Successful vaccination rates for common diseases are recognized as one of the biggest community health successes of the past century. Countries that are able to help their population, particularly their children, develop immunity to common diseases have taken the first step in achieving stronger families, a healthier workforce, and better long-term population outcomes.
The United States vaccination rates have been cause for both pride and concern as they have risen and fallen over the past decade. While we still have many children who have not completed their primary vaccinations until they go to school and many home-schooled children who fall through the regulatory cracks and never get vaccinated, there is increased attention regarding the importance of the basic vaccination for children and adults, particularly seniors. We know that not all individuals who receive a vaccination will develop immunity, and no vaccine is 100% effective. Nevertheless, the growing concern over antibiotic-resistant infections underscores the importance of disease prevention through vaccines now more than ever.
One area in which the US has not made significant inroads has been innoculating teenagers with the human papillomavirus (HPV) vaccine. A recent posting from
Family Practice News claims, “The strength of your vaccine recommendation continues to be the most important factor affecting the parental decision to vaccinate a child.” The author suggests that when most clinicians see patients for routine immunizations, they just announce what vaccinations the child will receive that day: “Today your child will receive tetanus, diphtheria, and pertussis vaccine.” This results in a very high rate of immunization, and there is little discussion, explanation, or debate.
However, the announcement process varies dramatically with what is often encountered when clinicians offer, rather than recommend, the HPV vaccine. In contrast to routine recommendations, many practitioners begin by discussing, explaining, and debating HPV vaccine necessity when they seek to establish what the parents know about it, answer questions regarding vaccine safety, and, finally, explain its cancer prevention action.
As nurse practitioners (NPs), we do believe in teaching and counseling our patients. In some families, HPV vaccination is not viewed as typical, and parents or teenagers who are not sexually active may have some justifiable reasons for needing additional information. Clearly, if we suggest that the family only “think about” the vaccine for the next visit, we are sending them out the door without receiving the vaccine. Whether they will consider it and have it on a future visit is unclear.
Currently, a 3-dose HPV vaccine schedule is recommended. There have been suggestions in the medical literature that there will be a simplified HPV vaccine schedule in 2014. Research documents that between 2009 and 2011, there was a moderate increase in the number of physician providers who recommended HPV vaccine to girls 11 and 12 years old; there was no substantial increase in vaccine recommendations for girls and young women 13 to 26.
Vaccination of boys for HPV has only begun. Today, many vulnerable individuals are left unnecessarily unprotected. Perhaps a reduced number of HPV vaccinations in the series will help increase the number of patients who receive the vaccine.
If the most important variable in getting your patients vaccinated is your recommendation, add HPV vaccine to your list of standard recommendations for teenagers. As NPs we can do something to change the low rates of HPV vaccination by setting a goal to give it to all eligible patients.
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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