Should Kids Get the HPV Vaccine Earlier?
Recommending the human papillomavirus (HPV) vaccination to parents of 9- to 10-year-old children allowed clinicians to discuss cancer prevention and avoid the sticky subject of sexual activity that often comes up with older age groups, new research showed.
The study, published in Pediatrics , also found that parents were generally open to having their 9- to 10-year-old children vaccinated for HPV.
'At ages 9-10, sexual activity was less salient, and HPV was the only vaccine to discuss,' said Caroline Tietbohl, PhD, an assistant professor in the Department of Family Medicine at the University of Colorado in Aurora, Colorado, and lead author of the study. 'This made discussions shorter and easier and also paid forward to the 11-year-old visit, where there was now one less vaccine to discuss.'
HPV is the most common sexually transmitted infection in the US, with approximately 42 million people currently infected.
The US CDC currently recommends the HPV series vaccine as part of routine vaccination beginning at age 11 years, but states that vaccination can start at age 9 years. The vaccine is highly effective for preventing several types of cancer, including cervical and oropharyngeal cancers.
Two doses are recommended for most people who start the series before age 15 years, and three doses are recommended for those who start the series after age 15 years, as well as immunocompromised individuals. Yet only 40% of children between 9 years and 17 years of age have received at least one dose.
Tietbohl said her team was motivated to conduct the research by persistently low completion rates of the HPV series despite strong evidence that the vaccine is safe and highly effective at preventing cancer.
'We anticipated that bringing up the HPV vaccine at this age could make the discussion easier by decoupling it from sexual activity and focusing on its purpose — cancer prevention — and this seems to have been true for many parents in our study,' Tietbohl said.
She and her colleagues surveyed and interviewed pediatricians and staff between 2021 to 2022 at 17 clinics in Colorado and 16 in California.
The practices were randomly assigned to either recommend the HPV vaccine to parents of the younger children or to continue at the current standard at ages of 11-12 years. Surveys assessed how the shift was implemented, while interviews provided more detail about any challenges or benefits observed.
Prior to the intervention, none of the clinics had recommended the vaccine to younger patients, instead following the current standard recommendation. One month after the intervention, over 90% of clinicians in Colorado and 77% of those in California reported routinely recommending the vaccine to children at ages 9 years or 10 years.
Most clinicians and staff in the intervention group reported that parents were largely receptive to the earlier recommendation, sometimes to the clinician's surprise. Many said they had expected parents to push back, assuming that discussions of the HPV vaccine would raise concerns about sexual activity or be met with hesitation. Instead, they found that conversations were easier at ages 9 years and 10 years because sexual activity was less of a consideration for parents at that age.
Angela Myers, MD
The findings build on evidence that parents may be more receptive when the discussion starts earlier, said Angela Myers, MD, professor of pediatrics and pediatric infectious diseases at the University of Missouri-Kansas City, who was not involved in the study.
'The earlier we get kids vaccinated against HPV, the better their immune response,' Myers said. 'Sexual activity becomes kind of a nonthought at age 9. That's as it should be because this is a cancer prevention vaccine.'
Despite the positive response, some clinicians noted challenges, including electronic health record reminders that still reflected the older age recommendation, as well as occasional parental surprise at being offered the vaccine at a younger age.
'The main hitch was that some parents were not expecting to discuss the HPV vaccine until age 11 and had already promised their kids that the 9- or 10-year-old visit would not include shots,' Tietbohl said.
The next phase of the research will focus on analyzing whether earlier vaccination improves rates of series completion by age 13 years, Tietbohl said.
Myers said recommending the vaccine earlier could help improve vaccination rates by giving families more time to complete the series before adolescence.
'Every new study that gets published adds a little bit more to the story,' Myers said. 'Collectively, all of the data can help in saying, 'Perhaps we should take another look at this and perhaps we should change the language slightly.'
Tietbohl and Myers did not report any relevant conflicts of interest. The study was supported by the National Cancer Institute of the National Institutes of Health.
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