“Concerning” disparities in HP vaccine uptake among US adults, with men and Hispanic people among those least protected
In a national sample of 27-45 year olds, nearly 85% had not been vaccinated against the virus – highlighting an “urgent need” to address uptake disparities
TAYLOR & FRANCIS GROUP
An analysis of data from a nationwide health survey reveals “concerning” disparities in human papillomavirus (HPV) vaccine uptake among US adults aged 27 to 45 years.
More than 84% of the 9,440 people involved in a national sample had yet to be vaccinated for this common virus which can cause cancers later in life such as cervical, oropharyngeal (throat), anal, penile, vaginal and vulvar.
Low uptake in the vaccine was observed among men, as well as people of Hispanic heritage, and those with lower educational levels.
Publishing their findings in the peer-reviewed journal Human Vaccines & Immunotherapeutics, the expert team state the results highlight an “urgent need” to address and mitigate disparities in HPV vaccine uptake in this age group and raise awareness of the importance of the vaccine – especially for men who were more than three times less likely to be vaccinated.
“The overall low uptake of the HPV vaccine in this age group, raises concerns regarding cancer prevention efforts,” states lead author Dr. Nosayaba Osazuwa-Peters, who is a head and neck cancer epidemiologist at Duke University School of Medicine’s and the Duke Cancer Institute, in North Carolina.
“Given the importance of the HPV vaccine in cancer prevention, it is critical that these disparities are addressed and mitigated.
“Addressing disparities and improving access to vaccination services are crucial steps in preventing HPV-associated cancers and improving public health outcomes for all.”
Dr, Osazuwa-Peters adds: “Males are in particular need of increased knowledge of the vaccine, in light of the increasing incidence of both anal and oropharyngeal cancers, which are known to originate from the HPV virus.
“When the HPV vaccine was first approved in the US in 2006, it was approved for only girls, and with a focus on cervical cancer; so, males have literally been playing catch-up the whole time. Interestingly, as of now, oropharyngeal cancer, 75% of which are in males, have overtaken cervical cancer, for which the vaccine was originally developed.”
With nearly 36,000 people diagnosed with an HPV-associated cancer each year in the US, HPV vaccination offers a critical opportunity for cancer prevention, potentially preventing more than 90% of these cancers.
While routine HPV vaccination was initially recommended for children aged 11 to 12 years, with catch-up vaccination through to age 26 years, the US Food and Drug Administration (FDA) expanded the age range for eligibility to adults aged 27 to 45 years in 2018. However, there is little currently known about the uptake of the vaccine within this age group.
This research analyzed data from the 2019 National Health Interview Survey, which collects cross-sectional health data from a nationally representative sample of the US population. It is the first study since the FDA age expansion to exclusively examine differential HPV vaccine uptake in a diverse sample of 27- to 45-year-old adults from across the US population.
Results reveal that a significant proportion (84.5%) of participants had not yet been vaccinated against HPV.
The outcomes also unveil disparities in HPV vaccine uptake based on demographic and socioeconomic factors:
Females had over three times greater odds of vaccine uptake compared to males.
Non-Hispanic Blacks were 36% more likely, while Hispanics were 27% less likely, to receive the vaccine compared to non-Hispanic Whites.
Individuals without a usual place of care and those with lower educational levels had lower odds of vaccine uptake.
Dr. Osazuwa-Peters, who led a team of specialists from institutions across the US, adds: “For oropharyngeal cancer, about 75% of new cases are in males. As oral HPV is the primary cause of HPV-associated oropharyngeal cancer, providing the HPV vaccine to middle-aged individuals is undoubtedly an important strategy to decreasing risk of infection, persistence, and eventual HPV-associated oropharyngeal malignancy.
“While the population benefit of the HPV vaccines in preventing oropharyngeal cancer may not be realized until years later, there are ongoing clinical trials to definitely establish that the current vaccines are effective in the prevention of oral HPV infection.”
Of particular concern, too, is the lower likelihood of HPV vaccine uptake among Hispanic adults, they authors add, emphasizing the need for targeted interventions to increase awareness and access to vaccination.
Overall, the expert team state their findings should “serve as a call to action for policymakers, healthcare providers, and community leaders to intensify efforts to promote HPV vaccination among adults aged 27 to 45 years”.
A key strength of this study lies in its analysis of a nationally representative sample of data. However, its limitations include a reliance on self-reported data and the inability to determine the exact age of HPV vaccination among participants.
JOURNAL
Human Vaccines & Immunotherapeutics
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Racial and ethnic disparities in human papillomavirus (HPV) vaccine uptake among United States adults, aged 27–45 years
ARTICLE PUBLICATION DATE
28-Mar-2024
You are never too old for an STI – more older adults being diagnosed with STIs such as gonorrhea and syphilis
Infectious disease expert addresses how to manage the rise in sexually transmitted infections in older adults
- Infectious disease expert addresses how to manage the rise in sexually transmitted infections in older adults.
- STIs in Americans aged 55 to 64 years have more than doubled over the past decade; in England the number of over 45s diagnosed with gonorrhoea and syphilis doubled between 2015 and 2019.
- Availability of sildenafil (Viagra) in late 1990s had an impact on STIs in older men.
- Sexual health campaigns overlook the needs and experiences of the baby boom generation.
- Health professionals must be proactive in discussing sexual concerns and making sexual health a routine part of general health care for older adults.
**Note: the release below is a special early release from the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024, Barcelona, Spain, 27-30 April). Please credit the congress if you use this story**
A new research review presented at a pre-congress day for this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024, Barcelona, 27-30 April) will look at how to manage the rise in sexually transmitted infections (STIs) in older people, such as gonorrhoea, syphilis, and genital warts. It will focus on the importance of sex, intimacy, and sexual health to the Baby Boomer generation, especially given that 1 in 6 individuals worldwide will be aged 60 and older by 2030. The presentation will be given by Professor Justyna Kowalska from the Medical University of Warsaw, Hospital for Infectious Diseases in Warsaw, Poland—who will highlight the need for conversations around older people and sexual health to be normalised.
Data from the US Centers for Disease Control and Prevention (CDC) indicate that rates of chlamydia, gonorrhoea, and syphilis among US adults aged 55 and older have more than doubled over the past 10 years. For example, rates of gonorrhoea among those aged 55 to 64 years rose from around 15 cases per 100,000 people in 2015 to 57 per 100,000 in 2019 [1]. In England, 31,902 new STIs were recorded in the over 45s in 2015, which rose to 37,692 in 2019 – an increase of 18%, with the majority of new diagnoses in men who have sex with men [2]. High STI prevalence estimates have also been reported more broadly in older adults around the world, including China, Korea, Kenya, and Botswana.
“Rising divorce rates, forgoing condoms as there is no risk of pregnancy, the availability of drugs for sexual dysfunction, the large number of older adults living together in retirement communities, and the increased use of dating apps are likely to have contributed to the growing incidence of STIs in the over 50s”, explains Professor Kowalska. “These data likely underestimate the true extent of the problem as limited access to sexual health services for the over 50s, and trying to avoid the stigma and embarrassment both on the part of older people and healthcare professionals, is leading to this age group not seeking help for STIs.”
Compounding the problem are the many misconceptions around sexuality and sexual activity in older adults, and the importance of sex and intimacy to older people’s happiness and wellbeing. As Professor Kowalska explains, “People do not become asexual with age. In fact, with preventive medicine and improved lifestyles people are enjoying a healthy life and sex life for longer. Older people often find greater satisfaction in their sex lives due to experience and known expectations. We need more role models like Samantha Jones in the TV show Sex and the City to challenge stereotypes around older sexuality.”
Although the frequency of sexual activity tends to decline with age, older adults are still having lots of sex. In a study in England, half of men and almost a third of women aged 70 and over reported being sexually active. Similarly, in a Swedish study, 46% of individuals aged 60 years and older reported being sexually active, as did 10% of those aged 90 years or older [3].
Studies show higher levels of sexual desire, greater sexual frequency, and more sexual partners among older men than women. A retrospective study from the USA involving 420,790 couples aged 67 to 99 years, found that widowhood was associated with an increased risk of STIs in older men, but not women. And the effects in men were larger after sildenafil (Viagra), the first phosphodiesterase type 5 inhibitor (PDE5 inhibitor), hit the market. Professor Kowalska says, “These findings indicate that sexual risk taking is common among older adults, particularly men. Given that the number of people aged 60 years and older is set to double worldwide by 2050 and the widespread availability of drugs to enhance sexual activity, health professionals must be proactive in discussing sexual concerns and making sexual health a routine part of general health care for older adults.”
Although the incidence of STIs among the over 50s is small compared to younger age groups, it is rising, and Prof Kowalska will call for raising awareness about sexual health in older adults, explaining that they came of age at a time when sex education in school did not exist. “Sexual health campaigns are focused on young people and overlook the needs and experiences of those aged 50 and older”, she says. “Health promotion messages give the impression that condoms and concerns about STIs only apply to young people. But the dangers of undiagnosed and untreated STIs such as HPV-related cancers and onwards transmission are very real, particularly in this age group who are more likely to have underlying conditions such as heart disease and stroke.”
Prof Kowalska will also highlight the lack of evidence for using communication to promote positive behaviours to reduce the spread of STIs in older adults, particularly outside the USA and for infections other than HIV. “Increasing older adults’ knowledge of the risk of STIs and how to engage in safer sex is crucial to tackling record levels of STIs”, says Professor Kowalska. “Tailoring education programmes to the over 50s and including peer support and ensuring they are located within existing community settings is vital to their success.” Ultimately she says, “Older people have a right to good sexual health, so let’s normalise conversations around sex and older people, and change the narrative on ageing.”
ARTICLE PUBLICATION DATE
27-Mar-2024
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