Recommendations for HPV vaccine
The Centers for Disease Control and Prevention (CDC) puts forth three major
recommendations with reference to Human Papillomavirus (HPV) vaccines. To begin with, the
organization indorses vaccination at the age of 11 to 12 years, but immunization may be initiated
as early as at the age of nine through a series of three injections administered in the span of 6
months (Meites, 2016). FDA has already granted approval for the tetravalent HPV vaccine for
females aged nine to 26 years since immunization is recommended before sexual maturity. The
advisory committee also advocates vaccination for females between the age of 13 and 26 as well
as for males between the age of 13 and 21, particularly those who have not been adequately
vaccinated previously or completed the 3-dose series. The final recommendation covers gay,
bisexual, transgender, and immunocompromised persons (taking account of people with HIV) of
up to 26 years who have not been properly vaccinated beforehand (Petrosky et al., 2015).
Preferably, all adolescents should receive vaccinations before exposure to the virus. Nonetheless,
those who are already infected with any of the HPV types can receive protection from other
types of HPV through vaccination.
Risk Behaviors
Common risk behaviors for HPV infection include rampant sexual behaviors and
smoking. HPV is predominantly sexually transmittable through vaginal and anal intercourse, and
often involves skin-to-skin contact. On analyzing multiple heterogeneous populations
worldwide, studies have shown that more than 90% of all HPV infections are transmitted by
sexual contact (Golusiński, Leemans, & Dietz, 2017, p.79). The same studies have also revealed
INFECTIOUS DISEASE PREVENTION AND CONTROL 3
that HPV is uncommon in sexually inexperienced groups. In the past, scientists have used the
number of sexual partners as a behavioral measure. However, infection by sexual contact is
mostly multifactorial in nature and normally depends on the form of sexual contact.
Smoking is also a significant causative factor of HPV-related neck and head tumors
(Marur, D’Souza, Westra, & Forastiere, 2010). In fact, in cases where smoking is a necessary
cause of cervical cancer, tobacco smoking has been cited as a co-existing factor for HPV
infection (Xi et al., 2009). Literature also shows that there is a dose-dependent connection
between tobacco smoking and HPV infection.
Social, Cultural, and Legal Factors
Although physician attitudes and recommendations may influence parent and adolescents
in decision-making and acceptance of immunization for HPV, a number of social, cultural, and
legal factors are likely to interfere with administration. Among the most significant factors
influencing recommendations for physicians are office procedures, cost of vaccine, as well as
personal and professional characteristics, including practice location, age, beliefs about impact
sex behaviors, and comfort in discussing sexual matters (Gamble, Klosky, Parra, & Randolph,
2009). Parental factors that may affect decision-making are denial that the child is at risk,
concerns about vaccine safety, riskier adolescent behaviors, vaccine requests, the belief that the
child has already received too many vaccines, and reluctance to discuss sexual issues. Parental
attitudes toward vaccination are especially contributory and parents with poor understanding of
HPV are likely to reject administration. Even so, parent’s socio-demographic factors do not
appear to have any relationship with acceptance of HPV vaccines (Gamble et al., 2009). Legal
factors may also trigger positive or negative responses to the vaccine. Currently, 42 states and
territories have introduced legislation to acquire, fund, and educate the public and school-going
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children about HPV vaccines (Ncsl, 2018). 25 states have already enacted legislation. Despite
this, administration remains low due to a number of exemptions.
Interventions
The Major interventions for reducing the risk of HPV are directly related to the causal
factors. Health education measures concentrate on popularizing and advocating for the use of
condom, promoting safer sex strategies, and reducing the number of sexual partners. The most
effective intervention, however, involves administration of HPV vaccine.
Rationale for Determining Success of Immunization
The public health nurse can determine whether immunization has increased and incidence
of HPV has decreased through formal monitoring programs that have been established by the
CDC such as the HPV impact system which monitors rates of high-grade cervical lesions in the
United States (Hariri et a., 2012). Else, they can use established frameworks that utilize cross-
sectional surveys along with administrative data in health facilities.
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References
Gamble, H. L., Klosky, J. L., Parra, G. R., & Randolph, M. E. (2009). Factors influencing
familial decision-making regarding human papillomavirus vaccination. Journal of
Pediatric Psychology, 35(7), 704-715.
Golusiński, W., Leemans, C. R., & Dietz, A. (2017). HPV Infection in Head and Neck Cancer.
Cham: Springer International Publishing.
Hariri, S., Unger, E. R., Powell, S. E., Bauer, H. M., Bennett, N. M., Bloch, K. C., … & HPV-
IMPACT Working Group. (2012). The HPV vaccine impact monitoring project (HPV-
IMPACT): assessing early evidence of vaccination impact on HPV-associated cervical
cancer precursor lesions. Cancer Causes & Control, 23(2), 281-288.
Marur, S., D’Souza, G., Westra, W. H., & Forastiere, A. A. (2010). HPV-associated head and
neck cancer: a virus-related cancer epidemic. The lancet oncology, 11(8), 781-789.
Meites, E. (2016). Use of a 2-dose schedule for human papillomavirus vaccination—updated
recommendations of the Advisory Committee on Immunization Practices. MMWR.
Morbidity and mortality weekly report, 65. References
Ncsl.org. (2018). HPV Vaccine: State Legislation and Statutes. [online] Available at:
http://www.ncsl.org/research/health/hpv-vaccine-state-legislation-and-statutes.aspx
[Accessed 28 Jun. 2018].
Petrosky, E., Bocchini, J. J., Hariri, S., Chesson, H., Curtis, C. R., Saraiya, M., … & Markowitz,
L. E. (2015). Use of 9-valent human papillomavirus (HPV) vaccine: updated HPV
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vaccination recommendations of the advisory committee on immunization
practices. MMWR. Morbidity and mortality weekly report, 64(11), 300-304.
Xi, L. F., Koutsky, L. A., Castle, P. E., Edelstein, Z. R., Meyers, C., Ho, J., & Schiffman, M.
(2009). Relationship between cigarette smoking and human papillomavirus type 16 and
18 DNA load. Cancer Epidemiology, Biomarkers & Prevention : A Publication of the
American Association for Cancer Research, Cosponsored by the American Society of
Preventive Oncology, 18(12), 3490–3496. http://doi.org/10.1158/1055-9965.EPI-09-0763
