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Doctors still hesitant to urge HPV vaccine for teenagers

Inoculation rate is ‘unacceptably low,’ says CDC

The percentage of teens receiving the human papillomavirus vaccine remains “unacceptably low” and doctors’ failure to recommend it as strongly as other vaccines may be partly to blame, officials with the Centers for Disease Control and Prevention said Thursday.

The federal agency’s 2013 National Immunization Survey found that 57 percent of girls and 35 percent of boys ages 13 to 17 received at least one dose of the HPV vaccine, which protects against a sexually transmitted virus responsible for cervical, anal, and many oral cancers. That compares with the nearly 86 percent of teens nationwide who had received the Tdap vaccine, which protects against tetanus, diphtheria, and pertussis.

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HPV vaccination rates in Massachusetts were only slightly better than the national average: 62 percent of teen girls and 53 percent of teen boys received at least one HPV shot in 2013, and 39 percent of girls and 22 percent of boys received all three shots needed to have full protection.

The CDC found that HPV immunization rates nudged up slightly from previous survey data, especially for boys, but CDC officials said pediatricians need to do more to improve acceptance of the vaccine to help prevent many of the 27,000 HPV-related cancers that occur in the United States every year.

“We were disappointed with the overall findings,” Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases, said in a press briefing. “When a teen is in a doctor’s office and receives another vaccine and not HPV, that’s a missed opportunity.”

Massachusetts has immunization requirements for those entering seventh grade, though the HPV vaccine is not among those mandated.

Schuchat said pediatricians should be recommending the HPV vaccine to parents during annual checkups of preteens as vigorously as other vaccines that are mandated by states.

Parents reported in the survey that not receiving a doctor’s recommendation was a main reason they decided to skip the HPV vaccine for their teen. Nearly three-quarters of those who decided to get the vaccine for their child said their doctor has recommended it, compared with half of those who decided against the HPV shot. The CDC surveyed more than 18,000 parents of teens ages 13 to 17.

Lingering safety concerns have made some parents wary. Schuchat pointed out, however, that early worries among public health officials about possible serious risks have been laid to rest after 67 million doses of the vaccine have been distributed since it was first approved in 2006.

The most commonly reported symptoms after receiving an HPV vaccine include injection-site reactions such as pain, redness, and swelling, according to the CDC, and other commonly reported side effects include dizziness, fainting, nausea, and headache.

“I personally feel it’s a very safe vaccine,” said Dr. Courtney Gidengil, a vaccine safety researcher and instructor in pediatrics at Boston Children’s Hospital. “Side effects are pretty minimal.”

Reasons for the low acceptance of the HPV vaccine are not fully understood. “Either the conversation isn’t happening in the doctor’s office, or parents are declining it when offered,” Gidengil said.

New Hampshire and four other states that have made efforts in recent years to educate physicians and parents about the vaccine’s benefits experienced a dramatic rise in HPV immunization rates from 2012 to 2013, Schuchat said.

Massachusetts and 10 other states received federal grants for 2014 to help educate physicians and the public on the importance of HPV vaccination, with a goal of having 80 percent of teens vaccinated with three doses of the vaccine by 2020. The state Department of Public Health is using its $800,000 in funds to run public service announcements aimed at parents and to encourage physicians to more routinely recommend the vaccine.

“I think providers are increasingly recommending it,” said Dr. Larry Madoff, director of epidemiology and immunization at the state health department.

But doctors need to make the HPV shot more of a presumption, he added, among the immunizations that they tell parents their teens need as part of the CDC’s recommended schedule.

The health department has no plans to make the HPV vaccine mandatory for seventh graders, Madoff said.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.
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