Half of Tex. Doctors Don't Recommend HPV Vaccine


Less than half of some 1,100 surveyed primary care physicians in Texas said they follow current recommendations to vaccinate adolescent girls with the approved quadrivalent human papillomavirus vaccine.

The results suggest that “additional efforts are needed to improve clinician awareness of and adherence to national recommendations,” the study investigators reported in Cancer Epidemiology, Biomarkers & Prevention.

The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices has recommended targeting HPV vaccination to 11- to 12-year-old girls. The group advises catch-up vaccinations in 13- to 26-year-old females and vaccination of 9- to 10-year-olds at the provider's discretion. The Food and Drug Administration has approved the vaccine for use in girls and women aged 9–26.

Of the 1,122 family physicians, pediatricians, ob.gyns., and internists who responded to the survey, 49% said they always recommend the HPV vaccine to girls aged 11–12. Sixty-four percent, however, said they always recommend vaccination for 13- to 17-year-old girls, “suggesting that parents or physicians may be delaying vaccination until girls are older than 12,” the authors said.

Nearly 70% of respondents said they would be “extremely” or “somewhat” likely to recommend the vaccine for boys aged 11–12, if the vaccine were approved for use in that population.

Physicians in academic settings were about twice as likely to recommend vaccination as their counterparts in nonacademic settings.

Barriers to recommending the vaccine included parental refusal because of concerns over vaccine safety (70%) and inadequate insurance coverage (67%), the researchers wrote (Cancer Epidemiol. Biomarkers Prev. 2009;18:25–32).

“Two years after the [FDA] approved the vaccine, the study suggests that additional efforts are needed to encourage physicians to follow these national recommendations,” Dr. Jessica A. Kahn, the study's lead author, said in a statement issued by the American Association for Cancer Research, which publishes the journal. “Most physicians are aware of the vaccine and what it prevents, but they may lack knowledge about issues of safety and how to address parental concerns. That may be making them reluctant to deliver the vaccine,” she added.

In the statement, Dr. Kahn, associate professor of pediatrics at Cincinnati Children's Hospital Medical Center, said she believed that the opinions of the Texas physicians “might also be representative of physicians in other states. The study notes that in 2007, HPV vaccination rates among girls aged 11–18 years in the United States ranged from about 6% to 25%, and that “physician endorsement of vaccination is one of the most important predictors of vaccine acceptance.”

Dr. Kahn is a co-principal investigator in a National Institutes of Health-sponsored study of use of the HPV vaccine in HIV-infected adolescents. Merck is providing the vaccine (Gardasil) used in that study.

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