The human papillomavirus (HPV) vaccine, recommended for children aged 11 to 12, is very effective in preventing cervical cancer. But in the United States, only 54% of teens are fully vaccinated against HPV, a rate lower than those of other adolescent vaccines, including those that prevent meningitis, tetanus, diphtheria and pertussis.
A new study from Yale reveals that an important strategy to improve immunization rates may be to allow teens to consent to the HPV vaccine without parental involvement, which is already a policy in a handful of U.S. states.
For the study, published on November 15 in JAMA Pediatrics, the researchers analyzed adolescent vaccination data in the United States from 2015 to 2018, comparing HPV vaccination rates between jurisdictions with these laws and those without. The data set included 81,889 adolescents aged 13 to 17.
They found a positive correlation between jurisdictions that allow adolescents to consent to the HPV vaccine and higher first-dose vaccination rates. In areas with the laws, 67.9% of teens had received at least the first dose of the vaccine compared to 61.4% of teens in states without the laws.
While researchers can’t say for sure whether these laws result in higher vaccination rates, it’s worth considering the impact they might have if passed more widely, said Sangini sheth, associate professor of obstetrics, gynecology and reproductive sciences at Yale and lead author of the study.
“It’s definitely food for thought, ”she said. “I think it could lead to some very interesting political conversations.”
In addition to the HPV vaccine, the Centers for Disease Control and Prevention recommends that teens receive the Tdap vaccine – which protects against tetanus, diphtheria, and pertussis – and a meningitis vaccine that protects against four different strains of bacteria. meningococcal. Vaccination rates for both are higher than that of the HPV vaccine. Almost 89% of adolescents are vaccinated against meningitis and over 90% are vaccinated with Tdap.
Sheth says that one of the reasons HPV vaccination rates are lower than other adolescent vaccines is that the HPV vaccine is often not approached the same way. “We know it’s safe, we know it’s very effective, but I think it’s always treated differently,” Sheth said. “Whether parents think the HPV vaccine is somewhat optional, that their children can wait and get it later, or that it is not for all children, none of this is true. And sometimes the HPV vaccine is not discussed at all.
States and jurisdictions that have passed laws allowing teens to be vaccinated without parental consent include Alabama, Alaska, California, Delaware, Idaho, New York, Oregon, Carolina South and Washington, DC. The laws fall into two main categories. Most allow adolescents to consent to sexual and reproductive health care. And some allow adolescents to consent to care more broadly.
Although the study found a positive correlation between consent laws and higher vaccine run-in rates, there was less association between these laws and multi-dose vaccine run completion, which consists of two or three doses depending on the age at which individuals receive the first dose. .
“It makes sense that the ability to consent seems to be more associated with starting the vaccine series, ”Sheth said. “When it comes to that initial decision, a teenager who is able to make the decision for themselves can make a difference. “
As for how to encourage teens to complete the round of vaccines, Sheth said systems for sending reminders to the teenager or their family and the clinician can help. “And I think what needs to be studied further is the effect of having a pro-vaccine culture within a practice, where everyone has this message about the vaccine, from the waiting room. and from front desk staff to nurses and clinicians. “
Other Yale authors include Nicholaus Johnson, Mallory Ellingson, Caitlin Hansen, Carlos Oliveira, and Linda Niccolai.