Clinical and Public Health Considerations for HPV Vaccination in Midadulthood: A Narrative Review

Abstract

Human papillomavirus (HPV) is an important cause of anogenital and oropharyngeal cancers, anogenital warts, and recurrent respiratory papillomatosis. Beginning in 2019, US guidelines recommend shared clinical decision-making (SCDM) for HPV vaccination among mid-adults (27–45 years). We conducted a narrative review of existing literature on HPV vaccination in mid-adults. Available evidence demonstrates that HPV vaccination in mid-adults is safe, efficacious, and likely to benefit both HPV-naïve mid-adults and those with previous infections. However, gaps in knowledge related to HPV vaccination have been identified among clinicians and mid-adult patients. Universal mid-adult HPV vaccination in the United States could avert 20,934–37,856 cancer cases over 100 years, costing $141,000–$1,471,000 per quality-adjusted life-year gained. Wide variation in these estimates reflects uncertainties in sexual behavior, HPV natural history, and naturally-acquired immunity. Greater awareness among clinicians and mid-adult patients and broad implementation of SCDM may accelerate progress towards eliminating HPV-associated cancers and other diseases

Racial and ethnic disparities in human papillomavirus (HPV) vaccine uptake among United States adults, aged 27–45 years

“… 14 Although it is likely that most individuals in this age group have been exposed to some HPV subtypes, many may remain protected against some HPV subtypes covered by the nonavalent vaccine, thereby mitigating risk for developing some HPV-associated malignancies. 15 , 16 …”

“… 23 , 24 However, it is unclear whether the pattern of uptake is similar among adults. Based on already existing disparities in HPV vaccine uptake in general, as well as the shared decision-making model of this expanded recommendation, 16 we hypothesized that there are significant disparities in HPV vaccine uptake among racial/ethnic minorities compared to Non-Hispanic White individuals aged 27–45 years, and that racial/ethnic minorities would be disproportionately impacted. We also hypothesized that due to the shared-decision-making model of the expanded age of eligibility, individuals without a regular provider would be less likely to receive the HPV vaccine.…”

Assessment of Acceptability and Determinants of Uptake and Schedule Completion of Human Papillomavirus (HPV) Vaccine by 25 to 45 Years Old Women in Slovenia

“…This is founded on the results of two phase III trials that proved good vaccine efficacy in adult women that were HPV DNA-negative at the time of vaccination. However, there is still a limited understanding of the effectiveness of HPV vaccination in adult women and its impact on reducing cervical cancer incidence and mortality and the reduction of screening needs [ 20 , 21 ]. In addition, there are only scant data on acceptability of the HPV vaccine among adult women and men and on vaccination coverage among non-targeted adult women and men in Europe.…”