Doctors not strongly encouraging HPV vaccine to girls of certain age; National guidelines not closely followed, survey finds

Funded by the Centers for Disease Control and Prevention, this is the first study to look at current HPV vaccination practices of U.S. physicians since the three-dose vaccine series was licensed in 2006 and widely available.

Researchers from the University of Colorado School of Medicine and The Children's Hospital in Denver surveyed 429 pediatricians and 419 family physicians in early 2008 from throughout the U.S., and found that 98 percent of pediatricians and 88 percent of family physicians reported that HPV vaccine was being administered to their female patients.

"HPV vaccination is our best chance at preventing cervical cancer, so it's reassuring doctors are using it. However, vaccination should ideally begin at 11 years of age, so that young women complete the 3-dose series and are protected" said study lead author Matthew F. Daley, MD, a pediatrician and a researcher at the University of Colorado School of Medicine and the Kaiser Permanente Institute for Health Research in Denver, Colorado.

The goal of the HPV vaccine is to prevent HPV infections and ultimately reduce the rates of cervical cancer. Virtually all cervical cancer is caused by HPV infections, and caused by HPV. Approximately 20 million people in the United States are currently infected with genital human papillomavirus. There are many different HPV strains, and current HPV vaccines protect against two HPV strains that cause roughly 70% of cervical cancer cases. The vaccination is recommended currently for 11- to 12-year-old girls, with 'catch-up' vaccinations for 13- to 26-year-female patients who have not been vaccinated.

This survey also uncovered a range of attitudes among physicians related to administering the HPV vaccine to female adolescents. Forty two percent of pediatricians and 54 percent of family physicians considered it necessary to discuss sexuality before recommending HPV vaccine, though few physicians thought that vaccination would encourage earlier or riskier sexual behavior among teens. However, almost half of the physicians reported that parents were concerned about this issue.

Parent opposition to HPV vaccination for moral or religious reasons was perceived as definitely or somewhat a barrier by 23 percent of pediatricians and 33 percent of family physicians. Most surveyed physicians were not using active strategies (such as sending reminders) to ensure that patients who started HPV vaccination received all three doses, which may further delay the age which patients are fully immunized.

The study was conducted by the Vaccine Policy Collaborative Initiative, a program designed with the Centers for Disease Control and Prevention to perform assessments of physician attitudes about vaccine-related issues. Allison Kempe, MD, MPH, a pediatrician and a researcher at the University of Colorado School of Medicine, leads this project. A national network of physicians was developed for this program through the American Academy of Pediatrics and the American Academy of Family Physicians.

Other authors on the study include: Lori A. Crane, Ph.D., MPH of the Children's Outcomes Research Program, Children's Hospital, Aurora, Colorado, and Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado; Lauri E. Markowitz, MD of Division of Sexually Transmitted Diseases Prevention, National Center for HIV / AIDS; Sandra R. Black, DVM, MSPH, Brenda L. Beaty, MSPH, Jennifer Barrow, MSPH, Christine Babbel, MSPH, of Colorado Health Outcomes Program, University of Colorado, Aurora, Colorado; Sami L. Gottlieb, MD, MSPH, and Nicole Liddon, PhD, of Division of Sexually Transmitted Diseases Prevention, National Center for HIV / AIDS; Shannon Stokley, MPH of Centers for Disease Control and Prevention; L. Miriam Dickinson, PhD, of Family Medicine, University of Colorado, Aurora, Colorado; and Allison Kempe, MD, MPH of Department of Pediatrics, Colorado Health Outcomes Program, University of Colorado, Aurora, Colorado; Children's Outcomes Research Program, Children's Hospital, Aurora, Colorado;