U.S. public health officials have fretted about low use of human papillomavirus (HPV) vaccines among adolescent girls for a few years, but rates were at least trending upwards. Now this slow rise has stalled, though, with the proportion receiving all three doses falling for the first time.
The Centers for Disease Control and Prevention (CDC) observed the decline--from 34.8% to 33.4%--in data from the annual National Immunization Survey. Previous surveys showed a slow, but steady, increase in the three-dose vaccination rate, which rose from 5.9% in 2007 to last year's peak of 34.8%. Over the past year the proportion of girls who received one dose was flat too. In a call with reporters to discuss the findings, CDC director Dr. Thomas Frieden gave a frank evaluation of the situation.
"HPV vaccination coverage for girls getting the anti-cancer vaccine has not increased at all from one year to the next. Zero. We're dropping the ball," Frieden said. Typically, coverage rates of a new vaccine will increase 10% every year, but Merck's ($MRK) HPV vaccine Gardasil has fallen well short of these levels in the U.S. since winning FDA approval in 2006. The vaccine--and GlaxoSmithKline's ($GSK) rival Cervarix--is viewed as unnecessary or potentially unsafe by some parents, despite a strong safety record and evidence it cuts HPV prevalence and genital warts.
Officials also questioned if girls were failing to receive all three doses because they only visit the doctor infrequently during adolescence. The latest data undermine this theory, though. Visits to the doctor for other vaccinations were tracked to show whether healthcare systems are missing opportunities to administer an HPV shot. When girls aged 11 or over go for a vaccine other than HPV--DTaP, for example--it is an opportunity to administer Gardasil too.
In 2007, 20.8% of girls aged 11 and over who were yet to receive Cervarix or Gardasil visited their doctor for a non-HPV vaccination. Over the following 5 years use of other adolescent vaccines increased, driving a rise in the number of missed opportunities to give an HPV shot. If healthcare professionals had taken these opportunities, 92.6% of adolescent girls would have received at least one dose of an HPV vaccine. Instead, the vaccination rate languishes at 53.8%.
- here's the CDC report (PDF)
- view the press briefing transcript
- get the New York Times' take