THE COUNCIL OF STATE GOVERNMENTS

AUGUST 2013

CAPITOL FACTS & FIGURES

HEALTH

HPV: Vaccination Rates Increase and Infection Rate Decreases

Human papillomavirus, known as HPV, is the most common sexually transmitted infection in the United States and a principal cause of cervical cancer.
About 79 million Americans, the majority of whom are in their late teens or early 20s, are infected with HPV.1 Most people who become infected dont even know it. In many cases, those infected do not develop any symptoms and the bodys immune system clears HPV naturally in about 90 percent of cases. About 40 types of HPV can infect both men and women. Most HPV types cause no symptoms and go away on their own. But some types are associated with several kinds of cancers and can cause genital warts in both men and women.2

The Food and Drug Administration has approved, and the Centers for Disease Control and Prevention has recommended, two HPV vaccinesCervarix and Gardasil. Both prevent certain types of HPV that cause cervical cancer in women.3
Cervarix prevents two HPV types, 16 and 18, which cause 70 percent of cervical cancers. Gardasil prevents four HPV types: HPV 16 and 18, and HPV 6 and 11, which cause 90 percent of genital warts.4 Gardasil also protects males against most genital warts and anal cancers. Both vaccines are highly effective in preventing the targeted HPV types, as well as the most common health problems caused by them.5 The HPV vaccine is given in a series of three doses and the best way to get protected is to complete all three doses before becoming sexually active. The Advisory Committee on Immunization Practices recommends administering the vaccine to girls between ages 11 and 12, before they become sexually active. The advisory committee also recommends the vaccine for boys between ages 11 and 12 and in men ages 22-26 if they have not been previously vaccinated. In 2011, 53 percent of females in the United States ages 13 to 17 had received one or more doses, according to Centers for Disease Control and Prevention data; thats an increase from 44.3 percent in 2009.

The number of teenage girls who have been vaccinated has increased in the U.S. since 2009.
Over a two-year period, from 2009 to 2011, the percentage of girls 13 to 17 with at least one dose of the HPV vaccine increased by almost 20 percent in the U.S. During the same time period, the percentage of girls 13 to 17 who received all three doses of the HPV vaccine increased by 30 percent. Despite the overall increase in the country, in four statesColorado, Connecticut, Kansas and Massachusettsthe percentage of females vaccinated with one or more doses and all three doses decreased from 2009 to 2011. Colorado and Kansas had a more than 20 percent decrease in females who received all three doses of the vaccine. In New Mexico and North Dakota, three-dose vaccination rates fell by 16 and 12 percent respectively.

The HPV vaccine has produced positive results according to a June 2013 study.
Since the vaccine was introduced in 2006, the prevalence of the vaccine-type HPV has dropped by 56 percent.6 A study by the Journal of Infectious Diseases showed the types of HPV that could be prevented by vaccine

were 3.1 percent among vaccinated females and 12.6 percent among those who were unvaccinated.7 CDC Director Tom Frieden was quoted on the CDC website regarding this new data: This report shows that HPV vaccine works well, and the report should be a wake-up call to our nation to protect the next generation by increasing HPV vaccination rates.8

REFERENCES
Centers for Disease Control and Prevention. New study shows HPV vaccine helping lower HPV infection rates in teen girls. Press Release. June 19, 2013. http://www.cdc.gov/media/releases/2013/p0619-hpv-vaccinations.html. 2 Centers for Disease Control and Prevention. HPV Vaccine Information for Young Women-Fact Sheet. http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-young-women.htm. 3 Centers for Disease Control and Prevention. HPV Vaccine-Questions and Answers. http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm. 4 Centers for Disease Control and Prevention. HPV Vaccine Information for Clinicians-Fact Sheet. http://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-hcp.htm. 5 Centers for Disease Control and Prevention. HPV Vaccine Information for Young Women-Fact Sheet. http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-young-women.htm. 6 Centers for Disease Control and Prevention. New study shows HPV vaccine helping lower HPV infection rates in teen girls. Press Release. June 19, 2013. http://www.cdc.gov/media/releases/2013/p0619-hpv-vaccinations.html. 7 Markowitz, Lauri E., Susan Hariri, Carol Lin, Eileen F. Dunne, Martin Steinau, Geraldine McQuillan, and Elizabeth R. Unger. Reduction in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 20032010. The Journal of Infectious Diseases 208.3 (2013): 385-93. Oxford Journals, 19 June 2013. 8 Centers for Disease Control and Prevention. New study shows HPV vaccine helping lower HPV infection rates in teen girls. Press Release. June 19, 2013. http://www.cdc.gov/media/releases/2013/p0619-hpv-vaccinations.html.
1

Only Virginia and the District of Columbia mandate the HPV vaccinations for certain school-aged girls.

Virginia (S 1230) and the District (B 17-0030) require the vaccine for girls to enter the sixth grade, but parents may opt out for religious, medical or moral reasons. During the 2013 legislative sessions, three states considered legislation that would require the HPV vaccination. Floridas SB 146, which would have required girls entering the sixth grade to receive the vaccine, died in committee in May 2013. Kentuckys HB 358 requiring the vaccine for girls entering sixth grade passed the House in early 2013 and was sent to the Senate in February 2013. The Senate, however, never voted on it, and the bill died at the end of the session. New Yorks AB 2067 requiring the vaccine for school attendance of children born after Jan. 1, 1996, was sent to committee in January 2013, but has not yet been considered.

Margaret Leer, CSG Research Assistant | mleer@csg.org

Estimated HPV Vaccination Coverage Among Female Adolescents, 13 through 17 years, 2011
State

2009: Percent with one or more doses of the HPV Vaccine

49.4 40.8 52.8 34.6 49.2 52.7 61.2 51.5 60.0 39.3 38.6 65.0 30.2 34.3 37.1 42.4 44.1 31.0 48.6 44.4 39.6 69.0 39.0 44.9 22.9 32.7 35.0 49.4 39.0 60.0 42.2 53.1 48.8 50.3 45.1 40.6 40.1 52.9 53.2 68.3 28.5 62.4 43.6 37.6 32.5 60.7 36.8 60.0 38.5 49.2 43.6 44.3

2011: Percent with one or more doses of the HPV Vaccine

49.5 59.5 55.3 36.1 65.0 45.9 60.5 60.2 55.0 50.0 48.4 73.1 45.5 51.6 40.8 53.5 37.3 46.0 63.0 56.1 45.7 61.1 55.6 55.5 31.9 49.5 52.9 59.0 55.3 65.8 55.5 58.1 46.6 54.4 51.2 45.5 49.8 68.6 51.9 76.1 38.7 58.1 46.0 48.8 53.3 63.0 46.9 66.5 50.6 65.7 60.9 53.0

Change: 2009-2011
0% 46% 5% 4% 32% -13% -1% 17% -8% 27% 25% 12% 51% 50% 10% 26% -15% 48% 30% 26% 15% -11% 43% 24% 39% 51% 51% 19% 42% 10% 32% 9% -5% 8% 14% 12% 24% 30% -2% 11% 36% -7% 6% 30% 64% 4% 27% 11% 31% 34% 40% 20%

2009: Percent with 2011: Percent with three or more doses of three or more doses of HPV vaccine HPV vaccine
25.2 19.3 31.2 13.8 21.8 32.5 44.7 32.6 22.8 24.6 21.8 38.9 16.9 23.4 22.3 32.7 27.7 19.5 29.8 28.0 29.5 49.4 22.9 27.0 8.1 19.9 21.9 33.9 17.4 39.8 28.0 35.4 33.8 30.5 31.7 25.0 16.2 32.2 37.5 51.7 16.6 45.0 26.5 23.4 19.5 39.1 24.6 35.4 27.0 28.9 31.1 26.7 31.2 40.4 36.7 15.5 42.9 25.3 43.0 46.8 36.0 35.3 30.0 50.9 30.0 34.0 28.4 40.7 21.9 30.5 36.3 44.5 29.9 48.5 31.6 35.1 19.6 30.8 39.8 32.6 30.9 46.0 38.7 29.7 34.2 32.3 27.8 32.6 27.7 38.5 41.0 56.8 23.3 50.1 27.2 31.5 20.4 50.1 29.8 40.0 28.6 46.2 40.9 34.8

Change: 2009-2011
24% 109% 18% 12% 97% -22% -4% 44% 58% 43% 38% 31% 78% 45% 27% 24% -21% 56% 22% 59% 1% -2% 38% 30% 142% 55% 82% -4% 78% 16% 38% -16% 1% 6% -12% 30% 71% 20% 9% 10% 40% 11% 3% 35% 5% 28% 21% 13% 6% 60% 32% 30%

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming United States

Source: Estimated Vaccination Coverage, With Selected Vaccines Among Adolescents Aged 13-17 Years, by State and Selected Area--National Immunization SurveyTeen, United States, 2011. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/stats-surv/nisteen/tables/11/tab01_iap_2011.pdf.

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