Melinda Wharton, MD, MPH Director, Immunization Services Division HPV Vaccination Melinda Wharton, MD, MPH Director, Immunization Services Division Washington, D.C. June 27, 2019

HPV Vaccine Recommendations, United States, 2006-present 2006: HPV vaccine recommended as three dose series for girls at 11-12 years of age, with catch up through 26 years of age 2011: HPV vaccine recommended as three dose series for boys at 11-12 years of age, with catch up through 21 years of age. 2015: 9-valent HPV vaccine replaced 4-valent HPV vaccine 2016: For boys and girls who start series before 15th birthday, only two doses of HPV vaccine needed

Trends in Vaccination Coverage among Adolescents Aged 13-17 Years, NIS-Teen, United States, 2006-2017 Walker TY et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years – United States, 2017. Morb Mortal Wkly Rep 2018

Estimated Up-to-Date HPV Vaccination Coverage among Adolescents, 2017 National Coverage = 49% D.C. 70-79% 60-69% 50-59% 40-49% 30-39% 20-29% Walker TY et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years – United States, 2017. Morb Mortal Wkly Rep 2018

Reasons for Not Vaccinating Adolescents with HPV Vaccine, Unvaccinated Adolescents* Aged 13-17 Years, NIS-Teen, United States, 2017 Parents of Girls Parents of Boys Safety concerns/side effects 24% 17% Not needed/not necessary 14% Not recommended 15% 8% Lack of knowledge 9% Not sexually active 7% So why is coverage lower than it is for other recommended vaccines? In the National Immunization Survey, we ask parents of unvaccinated adolescents, who indicated that they do not intend to have their child vaccinated in the next 12 months, why their child is not vaccinated. In the 2017 survey, the most common reason reported by parents of both boys and girls was concern about safety or side effects. The other reasons – that HPV vaccine was not needed or necessary, that it was not recommended, that they don’t really know about it, or that their child is not sexually active – could all at least potentially be addressed by a strong provider recommendation. In surveys of pediatricians and family physicians, immunization providers acknowledge that they do not consistently give a strong recommendation for HPV vaccine at the recommended age of 11 to 12 years. CDC. National Immunization Survey-Teen, 2017.

Prevalence of Vaccine-type HPV (HPV 6,11,16,18) in Females, Early Vaccine Era Compared to Pre-vaccine Era Markowitz et al, J Infect Disease 2013 NHANES: National Health and Nutritional Examination Survey

Prevalence of Vaccine-type HPV (HPV 6,11,16,18) in Females, Late and Early Vaccine Era Compared to Pre-vaccine Era Markowitz et al, J Infect Disease 2013; Oliver et al, J Infect Dis 2017 NHANES: National Health and Nutritional Examination Survey