Role and uptake of human papillomavirus vaccine in adolescent health in the United States

Both the prophylactic human papillomavirus ( HPV) vaccines, Gardasil® and Cervarix®, are licensed for the prevention of cervical cancer in females, and Gardasilis also licensed for the prevention of genital wartsand anal cancerin both males and females. This review focuses on the uptake of these vaccinesin adolescent males and females in the USA and the barriers associated with vaccineinitiation and completion. In the USA in 2009, approximately 44.3% of adolescent females aged 13–17 years had received at least one dose of the HPV vaccine, but only 26.7% had received all three doses. In general, the Northeast and Midwest regions of the USA have the highest rates of HPV vaccineinitiation in adolescent females, while the Southeast has the lowest rates of vaccineinitiation. Uptake of the first dose of the HPV vaccinein adolescent females did not vary by race/ethnicity; however, completion of all three doses is lower among African Americans (23.1%) and Latinos (23.4%) compared with Caucasians (29.3%). At present, vaccinationrates among adolescent females are lower than expected, and thus vaccinemodels suggest that it is more cost-effective to vaccinateboth adolescent males and females. Current guidelines for HPV vaccinationin adolescent males is recommended only for “permissive use,” which leaves this population out of routine vaccinationfor HPV. The uptake of the vaccineis challenged by the high cost, feasibility, and logistics of three-dose deliveries. The biggest impact on acceptability of the vaccineis by adolescents, physicians, parents, and the community. Future efforts need to focus on HPV vaccineeducation among adolescents and decreasing the barriers associated with poor vaccineuptake and completion in adolescents before their sexual debut, but Papanicolau screening should remain routine among adults and those already infected until a therapeutic vaccinecan be developed.