Kids’ HPV shots far from goal in NC, US

It’s the most common sexually transmitted infection. So common, in fact, that most people will be infected with human papillomavirus, or HPV, at least once in their life.

An HPV vaccine, first recommended in the United States in 2006, protects against infections from the virus that can later cause certain types of cancer, such as cervical, penile, anal and cancers of the head and neck.

Yet North Carolina is among about a dozen states with the smallest percentage of children ages 13-17 considered fully vaccinated against HPV, according to 2022 data compiled by the Centers for Disease Control and Prevention. That year, 54.8% of North Carolina children had completed the vaccine series. Nationally, 62.6% of children were fully vaccinated, data show.

Starting vaccinations earlier and encouraging providers to recommend the HPV vaccination would help the state and nation improve, says one North Carolina public health expert.

Far from goal

Children can get the vaccine as early as age 9, and they should take it before age 13 for the greatest effect. 

A different sample, the 2022 National Health Interview Survey, found that when looking at vaccination among children ages 9 to 17, only 38.6% of U.S. children have received one or more HPV doses, according to an analysis released Wednesday. 

That survey’s data is self-reported and may not match information from other sources, such as the CDC, that verify vaccine administration.

Whichever number is closer to the actual amount, the country’s HPV vaccination data is troubling, said Noel Brewer, a researcher who studies why people engage in health behaviors at the Gillings School of Global Public Health at UNC Chapel Hill. 

The World Health Organization has set a goal of 90% of girls fully vaccinated against HPV by age 15 to help drive down cervical cancer rates. The U.S. has aimed at getting at least 80% of all 13- to 15-year-olds fully vaccinated.

Across the country in 2022, though, the percentage of children fully vaccinated ranged from a low of 38.5% in Mississippi to 85.2% in Rhode Island, one of the few states to require the vaccine. North Carolina does not require it.

“No matter what data source you look at, the United States is doing terribly on HPV (vaccine) coverage,” Brewer said. “Pretty much everywhere needs to have higher rates.”

The news comes as other sexually transmitted infections in the state and nation are rising, including congenital syphilis, which claimed the lives of eight North Carolina newborns last year. 

HPV cancers

About 625,600 women and 69,400 men get an HPV-related cancer every year across the globe, according to WHO. The virus causes about 5% of all cancers.

HPV infections play an outsized role in cervical cancer, causing 99.7% of cases, according to a 2020 study in the Journal of Obstetrics and Gynaecology.

Each year in the U.S., about 11,500 women are diagnosed with cervical cancer and about 4,000 women will die, according to CDC statistics.

North Carolina reported 325 new cases of cervical cancer and 142 deaths in 2021, the latest year available, according to preliminary data.

For women with human immunodeficiency virus, or HIV, the risks of getting cervical cancer are much higher. They are six times more likely to develop cervical cancer compared with women without HIV.

North Carolina has a higher rate of new HPV cancer cases than the national rate (13.2 versus 11.8 per 100,000), Brewer and co-author Nadja Vielot wrote last month in an article for the North Carolina Medical Journal. Cancers of the head and neck among North Carolina men account for much of the difference.

Vaccination during adolescence protects against more than 90% of the cancers caused by HPV, according to the American Academy of Pediatrics.

Explore teen vaccination data with this interactive tool from the CDC:

Starting earlier

Health officials generally recommend the HPV vaccine be taken between the ages of 11 and 12.

There’s been a push to start the vaccine series as early as age 9, in part because studies suggest that starting earlier leads to more children getting fully vaccinated. The HPV vaccine requires two doses if initiated before age 13 and three doses if the series is given later. 

While most effective if given before someone becomes sexually active, the vaccine can be given through age 26 for anyone not vaccinated when they were younger. In some cases, it can also be beneficial for adults aged 27 to 45.

Why start so young?

At 9 years old, children are more likely to be still going to annual wellness visits where the vaccine can be given as part of other routine inoculations. Also, parents may have fewer concerns about the vaccine encouraging sexual activity if it is administered before puberty, Brewer said.

Finally, the vaccine schedule for kids ages 11-12 is already pretty crowded, especially when adding the flu and COVID-19 shots. That’s a lot for one visit, Brewer said.

In Washington state, HPV vaccinations more than doubled after the state began recommending in January 2023 that they start at age 9.

Provider recommendation key

The American Academy of Pediatrics recommends providers administer the vaccine to patients ages 9 to 12, and it offers providers tips and information on how best to recommend the vaccine to parents. The CDC’s Advisory Committee on Immunization Practices still recommends vaccination for 11- to 12-year-olds, although it says vaccination can begin as early as 9.

That messaging needs to be consistent, Brewer said.

“Vaccination starts at age 9,” he said. “That’s the recommendation that providers need to get.”

The state also needs better provider recommendations, he said.

Providers may think that parents aren’t interested in getting the HPV vaccination for their child, or expect to have a difficult conversation about sex, Brewer said. That may lead providers to discuss the vaccine with discomfort, delay the conversation or not have it at all.

Moving HPV vaccinations earlier can help with that, and lead to improvement in the numbers of fully vaccinated children, he said.

“We should continue doing the work that we are doing to boost HPV vaccination, as well as all vaccination,” Brewer said.

This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.