Human Papillomavirus Vaccination Requirements in US Schools: Recommendations for Moving Forward

Abstract

Safe and effective human papillomavirus (HPV) vaccines have been available and recommended for adolescents for a decade in the United States, yet vaccination rates remain suboptimal. School entry requirements have increased uptake of other vaccines for adolescents and made coverage more equitable. However, only 3 jurisdictions require HPV vaccine for school. We summarize the current status of HPV vaccine requirements and discuss the rationales for and against these policies. The rationales for requirements include HPV vaccine efficacy and safety, effectiveness of requirements for increasing vaccine uptake and making it more equitable, and use of requirements as "safety nets" and to achieve herd immunity. The rationales against requirements include low parental acceptance of HPV vaccine, the financial burden on educational systems and health departments, and the possibility for alternatives to increase vaccine uptake. Many challenges to HPV vaccine requirements are addressable, and we conclude with recommendations on how to approach these challenges.

Knowledge of Cervical Cancer, Human Papilloma Virus (HPV) and HPV Vaccination Among Women in Northeast China

“…More people choose to believe in doctors, and the online platform also shows advantages. Therefore, a variety of publicity strategies can be combined to promote the HPV vaccination rate and promote HPV prevention and control of related diseases [11][12][13][14]. At the time of treatment, doctors should strengthen the promotion of CC and related knowledge.…”

“…Most HPV vaccines, including those launched in China, are prophylactic vaccines. There are no reports of serious adverse reactions so far [13]. However, HPV vaccines cannot prevent infections by all types of HPV.…”

The growing epidemic of sexually transmitted infections in adolescents: a neglected population

“…However, broader coverage through HPV vaccination requirements represents the potential for a further significant decrease in HPV-related cancer and associated costs. Rhode Island, Virginia, and Washington DC require HPV vaccination for school entry [59]. …”

Reaching 80% human papillomavirus vaccination prevalence by 2026: How many adolescents need to be vaccinated and what are their characteristics?

“…39 In addition, parental text-message and mailed reminders as well as in-clinic provider electronic reminders may boost vaccination rates, and repeated physician recommendations may be needed to convince parents who initially refuse. [49][50][51][52] In the United States, the impact of voluntary and mandated school-based initiatives is unclear. 41 Other countries, including Portugal, England, and Australia, have achieved HPVV initiation rates of 80% or higher with large-scale and population-based approaches, including school-based programs.…”

“…48 State-based school-entry requirements for other vaccines (eg, diphtheria and varicella) have been effective in achieving high (~95%) vaccination rates for these respective diseases, although such requirements for HPVV are controversial; parental support is ambiguous, and a positive impact on HPVV utilization has yet to be seen. [49][50][51][52] In the United States, the impact of voluntary and mandated school-based initiatives is unclear. 53,54 In 2008, Virginia and Washington, DC enacted school entry requirements, but it is unclear whether these requirements are related to HPVV utilization because of the existence of broad vaccination optouts.…”