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ACOG weighs in on HPV vaccination

The Congress urges vaccination in girls at 11 or 12 years. And because older girls and women may get benefit from the series, providers should offer it to them.

September 2010 · Vol. 22, No. 09
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An expert roundtable moderated by Neal M. Lonky, MD, MPH

(OBG Management, August 2010)

WEDNESDAY, AUGUST 25, 2010 —Girls should be routinely vaccinated against human papillomavirus (HPV) at the age of 11 or 12, although vaccination may be advisable in girls as young as 9, according to recommendations from the American Congress of Obstetricians and Gynecologists published in the September issue of Obstetrics & Gynecology.

In a new committee opinion, the Committee on Adolescent Health Care also recommends that ObGyns discuss the potential benefits of HPV vaccination with female patients ages 13 to 26 and offer the vaccine if they haven’t received it or completed the series. The bivalent and quadrivalent vaccines are most effective if given before sexual activity, but sexually active girls and women may still get some benefit from vaccination. The benefits of the vaccine may be limited in patients with previous genital warts or cervical intraepithelial neoplasia.

The organization doesn’t recommend HPV DNA testing before vaccination. In addition, the vaccination isn’t recommended during pregnancy, and patients should use contraception when receiving the series of vaccinations, the committee writes. Patients with immunosuppression may receive the vaccine, but they may have a diminished immune response.

“Studies of the quadrivalent HPV vaccine have shown that in participants naive to the vaccine genotypes who followed protocol, the vaccine was close to being 100% effective in preventing cervical intraepithelial neoplasia (CIN) 2, CIN 3, and condylomatous vulvar disease related to the HPV genotypes covered by the vaccine,” the authors write.

Teen HPV vaccination rates inch upward

The percentage of teenage girls who received at least one dose of human papillomavirus (HPV) vaccine increased 7 points in 2009, reaching 44%. Only about 27% of girls received the recommended three doses of HPV vaccine—but even that figure represents a 9% increase.

These are two of the findings of the 2009 National Immunization Survey–Teen (NIS–Teen) released last month by the Centers for Disease Control and Prevention (CDC).

No differences between racial and ethnic groups were observed for one dose of HPV vaccine. However, coverage was higher among teens living in poverty, compared with those living at or above the poverty level.

For the recommended three doses of HPV vaccine, differences were observed between racial and ethnic groups, including significantly lower coverage for blacks and Hispanics than for whites.

The NIS–Teen estimates the proportion of teens 13 through 17 years of age who have received the three recommended preteen vaccines: tetanus-diptheria-acellular pertussis, meningococcal conjugate vaccine, and HPV.

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