As we enjoy the remainder of our summer but look ahead to the upcoming school year, it’s time to start thinking about those back-to-school physicals and routine immunizations for our patients and our own kiddos. In this blog post, we will offer insight into two current methods of offering HPV vaccinations to our youngsters and their parents/caregivers and discuss which method improves HPV vaccination rates.
In March 2024, an article by Yours Truly was published in the Journal of the American Academy of PAs (JAAPA) titled, “Improving Clinician Communication to Increase Adolescent HPV Vaccination Rates.” This article reviews the issue of HPV infections in the United States and trends in adolescent vaccination rates compared to other routine adolescent vaccination rates. You can read the entire JAAPA article or listen to the AAPA PC RAP conversation.
HPV Infection and Vaccination Background
Human papillomavirus is the most common viral sexually transmitted infection in the United States. New HPV infections affect approximately 13 million patients every year, with the highest prevalence found in women ages 20-25 years old. Nearly 80% of sexually active women will be infected with one or more HPV strains during their lifetime. Several high-risk HPV strains cause different types of cancers: Cervical, vaginal, vulvar, anal, penile, and head and neck cancers. The CDC recommends initiating the HPV vaccination series for all adolescents ages 11 to 12, but it may be given to those as early as nine.
In 2022, only 62.6% of adolescents were considered up-to-date (UTD) on their HPV vaccination series, compared to 85% who were UTD on Hepatitis A, and >90% were UTD on MMR, Hepatitis B, and Varicella vaccines. This vaccination rate fell below the goal of 80% set out by the Healthy People 2023 initiative.
Methods of Vaccination Communication
Announcement/presumptive approach
This method involves a straightforward statement that the child is due for a vaccine and assumes the parents are ready for them to be vaccinated. For example,“Now that your child is 11 years old, they should receive four vaccinations at the end of the visit today: HPV, Tdap, influenza, and meningitis. These help protect your child from infections and cancers caused by HPV and infections caused by tetanus, diphtheria, pertussis, influenza, and meningitis.”
Several studies have shown that this approach is associated with higher rates of HPV vaccine acceptance compared to a conversational approach and is commonly employed for all other childhood/adolescent vaccines. Perhaps partly explaining why all other adolescent vaccination rates are higher than HPV vaccination rates.
Conversational/participatory approach:
This method introduces the vaccine and engages parents in an open-ended discussion about it before a decision to vaccinate is made. For example: “Now that your child is 11 years old, they are due for the following four vaccinations: Tdap, influenza, HPV, and meningitis. Have you heard of these vaccines before, and what questions or concerns do you have about them?”
This approach may unintentionally convey that the HPV vaccine is optional rather than routine and recommended and may also discount the vaccine’s value. But, it can increase clinical visit time and encourage more lengthy discussions about vaccine risks vs. benefits, side effects, etc.
Evidence-Based Best Practices for HPV Vaccinations
To improve adolescent HPV vaccination rates, the following evidence-based best practices should be utilized by clinicians:
- Use an announcement approach to introduce the vaccine rather than a conversational approach.
- Discuss the HPV vaccine as indicated rather than elective/optional.
- Convey a strong recommendation for the vaccine to patients and their parents/caregivers.
- Discuss HPV vaccination in the same way as all other indicated and routine vaccines; avoid drawing particular attention to it.
- Follow Advisory Committee on Immunization Practices (ACIP) age-based recommendations for all vaccinations; avoid using risk-based recommendations (suggesting the vaccine more frequently or strongly to patients the clinician believes to be at higher risk for acquiring HPV infection).
- Avoid discussing the HPV vaccination last in the list of routine vaccinations, as the one listed last can convey an unintentional order of importance.
- Emphasize the vaccine’s role in cancer prevention rather than the relationship to sexual activity.
Bringing Awareness to Evidence-Based Methods
Next month is National Immunization Awareness Month. Sharing this information and article with colleagues can be the first step to bringing awareness to evidence-based methods of how we, as clinicians, can affect and improve HPV vaccination rates in the United States and ultimately decrease the morbidity and mortality associated with this extremely common viral infection.
Unfortunately, we cannot change much about the HPV vaccination, but we can improve our knowledge of effective vaccine communication practices. It has been shown that the way in which clinicians offer the HPV vaccine affects how it is perceived and accepted by patients and their parents/caregivers. Over the past several years, we have made great strides in increasing adolescent HPV vaccination rates, but we still have much room for improvement.
The next time you offer routine HPV vaccination to one of your patients, remember these tips and put them into practice. As clinicians, they can help all of us to provide the best care to our patients and prevent future HPV-related healthcare issues. Learn more by listening to the "PA perspectives: Having the HPV Vaccine Conversation with Chelsey Meachum" segment on AAPA Primary Care RAP.
