38 AAP News •
www.aapnews.org • September 2015
• Morbidity and Mortality Weekly Report , http://www.cdc.
• AAP HPV Champion Toolkit, bit.ly/1eDJUal
• Red Book Online chapter on HPV, http://redbook.solutions.
• HPV implementation guidance, http://redbook.solutions.
• HPV vaccine resources for health care professionals,
• Tips for talking with parents about the HPV vaccine,
• PediaLink continuing medical education courses (free):
Adolescent Immunizations: Strongly Recommending
the HPV Vaccine and Adolescent Immunizations: Office
by Melissa Jenco • News Content Editor
Human papillomavirus (HPV) vaccination rates for
teens increased slightly last year, but remain well below
rates for other routine vaccines, according to a new
The Centers for Disease Control and Prevention
(CDC) released 2014 data July 30 showing 60% of
teen girls and 42% of teen boys had received at least
one dose of HPV vaccine, increases of three and eight
percentage points, respectively, over the previous year.
“This is where we still have much
more work left to do in order to
achieve impact on health,” said Anne
Schuchat, M.D., assistant surgeon
general and director of the CDC’s
National Center for Immunization
and Respiratory Diseases.
The data come from the 2014
National Immunization Survey—
Teen, which included more than
20,000 adolescents between the ages of 13 and 17
years and were published in the Morbidity and Mortality
Each year, roughly 27,000 people in the U.S. are
diagnosed with a cancer caused by HPV, according to
the CDC. The Academy and CDC recommend that
all 11- and 12-year-olds receive the HPV vaccine as
part of their routine vaccine schedule, although it can
HPV vaccination rates remain low despite small increases
be started as young as 9 years. The series includes three
Females ages 13 through 26 years and males 13 through
21 years who have not completed the series should be
vaccinated. The vaccine also is recommended through
age 26 years for people who are immunocompromised
and men who have sex with men.
Dr. Schuchat said there was “patchwork progress”
on HPV vaccination rates in 2014 and highlighted
significant increases among females getting at least
one HPV vaccine dose in Chicago, Washington, D.C.,
Illinois, Montana, North Carolina and Utah, which saw
jumps ranging from 13. 2 to 22. 8 percentage points.
The rate of females receiving at least one dose was
highest in Rhode Island with 76% and lowest in Kansas
“We have good news in this handful of areas that
we’re using a variety of practices to strengthen HPV
cancer protection,” Dr. Schuchat said. “So we know
now it is possible to do much better.”
The CDC identified several strategies that have been
• Establish links between cancer organizations and
• Recommend HPV vaccine when recommending
other routine vaccines at age 11 or 12.
• Launch public communication campaigns.
• Send reminders to parents when their child is due
The Academy also has been working to improve
awareness and educate providers on HPV vaccines.
For example, the Utah Chapter facilitated conferences
and a symposium and partnered with the Utah
Department of Health to develop provider resources.
The Washington, D.C., Chapter convened a group of
50 stakeholders to discuss improving HPV vaccination
rates and also facilitated presentations to local pediatric
practices. In Illinois, the AAP chapter provided vaccine
education sessions for continuing medical education
credit and also facilitated a web-based training session
for pediatricians who in turn will train their peers.
Dr. Schuchat stressed the important role of clinicians
recommending the HPV vaccine to adolescents and
doing so at 11 or 12 years old. The rate of girls receiving
their first dose at those ages did not increase significantly
“Our research shows that an
effective recommendation from a
health care professional is crucial
to a parent’s decision to get HPV
vaccine for their child,” she said.
Ann-Christine Nyquist, M.D.,
FAAP, a member of the AAP
“We’re going to be preventing cancer in the future,”
Dr. Nyquist said. “It’s our job to really do this now, and
we will see the effects of it.”
Looking at other routine adolescent vaccines in
2014, coverage with at least one dose of tetanus toxoid,
reduced diphtheria toxoid and acellular pertussis ( Tdap)
vaccine increased to 87.6% up from 84.7% the previous
year, according to the CDC data. For meningococcal
conjugate (MenACWY) vaccine, 79.3% of teens had
at least one dose, up from 76.6%.
The vaccination report also touched on the
measles, mumps and rubella (MMR) vaccine that is
recommended at 12 to 15 months and 4 to 6 years. The
rate of teens covered with two doses was below 90%
in seven states — Arizona, Idaho, Missouri, Montana,
Texas, Utah and West Virginia.
Dr. Nyquist said the low rate in those areas “puts
those states at a huge vulnerability for measles outbreaks
as we’ve seen over this last year” and encouraged
pediatricians to improve efforts for providing that
vaccine as well.
by Melissa Jenco • News Content Editor
The Academy is urging pediatricians to continue universal screening for autism spectrum disorder (ASD)
despite a national panel’s preliminary findings that
more research is needed.
The U.S. Preventive Services Task Force’s (USPSTF’s)
draft recommendation statement released Aug. 3 says
there is not enough evidence to assess the benefits and
harms of screening for ASD.
The recommendation applies to asymptomatic children under the age of 3 in which parents or clinical
providers have not raised concerns. The task force said
it is not recommending against screening, but believes
doctors should use their clinical judgment.
Susan E. Levy, M.D., M.P.H.,
FAAP, chair of the AAP Autism Subcommittee, called the findings “very
disturbing” and said it would be a
“major step back” to stop screening
while more research is done.
“If you get people tuned into doing surveillance and screening and
you identify the kids younger, in the
18-24 month range, and you get them into treatment
… we know that they do better, the outcome is better,”
Dr. Levy said.
Roughly one in 68 children in the U.S. has autism
spectrum disorder, according to the Centers for Disease
Control and Prevention (CDC).
Both Autism Speaks and the Autism Science Foun-
dation said the USPSTF statement on screening “is
troubling and may be easily misinterpreted.”
Clinical judgment “is not sufficient to identify all
individuals with signs and symptoms of autism at an
early age,” they said in a joint statement. “Moreover,
screening is quick, affordable and has no substantial
The advocacy groups and the Academy continue to
call for screening children at 18 and 24 months as well
as regular developmental surveillance at each well-child
visit. An updated AAP clinical report due out next year
also will recommend universal screening.
Dr. Levy agrees with the USPSTF that more research
is needed, but said it would be unethical to perform a
randomized control trial in which screening is withheld
from some children.
She took issue with the way the task force looked at
benefits of screening.
“I think the biggest problem I have is they are using
developmental outcome response to treatment as the
proxy to benefit,” she said. “And on some level I think
that’s true, but it’s not totally.”
Some outcomes are hard to measure, and there may
be benefits that haven’t been taken into account by ex-
isting studies such as whether a screening helped detect
a comorbid issue, according to Dr. Levy.
“I think it’s disingenuous just to look for cognitive
changes in IQ or changes in language or changes in diagnosis,” she said. “The problem is the trajectory is very
different. It may be different depending on the severity.”
The USPSTF’s full recommendation statement can
be viewed at bit.ly/1KOMDJG.
Academy calls for continued autism screening,
despite USPSTF recommendation
• AAP Council on Children with Disabilities autism page,
• Information for parents on the Healthy Children website
about autism symptoms, http://bit.ly/1EgHERc
• Bright Futures health initiative, https://brightfutures.
•AAP clinical report on identifying autism, http://
• AAP toolkit on caring for children with ASD, http://bit.