Missed opportunity

5 tips for discussing the HPV vaccine with parents of preteens

Some physicians wait until their patients are likely to become sexually active. But the talk needs to happen earlier, DOs say.

Parents might not be the only ones uncomfortable discussing the human papillomavirus (HPV) vaccine. A recent survey of 582 pediatricians and family physicians revealed that only approximately 60% strongly recommend the HPV vaccine to 11-to 12-year-old girls and the number is lower for boys, according to Pediatrics.

Believing their patients weren’t sexually active and that parents would decline the vaccination were common reasons physicians gave for avoiding the discussion. However, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends administering the HPV vaccination for 11- to 12-year-olds before they become sexually active.

“The HPV vaccination is recommended for ages 11 and 12 to coincide with other recommended vaccinations, such as the Tdap, given at the same well-child visit,” says Lisa Klatka, DO, who gave a presentation on the HPV vaccine at OMED 2014.

While parents and doctors might be anxious about broaching the topic of sex with younger patients, Ron Marino, DO, suggests they reframe the way they view the conversation.

“It’s not a time to talk about safe sex and condoms. The HPV vaccine helps keep patients from developing cervical cancer,” says Dr. Marino, an associate chairman of pediatrics at Winthrop University Hospital in Mineola, New York.

Parents often want to wait to administer the HPV vaccine until their children are older. However, Neil Levy, DO, says children should be vaccinated prior to becoming sexually active so they will be protected if they are exposed to the virus later.

“Just because parents give the OK to administer the vaccine doesn’t mean that they are giving consent to their child to have sexual relations. The HPV vaccine doesn’t prevent pregnancy or other sexually transmitted diseases,” says Dr. Levy, who serves on the Texas Immunization Stakeholder Working Group, which was created to help improve immunization practices in the state.

Some parents may be concerned about how long the vaccine provides protection. Because the vaccine first became available in 2006, long-term studies on its effectiveness are not available. However, clinical studies have shown that the HPV vaccine is effective for up to nine years. If future studies discover immunity does wane, patients can get a booster, Dr. Marino says.

5 tips for discussing the HPV vaccine with parents

Educating parents on what HPV is and what the HPV vaccine does is key to alleviating parents’ concerns. To begin the conversation and improve compliance rates, try the following:

  • Bring up HPV vaccination at the 11-year-old well-child visit. “Even if the parents say no, at least you’re introducing the concept to them, and maybe they will get the vaccine at their next visit,” says Dr. Marino.
  • Remind parents that the HPV vaccine is recommended for both boys and girls. “While cervical cancer is the most common HPV cancer, the virus can cause other types of cancer, including penile and oropharyngeal cancer,” says Dr. Klatka.
  • If you would or have given the HPV vaccine to your own child, share this information with patients. “Don’t just make it a recommendation because it’s something the CDC recommends, but because it’s your personal recommendation,” Dr. Marino suggests.
  • “Establishing a standing order to administer the HPV vaccination anytime an adolescent comes into the office is a good start toward alleviating these missed opportunities,” says Dr. Levy. The standing order should come with a strong recommendation from the doctor along with an explanation about the risks and benefits of the vaccine, he adds.
  • Review the CDC’s Tips and time-savers for talking with parents about the HPV vaccine. This fact sheet provides talking points and advice for physicians on educating parents on the vaccine.

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