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Are HPV Vaccines Less Effective in African-American Women?

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Research finds that African-American women are less likely than white women to have the cancer-causing HPV types covered by vaccines currently on the market.

Two HPV vaccines are available in the U.S. and throughout much of the world – Merck’s Gardasil and GlaxoSmithKline’s Cervarix- and both cover HPV 16 and 18, respectively, the two “high risk” HPV types found with about 70% of cervical cancers globally.

A number of other “high risk” HPV types can cause cervical cancer, though, so women remain at risk (and should continue having Pap and HPV tests) after being vaccinated.

This point was driven home in October, when Dr. Catherine Hoyo presented data at the International Conference on Frontiers in Cancer Prevention Research that indicates African-American women, compared to white women, are only half as likely to have HPV 16 and 18.

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HPV Infection Rates Drop 56% Since Vaccines Introduced

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A Centers for Disease Control and Prevention (CDC) study published in the June 2013 issue ofThe Journal of Infectious Diseases shows that in the first four years after an HPV vaccine came on the market, infections with the HPV types covered by the vaccine dropped in 14-19 year old girls by 56%. The kicker? Only about half of adolescent girls have had even one of the shots in the series, and fewer than 1/3 have had all three doses!

The first HPV vaccine came on the market in 2006, followed by a second one in 2009. HPV vaccines are routinely recommended for females ages 11-12, and also for those ages 13-26 who have not previously been vaccinated. One of the vaccines is also available for males in the same age range.

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Parents and HPV Vaccines

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Despite recommendations from healthcare providers that adolescents be vaccinated against HPV, a study published in the April issue of Pediatrics indicates Mom and Dad still have some worries and are less likely to have their kids vaccinated against the virus than they were a few  years ago.

HPV vaccines are available for males and females ages 9-26. Routine HPV vaccination is recommended by the Advisory Committee on Immunization Practices (ACIP) for all adolescents ages 11-12. ACIP also recommends all 11-12 year olds receive the Meningococcal conjugate (MenACWY), Tetanus, diphtheria, acellular pertussis (Tdap), and influenza vaccines.

HPV vaccine rates run far behind others on the adolescent vaccine schedule: the Centers for Disease Control and Prevention say that in 2011, just over half of females ages 13-17 had received at least one dose of an HPV vaccine, with only 35% having completed the three-dose series. Tdap, by comparison, had 78.2% uptake while the meningococcal vaccine had 70.5% coverage.

With parents who were queried as part of the 2008–2010 National Immunization Survey of Teens, those who indicated a reluctance to have their kids receive the MenACWY and Tdap vaccines most often cited that the vaccines aren’t needed or that the healthcare provider didn’t recommend them. These same reasons were often mentioned by parents who were hesitant with HPV vaccines, along with concerns about safety/side effects (mentioned by 16.4%, essentially triple from 2008) and a sense the HPV vaccine is unneeded due to their teens not being sexually active (17.4% of respondents).

Overall, approximately 44% of parents said they do not intend to have their children vaccinated against HPV, up from 40% in 2008.

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HPV Vaccination Doesn’t Cause “Type Replacement”

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When HPV vaccines were being developed, some researchers wondered if success in blocking infection with certain HPV types would potentially cause other types to rush in and fill the void (known as “type replacement”). The two vaccines on the market protect against infections related to a pair of “high risk” viral types found with most cervical cancers, HPV 16 and HPV 18. One of the vaccines also protects against the “low risk” types (HPV 6 and HPV 11, respectively) found with 90% of external genital warts.

Worries around type replacement were never too prominent with HPV vaccines, but did surface a number of times as vaccine efficacy (including cost effectiveness) was discussed. Fortunately, results from a study in Africa suggest type replacement isn’t an issue.

The subjects in this research were more than 2,700 males who were part of a circumcision trial in Kenya. The investigators, led by Dr. Anne Rositch of the Johns Hopkins Bloomberg School of Public Health, found that HPV vaccination did not encourage “competition” among different types of HPV, and appeared unlikely to result in non-vaccine types becoming more common. While more studies are needed to nail this down for certain, the results are encouraging and give a big boost to the “cost-effectiveness” of HPV vaccines, which would have been much weaker were vaccines shown to encourage other HPV types to simply step up as replacements. Read more here.

Reference:
Rositch A, Hudgens M, Backes D, Moses S, Agot K, Nyagya E, Snijders P, Meijer C, Bailey R, and Smith J. Vaccine-Relevant Human Papillomavirus (HPV) Infections and Future Acquisition of High-Risk HPV Types in Men. JID, 2012. 206(5): 669-677.

 

Report: Too Few Adolescents Being Vaccinated Against HPV

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HPV vaccination rates continue trail well behind those of other immunizations recommended for adolescents, according to data from the Centers for Disease Control and Prevention (CDC).

Two HPV vaccines are currently on the U.S. market, and both protect against the two high-risk types associated with about 70% of cervical cancers. One of the vaccines also covers a pair of low-risk types found with approximately 90% of genital warts. Both vaccines are given in a series of three doses over a period of six months.

The Advisory Committee on Immunization Practices (ACIP), which advises CDC and other federal agencies on vaccine issues, recommends routine HPV vaccine for all adolescents beginning at age 11. Additionally, ACIP recommends all 11-12 year olds receive the Meningococcal conjugate (MenACWY), Tetanus, diphtheria, acellular pertussis (Tdap), and influenza vaccines.

HPV vaccine rates badly lag the others: CDC says that in 2011, only 53% of females ages 13-17 had received at least one dose of an HPV vaccine, and a scant 34.8% completed the three-dose series. Uptake with Tdap, by comparison, was 78.2% while coverage with the meningococcal vaccine was 70.5%.

The challenge with males is even greater: In 2011 only 8.3% had received even one shot, with 1.3% completing the series.

One bright spot of the report is that more blacks (56%) and Hispanic (65%) females had started the HPV vaccination series than whites (47.5%), an important factor given that cervical cancer rates and mortality are higher among women of color. Nearly 60% of American Indians and 56% of Asians had received at least their first HPV vaccine doe, too. With all groups except Hispanics (41.6%), though, fewer than 40% had received all three shots.

CDC says getting more needles in arms involves doing a better job of making sure parents understand both the risks of HPV and the value of the vaccines in protecting their sons and daughters. More robust recommendations from healthcare providers might help, too, they say.

Read the report at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6134a3.htm.

 
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