The commentary is in response to an article in the January edition of the journal posing the question, "Who should be vaccinated against human papillomavirus?"- as well a review piece on HPV infection in men in the same issue.
The HPV vaccine protects women from acquiring two types of HPV, a sexually transmitted disease believed responsible for 70 percent of cervical cancer cases. Research shows that African American women are at twice the risk of dying from cervical cancer than Caucasian women.
"Although the reason for the disparity of HPV in African American women is not well understood – simply knowing that this group is disproportionately affected should lead to targeted vaccination efforts that administer the safe, effective, three-dose prevention tool to them," says Loida E. Bonney, MD, MPH, a research fellow at The Miriam Hospital and lead author.
The authors suggest that developing a school-based vaccine delivery program would provide an effective strategy for reaching the broadest number of at-risk African American females.
"School-based vaccine delivery surpasses traditional primary care provider vaccination rates, but this avenue is not widely used," Bonney says.
At-risk adolescents, the group that would be targeted for the HPV vaccine, remain the most difficult to vaccinate because of various barriers to care including the need for parental consent to receive vaccines. Bonney and her colleagues feel that parental consent should be waived for the HPV vaccine as it is for other sexually transmitted infection-related health care, such as treatment for gonorrhea and chlamydia.
In addition to school-based vaccination clinics, juvenile detention centers and prisons with high populations of African American adolescents and young adults are institutions the authors say should be actively targeted for vaccine delivery.
Historically, multi-dose vaccines, such as the HPV vaccine, have been difficult to distribute successfully. Bonney cites the approval of the hepatitis B vaccine as an example. Despite being made readily available in 1982, hepatitis B had low vaccination rates until a strategy was adopted for universal infant vaccinations in the early 1990's. The authors call for mandates and funding from the national level to support the development of early and aggressive intervention programs to avoid similar issues with distribution of the HPV vaccine.
The article states that although HPV does not affect all groups equally, it is imperative that the most vulnerable populations be proactively reached from the start to avoid another generation of cervical cancer tragedies.
Additional contributors to the article include: Michelle Lally, MD, The Miriam Hospital and Brown Medical School; David R. Williams, MD, Institute for Social Research at the University of Michigan; Michael Stein, MD, Rhode Island Hospital and Brown Medical School; and Timothy Flanigan, MD, The Miriam Hospital and Brown Medical School.
The Miriam Hospital, established in 1926 in Providence, RI, is a not-for-profit hospital affiliated with Brown Medical School. Nationally recognized as a top hospital in cardiovascular care, The Miriam Hospital (www.miriamhospital.org) offers particular expertise in cardiac catheterization, angioplasty and women's cardiac care. One of 20 designated Center for AIDS Research (CFAR) sites, The Miriam is a leader in the treatment, research and prevention of HIV/AIDS, attracting $17 million of the world's HIV/AIDS research dollars. The Miriam Hospital has been awarded Magnet Recognition for Excellence in Nursing Services three times and is committed to excellence in patient care, research and medical education. The Miriam is a founding member of the Lifespan health system.
Journal
The Lancet Infectious Diseases