Jonathan Miller, MD, pediatrician and chief of primary care, pediatrics at Nemours Children’s Health in the Delaware Valley, spoke about the latest data regarding early human papillomavirus (HPV) vaccination in children as young as 9 years old at the 2023 Pediatric Academic Societies meeting. He also provided some clinical pearls for opening the conversation with patients’ caretakers regarding earlier HPV vaccination.
Contemporary OB/GYN: Can you tell me about the abstract you presented at the Pediatric Academic Societies meeting, and why you chose this topic?
Jonathan Miller, MD: As primary care pediatricians, we’re really interested in prevention of disease. One of the diseases we can prevent now with a vaccine is certain types of cancer that are related to HPV. So we have the HPV vaccine available to us, and it is recommended for all children to get that vaccine, typically at 11 years old. However, it is allowed to be given as early as [age] 9. [In our study], we were really interested in seeing [whether] we [could] increase the percentage of our patients [who were] interested in getting that vaccine and [who] actually do get that vaccine by trying to start it a little earlier, because other [patients] have had some success at getting increased uptake of the vaccine when starting at [age] 9.
Contemporary OB/GYN: Can you tell me a little bit more about the results?
Miller: Our initial goal was initiation of the vaccine prior to [age] 11. When we started this, [approximately] 12% of our patients were starting HPV prior to [age] 11. By the end of our project, which we did over several years, we now have [more than] 42% of our patients starting before [age] 11. It was a massive increase over what our baseline was, and that led to significant improvements. In the national metric—the 13-year-old metric—we started at [approximately] 47% of our patients [who] were fully vaccinated for HPV by [age] 13. By the end of this, we were over 60%, and we’re doing better than some national benchmarks. We’re really proud of this work. I really do believe that early initiation of the vaccine is a major game changer. [These results] should inform the CDC and the Advisory Committee on Immunization Practices recommendations for when we start the vaccine. Right now, it is recommended to start at [age] 11, but you can start it at [age] 9. I think these types of studies will eventually lead to us having a recommendation for starting at 9 years [old].
Contemporary OB/GYN: What did you find the most interesting about the results?
Miller: My primary care network has 20 primary care practices that take care of [more than] 126,000 kids. This is a really large network. We started with a lot of variability within practices [and] providers in how they were recommending the HPV vaccine. In the past, [those] who recommended the vaccine talked about HPV as a sexually transmitted disease and the implications of that, but now we’re changing to speaking about this as something that’s about preventing cancer. That conversation became a little easier [to have] at [ages] 9 and 10 [rather] than at 11 and 12 years.
Contemporary OB/GYN: Do you have any clinical pearls when it comes to opening the conversation with parents about getting their children vaccinated against HPV? Especially because a lot of individuals assume only girls get vaccinated, but it’s also available for boys.
Miller: This is a vaccine that has been shown to prevent cancer in both men and women. So it prevents cervical cancer in women, but [it] clearly does a good job of preventing all types of cancer and throat cancers. What I find is that a lot of my patients have trust in me as their physician, so if I have a strong recommendation that their child will really benefit from this, a lot of families are listening to that. So, part of this project was teaching providers to make strong recommendations around this vaccine, to do it at earlier ages, and to focus on discussion of cancer. And we had excellent results in making those changes.
Contemporary OB/GYN: Do you have any top takeaways from this abstract that you think the audience should walk away with?
Miller: For our practices, one of the changes we made that was the most successful was updating our electronic medical record [EMR] to start to notify us that a child was behind on this vaccine at [age] 9 instead of 11 years. It was triggering that reminder for all our providers to say this is a child who’s now due for a vaccine, whereas it didn’t used to [remind us] until [the patient was] 11 years old. That was probably the single biggest factor that allowed us to be successful at doing this. What I would recommend to other pediatricians as they consider something like this is to really think about how you can use your technology to work for you. If you can make those EMR changes, it’s going to sort of be built into your system, [which is] what leads to change in culture.