Parents will be happy to learn (and their tweens and teens will be thrilled to hear) that the schedule in which human papillomavirus (HPV) vaccine is administered has changed. The Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) now recommend that HPV vaccine be given to children in two doses instead of three between 11-14 years old. The second dose should be given six months after the first (0 and 6 months). Teenagers 15 years old and up still need three doses, with the second dose given two months after the first and the third dose given 4 months after the second (0, 2, and 6 months). The new recommendation is based on recent scientific data demonstrating a stronger immune response to the HPV vaccine when it’s given between the ages of 11-14, and especially before puberty begins, allowing just two doses to be protective. Melissa Jenco has the official reaction:
CDC Director Tom Frieden, M.D., M.P.H., quickly approved ACIP’s HPV recommendations.
“Safe, effective, and long-lasting protection against HPV cancers with two visits instead of three means more Americans will be protected from cancer,” Dr. Frieden said in a news release. “This recommendation will make it simpler for parents to get their children protected in time.”
For a couple of reasons which we have discussed previously on The PediaBlog, HPV vaccine has been slow to catch onto the routine immunization schedule that guides pediatricians and other public health experts. Concerns about the vaccine’s safety profile have been essentially eliminated through careful, peer-reviewed research; claims doubting efficacy have been debunked; and fear that somehow receiving the vaccine series will make teenagers promiscuous and more likely to engage in sexual activities has been allayed for the most part. Some parents have a really hard time having honest discussions with the pediatrician concerning their children’s emerging sexuality. For this they can be forgiven. One of the main obstacles to better rates of immunization with HPV vaccine has been the need for three shots. It causes logistical problems for busy kids and parents to remember to schedule a time to come back into the office for the remaining injections. Hopefully the new schedule will make things easier and more convenient for everyone involved.
Even though HPV vaccine can be given safely as early as 9 years old, most pediatricians begin offering the series at the 11-year-old checkup. This is actually the best time to start the HPV series because studies have shown better immunogenicity (the immune system’s response to the vaccine) at this young age and also because other vaccines are due at this well visit, namely the meningococcal meningitis vaccine (Menactra) and Tdap booster (tetanus, diphtheria, and pertussis). If the influenza vaccine is available then that should be given at the same checkup as well. Some parents would rather their kids get one or two shots at a time, planning to return on a future date for more shots. This is inadvisable for a number of reasons:
- Giving the vaccines on time and together is the standard of care. In other words, physicians and scientists have concluded from scientific inquiry that this is the safest, most efficacious, most cost-effective way to administer vaccines. Standards of care are there for a reason and it’s best that doctors and patients respect that.
- Refusing or delaying one or more shots means your child remains vulnerable to the infection we are trying to prevent. That also increases the risk to others who have serious medical conditions or who cannot receive vaccines for medical reasons.
- Doing one or two shots and coming back for the others might sound good to parents, but it almost never sounds good to kids. Get the shots done and over with now and don’t subject them to the understandable (but also unnecessary) anxiety about shots that so many children have.
- Parents seldom come back for shots when they say they will. Life gets busy, things get put on the back burner, and shots get missed. This causes serious omissions and errors in physicians’ medical records and statewide immunizations registries, which can then cause headaches for parents trying to register their kids in schools and programs and hardships for doctors who pay a harsh financial price from insurance companies when their patients don’t receive immunizations according to accepted guidelines. (Sigh — yes, there is a heavy financial penalty on your pediatrician and his practice when parents refuse, delay, or forget immunizations, especially the HPV vaccine. Insurers demand adherence to clinical guidelines, including those associated with vaccines, as well they should.)
We’ve covered the reasons why vaccinating pre-teens and teenagers against human papillomavirus — a sexually transmitted cancer of the cervix in women and head and neck (tongue and throat) in males and females — is so important in other PediaBlog posts. Parents who wish to learn more about HPV and the vaccine to prevent it can read all about it, beginning here.
Parents who are in the midst of keeping their children on schedule for future HPV doses should call their pediatrician’s office to determine when the next shot in the series should be given.
(Editor’s note: Comments submitted from readers regarding vaccines are welcome here on The PediaBlog. However, comments from web trolls will not be published here, nor will contrary claims that are unaccompanied by verifiable, peer-reviewed science. False experts, cherry pickers, and conspiracy theorists who deny the value of vaccines in the modern world should expend their energies elsewhere.)