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Wednesday October 19, 2016

CDC Advisory Panel Changes Recommendation for HPV Vaccine from 3 Doses to 2 for Young Adolescents

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A federal advisory panel on Wednesday unanimously recommended reducing the number of shots needed for protection from cancer-causing HPV. 

Girls and boys should still receive the HPV vaccine at age 11-12, but under the new recommendations, those who start the vaccine series before they turn 15 will need only two doses instead of three to get the same or better protection than the original three-dose schedule would provide. The second dose should now be given any time from 6-12 months after the first dose.

The decision by the Advisory Committee on Immunization Practices is expected to raise vaccination rates against human papillomavirus significantly. In fact, it already has. Under the new guidelines, people who received two doses before the age of 15 and who received the doses at least 5 months apart are now considered fully vaccinated against HPV.

ACIP advises the U.S Centers for Disease Control and Prevention about the use of vaccines. The panel meets three times a year to review the most recent research on vaccinations; its finding earlier this year that the nasal-mist flu vaccine had not been effective during the past few years led to the recommendation that children this flu season receive an injected flu shot rather than the nasal spray.

For the future, the new HPV vaccine schedule will both reduce the costs of getting vaccinated and make it easier for families to finish the series. The schedule up to now has called for three doses over six months. The new recommendation allows not just for fewer doses for younger adolescents, but also for the second dose to be given over a much longer window of time (6-12 months) versus the shorter window outlined in the 3-dose schedule. Allowing for the second dose to be given up to 12 months after the first dose will allow for more families to adhere to the recommendation, ACIP members noted, as the timing fits in nicely with annual well-child exams that parents are bringing their children in for anyway.

The two-dose schedule is already the standard in many other countries, Dr. Lauri Markowitz, an epidemiologist with the CDC, told the advisory panel in a presentation before the vote. Earlier this month, the U.S. Food and Drug Administration approved a two-dose regimen of the vaccine for boys and girls in the U.S.; however, the FDA only approves what is on vaccine labels. It does not set the recommended vaccination schedules. 

Despite the effectiveness of the vaccine, HPV immunization rates have been slow to increase, Markowitz said, with only 42% of girls in the U.S. ages 13 to 17 having received all three doses, and only 28% of boys.

“HPV vaccines are highly effective and safe,” Markowitz said in her presentation, “and a powerful prevention tool for reducing the burden of HPV infection and related disease.” HPV is believed to cause 90% of cervical and anal cancers, according to the CDC, as well as large percentages of other cancers.

Patients getting the first dose at age 15 or older should still receive the three-dose series.

ACIP’s decision was based on results of numerous studies showing that in the younger group, the two-dose vaccine was just as protective, and even slightly moreso, than the three-dose series. But that effectiveness relied heavily on when the second dose was given; when the booster was only a couple of months after the first shot, the two doses were not as effective, Markowitz said.

While the recommendations call for boys and girls to receive their first dose at age 11 or 12, they can receive it as early as age 9 and as late as 26. The recommendation will go into full effect when it is published in the CDC's Morbidity and Mortality Weekly Report later this year. 

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