Dear Colleague: February 3, 2021
The American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists
(ACOG), American College of Physicians (ACP), and the Immunization Action Coalition (IAC) are asking you
to urge your patients to get vaccinated against human papillomavirus (HPV).
HPV vaccine is cancer prevention. However, HPV vaccine is underutilized in our country, despite the overwhelm-
ing evidence of its safety and eectiveness. While vaccination rates continue to improve for the other adolescent
vaccines, HPV vaccination rates are not improving as quickly. Missed opportunities data suggest that clinicians
are not giving strong recommendations for HPV vaccine when patients are 11 or 12 years old. The healthcare
provider recommendation is the single best predictor of vaccination. Studies show that a patient who receives a
clinician recommendation is 4–5 times more likely to receive the HPV vaccine.
1,2
What you say, and how you say it, matters. A half-hearted recommendation to a patient may result not only in
the patient leaving your practice unvaccinated, but also may lead the patient to believe that HPV vaccine is not as
important as the other adolescent vaccines. The undersigned organizations hope that this letter, which provides
key facts about HPV vaccine safety and eectiveness, will lead you to recommend HPV vaccination – rmly
and strongly – to your patients. Your recommendation will reect your commitment to prevent HPV-associated
cancers and disease in the United States.
HPV-associated disease
•
Approximately 79 million persons in the United States are infected with HPV, and approximately 14 million
people in the United States will become newly infected with HPV each year.
3
•
Each year, an estimated 44,000 cancers are associated with HPV; about 25,000 in women and 19,000 in men.
4
•
Cervical cancer is the most common HPV-associated cancer among women, and oropharyngeal cancers are
the most common among men.
4
▶ Despite these statistics, the use of HPV vaccination to prevent HPV infection is limited, and immunization rates
remain low in the United States.
Prevention of HPV-associated disease by vaccination
•
A nine-valent HPV vaccine (HPV9) is available to protect against multiple strains, including HPV 16, 18, 31,
and 33, the types that cause most cervical and other anogenital cancers, as well as some oropharyngeal
cancers.
•
The Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination of children
age 11 or 12 years with the 2-dose series of HPV9. If the rst dose of HPV vaccine is given after 14 years of
age, then 3 doses are required.
•
Vaccination is recommended routinely for all persons through age 26 years who were not vaccinated when
they were younger.
▶ In 2019, only 54.2% of teenagers 13–17 years were up to date on all recommended doses of HPV vaccine.
5
HPV
vaccination rates were lower in rural and less urban areas among adolescents living at or above the poverty level.
Safety of HPV vaccine
•
Through 2017, more than 270 million doses of HPV vaccine have been distributed worldwide
6
and more than
120 million doses have been distributed in the United States.
7
continued on next page
Give a condent, clear, and consistent recommendation
for HPV vaccine to increase uptake!
references
1. Health care provider recommendation, human papilloma-
virus vaccination, and race/ethnicity in the U.S. National
Immunization Survey. American Journal of Public Health.
2013. 103(1):164–169.2012. 30(20):3112–3118.
2. Factors associated with human papillomavirus vaccine-
series initiation and healthcare provider recommendation
in U.S. adolescent females: 2007 National Survey of Chil-
dren’s Health. Vaccine. 2012. 30(20):3112–3118.
3. Genital HPV Infection – CDC Fact Sheet. Available at:
www.cdc.gov/std/hpv/HPV-FS-print.pdf.
4. HPV-associated cancer statistics. Available at: www.cdc.
gov/cancer/hpv/statistics.
5. National, Regional, State, and Selected Local Area Vacci-
nation Coverage Among Adolescents Aged 13–17 Years –
United States, 2019. MMWR. 2020. 69(33);1109–1116.
6. Safety update of HPV vaccines. Available at: www.who.
int/vaccine_safety/committee/topics/hpv/June_2017/en.
7.HPVvaccinesafetyandeectivenessdata.Availableat:
www.cdc.gov/hpv/hcp/vaccine-safety-data.html.
8. Reasons for lack of HPV vaccine initiation in NIS-Teen
over time: shifting the focus from gender and sexuality
to necessity and safety. Journal of Adolescent Health.
2018. 63(5):652–656
•
More than 13 years of post-licensure vaccine safety monitoring in the United States provides continued evi-
dence of the safety of HPV vaccines. Data on safety are also available from post-licensure monitoring in other
countries and provide continued evidence of the safety of HPV vaccines.
•
Syncope can occur among adolescents who receive any vaccines, including HPV vaccine. ACIP recommends
that clinicians consider observing patients for 15 minutes after vaccination.
▶ Regardless of a safety prole that is similar to the other adolescent vaccines, parents cite safety concerns as one of the
top three reasons they do not intend to vaccinate their daughters and sons against HPV.
8
Ecacy of HPV vaccines
•
Among women who have not been previously infected with a targeted HPV type, HPV9 is estimated, via
comparisons of geometric mean titers (GMTs) vs. the previous 4-valent vaccine (HPV4), to have over 98%
ecacy in preventing cervical cancers caused by HPV types 16 or 18.
•
HPV9 also demonstrated 97% vaccine ecacy in preventing cervical, vulvar, and vaginal cancers in women
16 to 26 years of age who are naïve to HPV types 31, 33, 45, 52, or 58.
•
In males, HPV9 is estimated, via comparisons of geometric mean titers (GMTs) vs the previous 4-valent vac-
cine (HPV4), to have 89% vaccine ecacy in preventing genital warts and 75% vaccine ecacy in preventing
anal cancers caused by vaccine types 6, 11, 16, and 18.
•
Studies suggest that HPV vaccines oer long-lasting protection against HPV infection and, therefore, disease
caused by HPV infection.
▶ While HPV9 covers 90% of HPV types associated with cancer, the vaccine does not protect against all HPV types,
and so it does not replace other prevention strategies, such as regular cervical cancer screening.
What you say matters; how you say it matters even more.
Based on research conducted with parents and physicians, CDC suggests recommending the HPV vaccine
series the same way you recommend the other adolescent vaccines.
Parents may be interested in vaccinating, yet still have questions. Taking the time to listen to parents’ questions
helps you save time and give an eective response. CDC has created an excellent webinar-on-demand to assist
you in providing an eective recommendation and answering questions parents may have about HPV vaccines.
The webinar is viewable at www.cdc.gov/vaccines/ed/hpv/you-are-key-2018.html. Additionally, many other
tools on HPV vaccine are available on the CDC website at www.cdc.gov/hpv/hcp/index.html.
As a healthcare provider, we urge you to recommend HPV vaccination strongly and consistently to your patients.
Your recommendation is the number one reason why someone will get the HPV vaccine and be protected from
HPV-associated cancers and disease.
Signed:
Immunization Action Coalition
www.immunize.org/letter/recommend_hpv_vaccination.pdf
2/21
Gary LeRoy, MD, FAAFP
President, American Academy of Family Physicians
Maureen G. Phipps, MD, MPH, FACOG
Chief Executive Ocer, American College
of Obstetricians and Gynecologists
Jacqueline W. Fincher, MD, MACP
President, American College of Physicians
Deborah Wexler, MD
Executive Director, Immunization Action Coalition