New guidance for the American Cancer Society Human papillomavirus Vaccination is different from the recommendations by the Centers for Disease Control.
ACS has approved two recommendations by the Advisory Committee on CDC Vaccination Practices, but ACS does not agree with the third recommendation for older adults.
The ACIP recommends sharing clinical decisions about human papillomavirus (HPV) vaccination with some adults under-immunized, 27-45 years of age. ACS does not support this recommendation. “Because of the low efficacy of vaccination and the low likelihood of cancer prevention in this age group, there is not enough guidance on the decision-making burden on patients and clinicians, and the choice of individuals who may benefit. Dr. Debbie Saslow, a colleague of the ACS section on Human Papillomavirus and Gynecologic Cancer, wrote.
Dr. Saslow and colleagues share ACS recommendations CA: Cancer Journal for Clinicians..
The HPV vaccine protects against viruses that can cause cervical, oropharyngeal, anal, vaginal, vulvar, and penile cancer. For young people, the ACIP recommends regular HPV vaccination for boys and girls aged 9 to 12 and catch-up vaccination for anyone up to age 26 who is not fully vaccinated against HPV.
ACS supports both of these recommendations. It also advises doctors to inform patients aged 22 to 26 who have not received the HPV vaccine or have not completed the series that older people are less effective at reducing cancer risk.
After the Food and Drug Administration approved the HPV vaccine for adults aged 27-45, ACIP updated its recommendations, stating that people over the age of 26 are not recommended for regular catch-up vaccination. However, ACIP encouraged these seniors to discuss the risks and benefits of vaccines with their providers to determine whether to get the vaccine.
ACS then conducted a methodological review of ACIP recommendations and published its own guidance stating that ACS does not support shared decision making. An estimated 0.5% of additional cancer cases and 0.4% additional cases of cervical pre-cancer, even with HPV vaccine given to adults over the age of 26, and Genital warts The next 100 years or more compared to vaccination under the age of 26.
“In addition to the low efficacy of vaccination and the low likelihood of cancer prevention in this age group, other considerations include sufficient decision-making burden for patients and clinicians and the choice of individuals who may benefit. Lack of good guidance was included.” Guidance. ACS also expressed concern that discussions with these donors and patients could interfere with the public health goals of increasing HPV vaccination in adolescents.
HPV vaccination rates lag significantly behind other routinely recommended pediatric vaccinations. According to the National Immunization Survey, half of teens (51%) in the US between the ages of 13 and 17 were vaccinated with HPV, and 68% were vaccinated once in 2018.
According to Robert A. Bednarczyk, PhD, who specializes in HPV immunization research but is an associate professor of public health at Emory University in Atlanta, it is very rare for a professional medical institution to opt out of CDC recommendations, especially vaccines. .. Related to ACS statement or ACIP recommendations.
“In many cases, vaccination recommendations are harmonized among healthcare provider organizations such as the American Academy of Pediatrics and the American College of Family Medicine when new vaccination schedules are announced,” Vednerchik. Said the doctor.
He acknowledged ACS’s reasons for not approving HPV recommendations for ACIP in the elderly: communication problems, low efficacy of the vaccine in this population, and the burden of shared decision making due to ongoing HPV vaccine deficiency.
However, Dr. Bednarczyk also pointed out that the ACIP recommendations open the door to these discussions when they might actually be needed, such as in adults at high risk for HPV. he Citation data It suggests that in 2015, divorces occurred in 24 of 1,000 married people aged 25-39 and 21 of 1,000 aged 40-49.
“When you think that these marriages will end, in addition to marriages that end when one spouse dies, individuals who were previously at low risk of acquiring HPV are now in a new potential sexual relationship. It can come in,” said Dr. Bednarchik. “Additionally, it is estimated that about 4% of the population in the United States is open or consensus non-monogamous, and exposure to more sexual partners may increase the risk of HPV. Is just one example of a conversation with a healthcare provider. Shared clinical decision-making helps in targeted reduction of HPV risk.”
Dr. Bednarchik notes that the ACIP recommendations for adults aged 27 to 45 years also cover HPV vaccine coverage if you choose to obtain the HPV vaccine. Insurers may not need to cover HPV vaccination for people over the age of 26 without CDC recommendations.
However, Dr. Bednačik agreed on how ACS adapted the CDC’s recommendations for adolescent routine immunization. According to ACIP, the daily recommendations for CDC are 11-12 years old, but you can start at 9 years old. The ACS guidance modifies this statement to focus on promoting vaccines earlier.
“Regular HPV vaccination between the ages of 9 and 12 is expected to increase scheduled vaccination coverage and the number of cancers that are prevented,” said ACS. .. “Health providers are encouraged to start offering HPV vaccines at the age of 9 or 10.”
Dr. Bednarczyk pointed out some of his previous studies that found a low percentage of teenagers who were fully vaccinated against HPV by age 13 ((J infection. July 31, 2019; 220[5]: 730-4). Therefore, “all efforts to encourage vaccination, such as starting the series at the age of 9 to 10, may be helpful,” he said.
He also agreed that efficacy may be diminished in vaccinated adults aged 22 to 26, “this should be considered in comparison to the risk of individuals acquiring HPV.” ..
The lack of HPN vaccines is a major concern, and HPV vaccination efforts need to remain most focused on teenagers, but adults should not necessarily be ignored, said Bednarczyk. I will.
“Given the general extent of HPV infection in the population, open discussion between patients and health care providers helps identify adults who may be effective in HPV vaccination.” He said.
The development of ACS guidelines was supported by ACS working capital. ACS receives an independent educational grant from Merck Sharp & Dohme for projects aimed at increasing HPV vaccination coverage. Dr. Saslow is the Principal Investigator of the cooperation agreement to support the National HPV Immunization Roundtable between ACS and CDC, and the cooperation agreement between ACS and CDC to support efforts to increase HPV immunization. Is the chief investigator. The remaining authors and Dr. Bednarczyk did not report relevant disclosures.
Source: Saslow D et al. CA Cancer J Clin. 2020 July 8th. Doi: 10.3322 / caac.21616.
This article was first published MDedge.com..
