Poor Uptake Limits Otherwise Impressive Potential of HPV Vaccine

Maura L. Gillison, MD, PhD

Efficacy results for the human papillomavirus (HPV) vaccine continue to be impressive, with newly reported findings showing it reduced the prevalence of high-risk oral HPV infections by 88% in young adults who had at least 1 dose of the vaccine. But despite these promising findings, low vaccine uptake remains a concern.

Results from one of the first large studies to explore the impact of HPV vaccination on oral infections show that their prevalence among vaccinated young adults was 0.11% for HPV types 16, 18, 6, and 11, compared with 1.61% for unvaccinated individuals (P= .008). Prevalence of the 4 HPV types covered by the vaccine was eliminated in men who had been vaccinated compared with those who had not been vaccinated (0.0% vs 2.13%;P= .007). Prevalence of the 33 nonvaccine HPV types was similar between the 2 groups (3.98% vs. 4.74%;P= .24).

HPV vaccination is currently indicated for the prevention of cervical, vulvar, and vaginal cancers in women, and anal cancers in both women and men. It has not been clear, however, whether the vaccines could reduce incidence of oral cancers related to oral HPV infection.

“Our data indicate that HPV vaccines have tremendous potential to prevent oral infections,” said Maura L. Gillison, MD, PhD, professor of medicine at the University of Texas MD Anderson Cancer Center, who discussed the results during a press conference May 17 in advance of the 2017 ASCO Annual Meeting. “While we were encouraged that there was a notable impact of the vaccine on oral HPV infections among vaccinated individuals, that benefit was modest overall and lower than we would hope in men due to low vaccine uptake.”

Gillison and colleagues reviewed data collected from 2011 to 2014 in the National Health and Nutrition Examination Survey (NHANES) of Americans. Investigators compared HPV infection rates for 2627 men and women aged 18 to 33 who reported receiving at least 1 dose of HPV vaccine with a similarly aged cohort who was not vaccinated. HPV infection was detected from oral rinse samples collected by mobile health facilities and then tested for HPV in the laboratory.

Although the vaccine appears to show clear efficacy in preventing HPV infections, uptake in the population at large remains low. The vaccine was approved for young women aged 9 to 26 in 2006 and young men aged 9 to 21 in 2011. However, from 2011 through 2014, only 18.3% of adults received at least 1 dose of the vaccine before age 26. Young men were vaccinated at one-quarter the rate of young women (6.9% vs 29.2%).

Researchers estimate that the vaccine reduced oral HPV infections by 17% overall during the study period, representing nearly 170,000 cancers. As expected, the impact was greater among women compared with men, 25% versus 6.9%.

Because uptake has been poor, the vaccine hasn’t had the full effect that it could. Gillison said that with 100% coverage, the vaccine would have prevented an estimated 927,401 cancers.

“The HPV vaccine is one of the most important advances in cancer prevention in the last several decades. Parents who choose to have their children vaccinated against HPV should realize that the vaccine may provide additional benefits, such as prevention of oral HPV infections linked to oral cancers.”

There is some good news; uptake is higher now than during the study period. “Recent data indicate that in individuals under the age of 18, 60% of girls have received the vaccine and 40% of boys,” she said.

Emily Ko, MD, assistant professor of gynecologic oncology at the University of Pennsylvania, reviewed the data for OncLive. Despite clear evidence of efficacy, she said that patients aren’t getting the vaccine for a variety of reasons.

“There are multiple barriers—social, logistical, knowledge, and access,” she said. “There are cultural values and beliefs, as well as fear and stigma. There is still some apprehension about whether even talking about this vaccine or getting this vaccine could encourage sexual activity.”

“We have to think about how to expand knowledge about the benefits of the vaccine and how to educate people about the risks,” Ko continued. “I think people are still scared about the side effects of the vaccine. There have been studies that looked at whether getting the vaccine increases sexual activity. I don’t think that is the case, but there should be awareness that this is not the purpose of the vaccine. We have to correct those misbeliefs.”

Reference:

Gillison, ML, Broutian T, Graubard B, et al. Impact of prophylactic human papillomavirus (HPV) vaccination on oral HPV infections among young adults in the U.S.J Clin Oncol.2017(suppl; abstr 6003).