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NVAC HPV Working Group Charge

There are 25,900 cases per year, on average, of Human Papillomavirus (HPV)-associated cancer in the United States.1 Exposure to HPV is common through sexual contact and most infections resolve over time. However, persistent infection with oncogenic HPV types is associated with a variety of cancers. Virtually all cervical cancers are due to HPV along with 90% of anal cancers, 60% of oropharyngeal, 69% of vaginal, 51% of vulva and 40% of penile cancers.2 Further, 76% of cervical, 87% of anal, 60% of oropharyngeal, 55% of vaginal, 44% of vulva and 29% of penile cancers are caused by oncogenic HPV types 16 and/or 18.3 

Currently there are two HPV vaccines available, which both target and have been clinically proven to prevent infection by these two HPV types, 16 and 18. One vaccine (HPV4 (Gardasil)) protects against HPV types 16 and 18 as well as the most common cause of genital warts, types 6 and 11. Another vaccine (HPV2 (Cervarix) only protects against 16 & 18. To prevent cancer associated with HPV infections, the Advisory Committee on Immunization Practices (ACIP) currently recommends HPV immunization for all children aged 11 or 121, an age before sexual debut, with three doses of vaccine. Despite the ability of this vaccine to protect against HPV-associated cancers, coverage rates for completion of the HPV vaccine series remain below 40% for girls and 10% for boys1 with disparities by race and socioeconomic status. The ACIP has recommended routine HPV immunization for girls since 2006 and extended the recommendation to include boys in 2011. The lower coverage rate seen in boys can be partially attributed to this later recommendation.

Low vaccination coverage levels have been attributed to many factors including cost, missed opportunities, strength of provider recommendation, and parental knowledge and attitudes. The US 2010 National Vaccine Plan (NVP) states the need to ensure access to, and better use of recommended vaccines in the US (Goal 4). In addition it recommends supporting communications to enhance informed vaccine decision-making and to educate and support health care providers in vaccination counseling and vaccine delivery for their patients (Goal 3). To achieve goals outlined in the NVP and to increase coverage and, in-turn, prevention of HPV-associated cancer, understanding the barriers to implementation of the current recommendations and how to overcome them is required.

Charge

The Assistant Secretary for Health (ASH) asks the National Vaccine Advisory Committee (NVAC) to review the current state of HPV immunization, to understand the root cause(s) for the observed relatively low vaccine uptake (both initiation and series completion), and to identify existing best practices all with a goal of providing recommendations on how increase use of this vaccine in young adolescents.

  1. Watson et al. HPV-associated cancers. MMWR 2012;61(15):258-261
  2. Jemal A et al. Annual Report to the nation on the status of cancer, 1975-2009, Featuring the burden and trends in HPV-associated cancers and HPV vaccination coverage levels. JCNI 2012
  3. Gillison, Chaturvedi AK, Lowy DR. HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer. 2008;113(10):3038-3046.