Reducing Risk

What primary care physicians need to know about the HPV vaccine

Not enough patients are getting the vaccine, and not enough physicians are recommending it, a DO expert said at OMED.


Despite the fact that the human papillomavirus (HPV) vaccine has been around since 2006 and can prevent cervical cancer in women and genital warts in women and men, not enough patients are getting the vaccine, and not enough physicians are recommending it, said Lisa A. Klatka, DO, during an OMED session Sunday.

HPV strains cause roughly 26,000 cases of cancer each year in the U.S., according to 2012 data from the Centers for Disease Control and Prevention. In addition to cervical cancer, the virus can also cause vaginal, anal and oropharyngeal cancer.

The vaccine’s newness poses challenges to measuring its efficacy as a cancer prevention tool, but one study found a significant reduction in cases of anogenital warts in the vaccine’s target demographic, according to the American Journal of Public Health.

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However, HPV vaccination rates for adolescent women lag behind both CDC recommendations and the rates of vaccination against other diseases such as tetanus, said Dr. Klatka, a preventive medicine officer with the U.S. Army. Dr. Klatka noted that her views are her own and don’t necessarily reflect the views of the Army or the Defense Department.

The CDC’s Healthy People 2020 target HPV vaccination rate for adolescent females is 80%, but in 2012, only a third of girls received three doses of the vaccine as directed, and less than 55% received at least one dose.

What physicians can do

One of the most common reasons parents give for not vaccinating their daughters is that they don’t think it is necessary, according to the CDC’s National Immunization Survey-Teen 2011.

Physicians who encounter parents with this view should educate them on what HPV is and what the HPV vaccine does, Dr. Klatka said, noting that some parents may say their daughters don’t need the vaccine because Pap tests can detect early changes in the cervix.

“It is true that Pap testing in the U.S. has decreased the incidence of cervical cancer by 60 to 80%,” she said. “But does every woman get a Pap test when they are supposed to?”

Dr. Klatka noted that though approximately 83% of women get Pap tests on time, a significant number do not undergo the tests or do not get them when they should.

Also, the treatment for abnormal cervical cells can be invasive and painful, Dr. Klatka noted.

Another common reason parents cite is that their health care professional didn’t suggest the vaccine. A 2010 survey of physicians found that more than 90% administered the HPV vaccine to their female patients, but only 51% strongly recommended the vaccine to parents of girls in the target age range of 11 to 12.

Dr. Klatka urged physicians to encourage their patients to get the vaccines for their children.

“Give a very strong unequivocal recommendation,” she said. “ ‘We don’t suggest the vaccine, we recommend the vaccine.’ If you have kids and you’ve vaccinated them and you’re comfortable telling your patients that, then tell them that. That’s what I tell my patients.”

Dr. Klatka also urged physicians to check the vaccine records of adolescents at every visit and offer any that the patient is not up to date on.

“In public health we do this,” she said. “Every time we see somebody, we assess their need for vaccination.”

Physicians can also incorporate standing orders into the practice for all routine vaccinations, which would allow staff to administer them.

Safety concerns also top the list of reasons parents don’t get the vaccine for their daughters. Parents may have heard media reports of adverse reactions and even deaths following vaccination, Dr. Klatka noted, or they may think that the vaccine is untested because it is relatively new.

Dr. Klatka suggested physicians inform parents of the extensive testing the vaccine was put through before the Food and Drug Administration approved it, as well as the ongoing efforts to track its continued safety.

The CDC and the FDA operate the Vaccine Adverse Event Reporting System (VAERS), a website where clinicians and patients can report adverse reactions to vaccines. The agencies use VAERS to monitor reactions to vaccines for possible side effects. Between June 2006 and March 2014, clinicians administered 67 million doses of the vaccine, and the CDC has found no link between the HPV vaccine and serious complications such as death or ovarian failure.

Presentation attendee Jerrold L. Snow, DO, asked Dr. Klatka if he should be concerned about the long-term durability of the vaccine.

“Are we going to have new emergent high-risk strains?” asked Dr. Snow, a family physician in Portland, Oregon.

“Sometimes when you have a vaccine that covers certain strains but not all, they will suppress those and the other nonvaccine strains emerge,” Dr. Klatka said. “We have not seen that with HPV. We have eight years’ experience with it on the market and four years in trials. There’s no evidence yet that the vaccine efficacy has worn off.”

A new HPV vaccine is in development, and it will cover more strains of the virus than Gardasil, the HPV vaccine which covers four strains, Dr. Klatka noted. Within the next year, guidelines should be provided as to whether already-vaccinated patients should also receive the new vaccine, she said.

Presentation attendee Caitlin M. Allen, OMS II, said she was surprised to learn that the HPV vaccine is now recommended for males as well as females.

“People think of Gardasil and they think of cervical cancer, but the vaccine is also recommended for males, which is interesting,” said Allen, who attends the Edward Via College of Osteopathic Medicine–Carolinas Campus in Spartanburg, South Carolina.


  1. Joseph

    The HPV vaccine causes cancer it doesn’t cure it. Wake up. Get the movie “Bought”
    We are controlled by money and corporations. The evidence against big pharma is outstanding. Diseases have gone out the roof with too many vaccines, Monsanto’s GMO’s, the pesticide industry and commercial farming. Dr Still said the object of the physician was to find health. Not fight disease. Dr Sutherland used Osteopathy and cured 90% of the time what his contemporary Mayo brothers were trying to “cure” with surgery.

  2. charles J Smutny III, DO, FAAO

    SO, AOA shows us the government line and entirely leaves out the opposition. Situation normal.

    Without taking a side please look at the details of the other view which is in fact looking at the risk versus benefit issues that physicians have to look into, discuss intelligently and then resolve with patient input as to what they, the patients, are planning, from which to risk in order to take benefit.

    This is the physician in the trenches issue that government, MOC, MOL, OCC, FSMB,ABIM and IOM continues to ignore.

    HPV controversy continues in the news in a formidable way. How do we reconcile as physicians in a way that patients can actually understand, a clear division in the professional community of the facts as they are stated. The organizations that are supposed to clarify these things come into serious question when they continue to fail to reveal the complete truths that they themselves publish but refuse to discuss when pressed especially on the increases in risk factors.

    The anti HPV groups cite Sanevax .org ( ) who’s data comes directly from the CDC VAERS database recording adverse events in vaccines. (look at this cite today and see why there might be concern for us to discuss)

    Who is telling the truth? Until both sides all reveal all the data so that others can process that data independently, what are we to say to our educated patients that bring in these arguments to discuss. We are left to decide for ourselves and frankly the decision is not so clear as a risk benefit decision.

    This is happening across the pharmacological world’s newest releases of information as the apparent risk versus benefit decisions become more complex with higher revelation of serious side effects potentials in so many drugs and with such large numbers of drugs being removed or black labeled. Who do we trust as professionals? Our own experience usually trumps everything else.
    No one is collecting that particular information because it is considered anecdotal and that is in fact where the decision are being made. The practice of medicine considers human conditions with a background of science and statistics but the final decisions are made in the here and now of an “N” of one and an observation of the patient (with no “s” on the end) response. It is never a “population medicine decision”. The statistics in the VAERS database are not something to be dismissed. Where is the truth in this for any given person? If physicians are not making this recommendation often enough, there is concern in the public not to, that is big enough for physicians to consider the patient opinion valid enough until proven otherwise.

    Education is the answer to all these questions, not brute force, not government edict. Take the profit out of this for the government and all of its employes and lets see what happens to the risk benefit ration then.

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