Document text
Introduction to policy consideration:
Wording of the age for routine vaccination
Ruth Stefanos, MD, MPH
LCDR, US Public Health Service
Division of Viral Diseases
Advisory Committee on Immunization Practices
October 24, 2024National Center for Immunization and Respiratory Diseases
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Outline
•Current recommendation and historical context
•Clinical Decision Support for Immunization project
•Vaccination coverage
•Interest in vaccination at age 9 years
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Current Recommendation
https://www.cdc.gov/acip -recs/hcp/vaccine -specific/hpv.html•HPV vaccination is routinely recommended at age 11 or 12 years
•Vaccination can be given starting at age 9 years
•Since 2006 (first ACIP recommendation), the wording of age at HPV
vaccination initiation has not substantially changed
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1996 “This report presents a new strategy to improve the delivery of vaccination services to
adolescents and to integrate recommendations for vaccination with other preventive
services provided to adolescents. This new strategy emphasizes vaccination of adolescents
11-12 years of age by establishing a routine visit to their health -care providers.”
Immunization of adolescents. MMWR Recomm Rep. 1996;45(RR -13):1 -16.
2005 “The preferred age for Tdap vaccination is 11 –12 years”
Broder KR, Cortese MM, Iskander JK, et al. MMWR Recomm Rep. 2006;55(RR -3):1-34.
"Introducing a recommendation for MCV4 vaccination among young adolescents might
strengthen the role of the preadolescent visit and have a positive effect on vaccine coverage
among adolescents.”
Bilukha OO, Rosenstein N. MMWR Recomm Rep. 2005;54(RR -7):1-21.
2006 “ACIP recommends routine vaccination of females aged 11 –12 years with 3 doses of
quadrivalent HPV vaccine. The vaccination series can be started as young as age 9 years.”
Markowitz LE, Dunne EF, Saraiya M, et al. MMWR Recomm Rep. 2007;56(RR -2):1-24.Adolescent Platform
Adolescent
Platform
Tdap
MCV4
HPV
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https://www.cdc.gov/hpv/hcp/vaccination -considerations/boost -rates.htmlAdolescent Platform
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Current HPV Vaccination Recommendations
https://www.cdc.gov/acip -recs/hcp/vaccine -specific/hpv.htmlRoutine VaccinationAge 11–12 years,
can be started at age 9 years
Catch -Up VaccinationAge 13–26 years,
if not adequately vaccinated
Shared Clinical Decision -MakingSome adults age 27–45 years,
if not adequately vaccinated
Special situation:
History of sexual abuse or assault: Start at age 9 years
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Notes and full schedule available at: https://www.cdc.gov/vaccines/hcp/imz -schedules/child -adolescent -age.htmlVaccine Birth 1
mo2
mos4
mos6
mos9
mos12
mos15
mos18
mos19–
23
mos2–3
yrs4–6
yrs7–10 yrs 11–
12
yrs13–
15
yrs16
yrs17–
18
yrs
HPVSee
notes
Range of
recommended
ages for all
childrenRange of
recommended
ages for catch -
up vaccinationRange of
recommended
ages for
certain high -
risk groupsRecommended
vaccination can
begin in this age
groupRepresentation of HPV Vaccination Recommendations
on Child and Adolescent I mmunization Schedule
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Recommended Immunizations for Children 7‒18 Years Old
Parent -Friendly Schedule
https://www.cdc.gov/vaccines/imz -schedules/adolescent -easyread.html8
Clinical Decision Support for Immunization (CDSi)
•Logic for applying ACIP rules to CDS
engines
•For HPV vaccine:
•Minimum age: 9 years
•Earliest recommended age: 11 years
•Prompt for HPV vaccination occurs at
earliest recommended age (11 years)
9https://www.cdc.gov/iis/cdsi/
Estimated Vaccination Coverage, Adolescents Aged 13 –17 Years,
National Immunization Survey -Teen, United States, 2006 –2023
Pingali et al. MMWR 2024 UTD: up -to-date0102030405060708090100
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023Percent Vaccinated
Survey Year≥1 HPV (females, 79%)
≥1 HPV (males, 75%)
HPV UTD (females, 64%)
HPV UTD (males, 59%)≥1 Tdap
≥1 MenACWYHPV vaccination
recommendation
for malesHPV vaccination
recommendation
for females
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American Academy of Pediatrics Recommendations
•Beginning in the 2018 –2021 Redbook, HPV vaccination recommendation language
was modified.
“The AAP recommends starting the series between 9 and 12 years, at an age that the
pediatric health care professional deems optimal for acceptance and completion of
the vaccination series.”
American Academy of Pediatrics. Red Book: 2024 -2027 Report of the Committee on Infectious Diseases (33rd Edition)11
Interest in V accination at Age 9
https://www.tandfonline.com/journals/khvi20/collections/HPV -vaccination -starting -age-912
Policy Question
Should the ACIP recommendations state:
HPV vaccination is routinely recommended at age 9 –12 years
instead of
HPV vaccination is routinely recommended at age 11 or 12 years;
vaccination can be given starting at age 9 years
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ACIP HPV Vaccines Work Group Next Steps
•Review literature
-Systematic review (completed by CDC)
-Will be presented today
•Review other data
-NIS-Teen
-Randomized Controlled Trial (f inal data not available until 2026)
•Conduct modified Evidence to Recommendations (EtR)
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15•4 countries: begin at age 9 years
•6 countries: begin at age 10 years
•20 countries: begin at age ≥11 years
•UK: age 12 –13 years
9 10 11 12 13 14 15 16 17 18
Austria
Belgium
Bulgaria
Croatia
Cyprus
Czechia
Denmark
Estonia
Finland
France
Germany
Greece
Hungary
Iceland
Ireland
Italy
Latvia
Liechtenstein
Lithuania
Luxembourg
Malta
Netherlands
Norway
Poland
Portugal
Romania
Slovakia
Slovenia
Spain
SwedenCountry Age (years)
graph adapted from https://vaccine -schedule.ecdc.europa.eu/Scheduler/ByDisease?SelectedDiseaseId=38&SelectedCountryIdByDisease= -1
https://www.gov.uk/government/publications/hpv -universal -vaccination -guidance -for-health -professionals/hpv -vaccination -guidance -for-healthcare -practitioners
Policy Question
Should the ACIP recommendations state:
HPV vaccination is routinely recommended at age 9 –12 years
instead of
HPV vaccination is routinely recommended at age 11 or 12 years;
vaccination can be given starting at age 9 years
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For more information, contact CDC
1-800-CDC-INFO (232 -4636)
TTY: 1 -888-232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Acknowledgments
Sarah Brewer, PhD, MPH
Carla DeSisto, PhD, MPH
Julia Gargano, PhD
Lauri Markowitz, MD
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