaccine-specific exemption procedures. A third requirement will take effect in Rhode Island in August 2015.

In a comparison of requirements eight years after publication of a routine Advisory Committee on Immunization Practices recommendation, hepatitis B vaccine was required in 36 states and D.C., varicella vaccine in 38 states and D.C., meningococcal conjugate vaccine in 21 states and D.C., and HPV vaccine in 1 state and D.C.

"Why HPV vaccine requirements have not been more widely implemented is unclear, but may reflect reluctance among states to revisit the contentious political climate surrounding requirement proposals in 2006-2007. The novelty of the 3-dose HPV vaccine series in the adolescent schedule may present additional challenges. The recent approval and recommendation of a 9-valent HPV vaccine offers a new opportunity to consider all strategies shown to promote high vaccination rates, including school requirements," the authors write.