CLPeds Mobile Logo

Search form


How to Pump up the Volume on Gardasil Coverage

How to Pump up the Volume on Gardasil Coverage

If you combined the number of annual deaths in America caused by meningococcus, measles, mumps, rubella, polio, diphtheria, and tetanus before the introduction of the specific vaccines, the number is approximately 6,000. Compare this to the estimated number of deaths caused by HPV-induced cancers each year—about 11,000. The CDC estimates that 75-80% of Americans have been infected with genital strains of HPV by age 50 years. HPV disease is both common and deadly.

So why is our completed vaccination rate for HPV among eligible recipients (about 40%) lower than that achieved in many third world countries? If you ask health care providers the question, many would answer that parents refuse it. Some refuse based on fear of lasting side effects listed on anti-vaxxer web sites. Some refuse because they know their child will marry a virgin and not have sex until marriage. Some refuse it for the middle-school-aged child for whom it is recommended, but plan to get it when the child is older. Unfortunately, most adolescents have their first sexual encounter way before the parents think they will. The result is teens with a vaccine-preventable infection that would have been prevented had the vaccine only been given earlier.

If you ask the CDC why our completed vaccination rate for HPV is below all the other recommended vaccines in the pediatric age group, they will point a finger at us, the health care providers (aka the pro-vaxxers). In a study by Gilkey et al1 on the quality of physician communication about HPV vaccine, 27% of surveyed pediatricians and family practice physicians did not “strongly recommend” HPV vaccination at the CDC recommended time. Is there any advantage to delaying the vaccine? No, immunity does not seem to wane. We vaccinate babies against hepatitis B, also a sexually transmitted disease. Should we wait until they are older and more likely to engage in risky behaviors? We already tried that and it didn't work when the hepatitis B vaccine was just given to those “at risk.”  I tell parents that age11 years is the perfect time to give Gardasil since it is nearly always ahead of possible exposure and that 11-year-olds produce higher antibody levels than 16-year-olds. (Not that that really matters; the protection from this vaccine is extremely good no matter when it is administered.)

There are experts who think, too, that even those providers who do feel strongly that HPV vaccine should be given may be using an ineffective communication approach. We like to think that if we provide the parents with the correct information, they will make the correct choice. Health care professionals are aware of the controversy around the HPV vaccine that circulates through social media and lives on the Internet and often feel obliged to provide more information about this vaccine than they do about dTap and meningococcus—the other two vaccines given at the 11-year-old visit.

Clark and Kuter2 audiotaped pediatric well visits and found that in 72% of the total visits, more time was spent discussing HPV vaccine versus the other two. In 17% of the visits the HPV vaccine was mentioned without a recommendation and in 11% of the visits the parents were basically told, “Your child is due for 3 vaccines today, HPV, dTap, and meningococcus.”  

See if you can match up the same-day immunization rate with the 3 different communication approaches; which approach had the highest success rate?

Communication approach                                          Same-day vaccination rate

1. Extra time spent recommending and discussing HPV as compared to time spent talking about the other 2 vaccines.

a. 27%

2. HPV mentioned and offered, but not recommended or discussed in depth.

b. 94%

3. Parents simply told their child will be receiving the 3 recommended vaccines today and did they have any questions.       

c. 38%


Please click here for answer and discussion.


Loading comments...

By clicking Accept, you agree to become a member of the UBM Medica Community.