Improving pediatric HPV vaccination rates: Early initiation and addressing disparities

In this discussion, Jonathan Miller, MD, and Caitlin Miller, a medical student, discussed methods of improving the human papillomavirus (HPV) vaccination rates in pediatric patients, focusing on a quality improvement project aimed at addressing low vaccination uptake.

Historically, HPV vaccination rates in children have been lower compared to other vaccines, such as Tdap and meningococcal, with national rates hovering around the mid-60s. This is significantly lower than the high 80s or 90% uptake seen for other childhood vaccines.

This gap in HPV vaccination led to the development of a quality improvement project aiming to increase vaccination rates, particularly by initiating the vaccine at an earlier age. The standard practice had been to begin HPV vaccination at age 11 or 12 years, but the project sought to start at age 9 years. By doing so, the goal was to ensure children were fully vaccinated by age 13 years, before potential exposure to the virus.

The project showed positive results, with providers successfully starting the vaccine at younger ages, leading to higher rates of complete vaccination by age 13 years. Additionally, the initiative had a significant impact on reducing health disparities related to HPV vaccination. A health disparities analysis revealed that vaccination rates improved notably in historically underserved groups, such as rural populations and certain racial and ethnic communities. The increased access to vaccination opportunities, along with cancer prevention messaging, helped bridge the gap between higher and lower vaccination rates.

Dr. Miller emphasized the importance of early initiation of the HPV vaccine to effectively prevent HPV-related cancers. Vaccination before exposure to the virus ensures that children develop immunity, significantly reducing their risk of cancers caused by HPV later in life.

Caitlin Miller highlighted the critical role of improving HPV vaccination rates across all demographics, especially in addressing disparities in cancer prevention. She pointed out that increasing vaccination rates can help reduce the disparities seen in cervical cancer rates, particularly in lower-income and rural populations.

According to Dr. Miller, the Centers for Disease Control and Prevention's recommendation should be adjusted to move the standard age for HPV vaccination to 9 years old. This recommendation is based on the success of recent studies and quality improvement projects.

The conversation underscores the importance of early intervention, provider influence, and addressing health disparities to improve public health outcomes, particularly in cancer prevention through increased HPV vaccination uptake.