Low Rates of HPV Vaccination in the South

HPV vaccine initiation and completion lowest in the South

November 5, 2013 / Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

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(dailyRx News) The South is known for its quaint accents, its rich country cooking and a relaxed culture that’s distinct from other regions of the US. The South now may be known for something else that’s not so charming.

Women who live in the southern US had much lower rates of human papillomavirus (HPV) vaccination rates than women in other parts of the country, a new study found.

These vaccines protect women against the most common strains of the sexually transmitted HPV that causes virtually all cases of cervical cancer.

These findings are particularly worrisome, according to the researchers, because cervical cancer is more common in the South than in any other geographic region of the US.

"Talk to your doctor — or your child’s doctor — about HPV vaccines."

Mahbubur Rahman, MBBS, PhD, MPH, associate professor of obstetrics and gynecology at the University of Texas Medical Branch at Galveston, collaborated with other researchers to look at the association between geographic regions and HPV vaccine initiation and completion among 18 to 26 year old women.

In addition to causing most cervical cancers, the human papillomavirus is also associated with genital warts and vulvar, vaginal, penile, anal and oropharyngeal (mouth and throat) cancers.

There are currently two HPV vaccines available in the US: Gardasil and Cervarix.

The Advisory Committee on Immunization Practices (ACIP) now recommends routine vaccination for all US girls at 11–12 years of age and “catch-up” vaccination for those 13 to 26 years old not previously vaccinated.

Both vaccines are given in three separate shots over a six-month period.

In this study, the researchers relied on data retrieved between 2008 and 2010 from the Behavioral Risk Factor Surveillance System, an ongoing health telephone survey of individuals 18 years and older.

Information was collected from 12 states, representing four geographic regions:

  • Northeast: Connecticut, Massachusetts, Pennsylvania and Rhode Island
  • Midwest: Kansas, Minnesota and Nebraska
  • West: Wyoming
  • South: Delaware, Oklahoma, Texas and West Virginia

The researchers uncovered the following patterns over the three-year study period:

  • Nationwide, an average of 28 percent of women reported beginning the vaccine, and 17 percent said they had completed the three-dose series.
  • 37.2 percent of women in the Northeast started the vaccine, while 23.1 finished the series.
  • In the Midwest/West, 28.7 percent of the women began the vaccination and 19.3 percent completed it.
  • In the South, 14 percent of the ladies started, and 6 percent finished the shots over the three-year period.

The number of women who started the vaccine series rose between 2008 and 2010 in the Northeast and the South but declined in the Midwest/West, according to the study's findings.

The rate of initiation was 14 percent in the South in 2008 and 22.5 percent in 2010.

Even after adjusting the statistics for age, race/ethnicity, education, marital status, insurance coverage, income, routine medical visits and flu vaccines, the HPV vaccination rates in the South remained the lowest in the country.

The authors theorized that the trends seen in the South may be due to differences in education, income levels and health insurance coverage.

Abbey Berenson, MD, professor in the department of obstetrics and gynecology and director of The University of Texas Medical Branch at Galveston Center for Interdisciplinary Research in Women's Health, contributed to this study. In a prepared statement, Dr. Berenson said, "If a lower rate of HPV vaccine uptake in the South persists, it could contribute to the national burden of cervical cancer in the long run."

Results from this study were published in the November issue of the journal Vaccine.

Federal support for this study was provided by the Eunice Kennedy ShriverNational Institute of Child Health & Human Development.

No conflicts of interest were reported.

Review Date: 
November 5, 2013
Last Updated:
December 30, 2013