The first human papillomavirus (HPV) vaccine was licensed for use in the United States in 2006. Since introduction of the vaccination program, there have been changes in recommendations, challenges with implementation and evidence of vaccine impact. To review the first decade of vaccination, we summarize policy, program and impact of HPV vaccination in the United States.
We reviewed policy statements of the Advisory Committee on Immunization Practices (ACIP), information from the National Immunization Survey –Teen, and other published data.
In the United States, routine HPV vaccination has been recommended for girls since 2006 and for boys since 2011. All vaccines are licensed as 3-dose series. ACIP recommends routine vaccination of girls and boys at age 11 or 12 years, and through age 26 for women and age 21 for men if not vaccinated previously. The United States was the first country to include boys/men in their routine program, a decision based in part on cost effectiveness modeling which showed including boys/men was cost effective given the low coverage among girls at that time. While 3 vaccines are licensed in the United States: quadrivalent HPV vaccine (licensed in 2006), bivalent HPV vaccine (licensed in 2009) and 9-valent HPV vaccine (licensed in 2014), through 2014 almost all vaccine used was quadrivalent HPV vaccine. Vaccine uptake has been slower than expected with >1 dose and 3 dose coverage reaching 60.0% and 39.7%, respectively, among 13–17 year-old girls and 41.7% and 21.6%, respectively, among 13–17 year-old boys in 2014. Multiple professsional and public health groups are working together to increase provider knowledge and strength of recommendation, which are critical for delivering vaccine through primary care providers. The introduction of 9-valent HPV vaccine in 2015 raised several questions, including whether to provide 9-valent vaccine to those who had completed the series with quadrivalent or bivalent HPV vaccine. Despite the good safety profile documented in pre- and postlicensure studies, safety concerns continue to be raised both by anti-vaccine groups and the general public. Early impact of HPV vaccination has been demonstrated by decreases in vaccine type HPV prevalence, genital warts and cervical precancer lesions. Modeling studies predict more substantial decreases in these health outcomes in the future, as well as notable reductions in cervical and other HPV-associated cancers.
Despite challenges in implementation of the HPV vaccination program, progress is being made and vaccine impact on early outcomes demonstrated. Multiple partners are working together to raise vaccination coverage in the United States.