Human Papillomavirus Vaccine: An Opportunity for Minnesota Pharmacists to Impact Public Health
By Ann M. Philbrick, PharmD, BCPS, BCACP; Caitlin K. Frail, PharmD, MS, BCACP; Taeho Greg Rhee, PhD, MSW
The most common sexually transmitted infection in the United States is human papillomavirus (HPV).1 In 2013-2014, the prevalence of any genital HPV in adults age 18-59 was 42.5%.1 In some instances, HPV infection can cause chronic conditions (e.g., malignant genital warts) or cancer in many sites in the body, including the cervix, vagina, vulva, penis, anus, rectum, and oropharynx.2 It is estimated that HPV is attributed to 19,400 female and 12,100 male new cancer cases each year in the United States.2 In Minnesota, the incidence rate of all HPV-associated cancers was 10.2% in 2008-2012.3
Despite studies that have demonstrated HPV vaccine to be safe and effective in preventing HPV-associated cancers, state and national HPV vaccination rates remain low. According to a national survey of adolescents aged 13 to 17 years in 2015, 62.8% of females and 49.8% of males received at least one dose of HPV vaccine.6 This was reduced to 41.9% for females and 28.1% for males when considering adolescents who had received at least three doses of HPV vaccine, which is well below the Healthy People 2020 goals of 80% coverage with three doses of HPV vaccine for adolescent females and males.7 This same survey found that Minnesota HPV vaccination coverage among adolescents was also low, with 65.5% of females and 57.1% of males receiving one or more doses of HPV vaccine and 44.5% of females and 22.4% males receiving at least three doses.6
In 2015, a change to Minnesota Statute 151.01 subdivision 27 allowed pharmacists to provide HPV vaccine to patients aged 13 years or older (previously aged 18 years) under a standing protocol and according to ACIP recommendations. With this change, the doors were opened to allow pharmacists to impact HPV vaccination rates in Minnesota. In addition, when Minnesota Statute 151.01 subdivision 27 was updated in 2015 to expand the age range for pharmacist-administered vaccinations, it also added pharmacy requirements with respect to the Minnesota Immunization Information Connection (MIIC). In Minnesota, pharmacists are required to report administered vaccinations to MIIC, as well as access a patient’s MIIC history when considering administration of a vaccine (with the exception of influenza vaccine in patients age 9 and older). More information about MIIC in pharmacies can be found here.
1. National Center for Health Statistics. Prevalence of HPV in adults age 18-69; United States, 2011-2014. NCHS Data Brief No. 280, April 2017. Available: https://www.cdc.gov/nchs/products/databriefs/db280.htm Accessed: April 24, 2017.
2. Centers for Disease Control and Prevention. How many cancers are linked with HPV each year? Available: https://www.cdc.gov/cancer/hpv/statistics/cases.htm Accessed: April 24, 2017.
3. Centers for Disease Control and Prevention. Human papillomavirus-associated cancers – United States, 2008 – 2012. MMWR. 2016;65(26)661-6.
4. Centers for Disease Control and Prevention. Use of a 9-valent human papillomavirus (HPV) vaccine: update recommendations of the advisory committee on immunization practices. MMWR. 2015;64(11);300-4.
5. Centers for Disease Control and Prevention. Use of a 2-dose schedule for human papillomavirus vaccination – updated recommendations of the advisory committee on immunization practices. MMWR. 2016;65(49):1405-8.
6. Centers for Disease Control and Prevention. National, regional, state, and selected local area vaccination coverage among adolescents age 13-17 years –United States, 2015. MMWR. 2016;65(33):850-8.
7. Healthy People 2020. Immunization and Infectious Disease. Available: https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases/objectives Accessed: May 24, 2017.
8. McKinney ZJ. The merits of MIIC – Minnesota’s Immunization Information System excels at population health surveillance. Minnesota Medicine. 2017;May-Jun:20-2.
9. Centers for Disease Control and Prevention. IISAR data participation rates and maps. Available: https://www.cdc.gov/vaccines/programs/iis/annual-report-iisar/rates-maps-table.html Accessed: April 24, 2017.