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Adolescent HPV Vaccination
Adolescent HPV Vaccination: Answers to Key Questions

Released: March 29, 2023

Shanna Barton
Shanna Barton, MD, MSc
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Key Takeaways
  • HPV vaccination can begin at 9 years of age to avoid the social stigma associated with vaccination in adolescents.
  • If parents and patients forgo HPV vaccination at 9 years of age, healthcare professionals should bundle HPV vaccination recommendations at the 11-year-old visit.
  • Vaccine hesitancy can occur on the part of the patient, parent, or healthcare professional, and education is important to overcome this vaccination barrier.

At the 2023 Society for Adolescent Health and Medicine conference, these were commonly asked questions regarding human papillomavirus (HPV) vaccination following the Clinical Care Options symposium titled, “Giving Adolescents the Best Shot Against Cancer: Overcoming Barriers to HPV Vaccine Uptake.”

Why do some parents or adolescent patients want only the school-required vaccines rather than all vaccines that are indicated at 11 and 12 years of age (including HPV vaccination)?
Often, parents and young patients are given a school form that lists only the vaccines required by the school district. That is unfortunate because it can preempt a conversation about optional vaccines, including HPV and influenza. Addressing this issue requires a shift in the conversation with the parent and patient from “These are the vaccinations required for school” to “These are the vaccinations that can help keep you healthy long term.”

In this situation, it is important to probe the parent or patient a little further to understand their views about vaccines in general, what their knowledge of the HPV vaccine is, and what their reservations or concerns about HPV vaccination are. This can help sort out whether it is a vaccine knowledge issue vs an issue rooted in social influence, social stigma, etc.

Ideally, the conversation about adolescent vaccines is bundled so that HPV vaccination is not singled out from the others. Also, HPV vaccination is indicated for people 9-26 years of age, so vaccinating at age 9 may avoid the social stigma associated with vaccination in adolescents.

How do you handle a scenario where a family’s previous healthcare professional (HCP) told them that HPV vaccination was unnecessary for male patients?
This scenario regarding vaccination denial because the patient is male is both an equity issue and a gender bias. HPV is ubiquitous, and therefore both male and female patients can be exposed to and infected with it. HPV vaccination prevents penile, anal, and oral cancers, all of which are possible in birth-assigned male patients.

It is important within any medical practice or health system to ensure that HCPs understand the reason for HPV vaccination, the indicated populations, and how to effectively counsel parents and adolescent patients about the vaccine.

It can be difficult to navigate the conversation when a family has had a previous experience where an HCP did not recommend the HPV vaccine (or recommended against it). It is important to center the conversation on your recommendation and why you are recommending the vaccine for this patient; framing the conversation around the importance of cancer prevention is helpful.

The HPV vaccine has been approved and in use since 2006, so we have a wealth of data and experience with administering it in the adolescent and adult populations. It is our responsibility as HCPs to recommend evidence-based vaccinations.

How do you address an adolescent patient who wants the HPV vaccine, but their parent refuses?
It is really important at the adolescent stage to give the patient the opportunity to voice their opinion and ask questions. It is important to talk with them and ask what they are thinking and feeling.

In some cases, this may be the first opportunity for parents to hear what their child thinks about the HPV vaccine. In some instances, parents might say no to the vaccine initially, thinking that their adolescent does not want it or is afraid of needles, but they are willing to have their adolescent receive the vaccine when they hear that the patient wants it.

In 8 states and in Washington, DC, adolescents can self-consent to HPV vaccination. In all other states, adolescents cannot consent until 18 years of age. As HCPs, we must advocate for state legislation that allows adolescents to self-consent for vaccines related to sexual health, such as the HPV vaccine.

Would you recommend HPV vaccination for a 16-year-old female patient who is sexually active and has a history of vaginal warts?
Yes, it is important to vaccinate this patient because our current HPV vaccine protects against 9 viral serotypes related to warts and HPV-related cancers.

Even if a patient already has developed vaginal warts, they could be exposed to other HPV serotypes and be at risk for HPV-related cancers in the same or other locations.

In Canada, HPV vaccination is administered within school-based clinics. Could this be an approach in the United States that could increase rates of HPV (and other) vaccination?
Yes, in some school-based clinics in the United States, vaccination information is bundled for the families.

Anecdotally, I have heard that the bundling of vaccination recommendations leads to fewer parents opting out of HPV vaccination for their adolescent.

What resources do you recommend for parents and HCPs to help guide HPV vaccination conversations with adolescents?
Many helpful resources are available, including:

Your Thoughts?
How do you educate patients, parents, and/or HCPs at your institution about the HPV vaccine? Join the discussion by posting a comment below.