HPV Vaccination in North Carolina

North Carolina

Approximately 36,500 annual cancer cases in the United States are attributable to human papillomavirus (HPV), 34,400 of which may have been prevented through HPV vaccination.

HPV is the most common sexually transmitted infection in the U.S., affecting about 85% of people in their lifetime. Each year 13 million Americans, including teenagers, are newly infected. HPV infections can cause cancer as well as genital warts. Most cases of genital warts, cervical cancer and cancers of the anus, throat, vagina and vulva are associated with HPV infection.

Preventing and treating HPV-associated diseases cost the U.S. an estimated $9 billion in direct medical costs each year.

Adolescents remain the main focus of HPV immunization in the United States. Prior infections happen quickly and reduce the efficacy of the HPV vaccine, so it is important to immunize youth before they become sexually active. Populations of teens with higher HPV immunization coverage include:

• American Indian/Alaska Native, Asian and non-Hispanic Black teens compared with non-Hispanic white and multiracial teens.
• Teens with health insurance compared with uninsured teens.
• Teens living in metropolitan areas compared with those living in non-metropolitan areas.

The best time to vaccinate teens is before they are exposed to HPV, typically through sexual activity. However, those who have already been infected with one or more strains of HPV can still get protection against other strains through vaccination. 

The Centers for Disease Control and Prevention (CDC) recommends the HPV vaccine for everyone under age 26, ideally around age 11 or 12. The vaccine requires two doses for those who begin before age 15, and a third dose is recommended for older teens and young adults. The full vaccination schedule and dosing recommendations can be found on the CDC website, along with additional information about who should and should not get it.

Achieving and maintaining high vaccination coverage is critical to sustaining progress in reducing the impact of vaccine-preventable diseases. The CDC supports immunization operations at the local, state and national levels through funding and initiatives such as the Vaccines for Children Program, which provides free vaccines to children whose health insurance does not cover them. The 2010 Affordable Care Act requires health insurance plans to cover preventive services, including immunizations, without charging deductibles, copayments or coinsurance. This legislation allows the Vaccines for Children Program to provide eligible children with access to vaccines at no cost through certain doctors. 

The CDC recommends that health care providers implement a reminder system to identify and inform families when children are due for a vaccine. These notices can be sent via phone call, text message or letter and should include a message about the importance of vaccination. This is a cost-effective method to improve vaccination rates. 

Healthy People 2030 has a goal to increase the proportion of adolescents who receive the recommended doses of the HPV vaccine.

Centers for Disease Control and Prevention. “Cancers Associated with Human Papillomavirus, United States—2015–2019.” USCS Data Brief No. 31. Atlanta, GA: Centers for Disease Control and Prevention, Department of Health and Human Services, October 2022. https://www.cdc.gov/cancer/uscs/about/data-briefs/no31-hpv-assoc-cancers-UnitedStates-2015-2019.htm.

Clay, Patrick A., Trevor D. Thompson, Lauri E. Markowitz, Donatus U. Ekwueme, Mona Saraiya, and Harrell W. Chesson. “Updated Estimate of the Annual Direct Medical Cost of Screening and Treatment for Human Papillomavirus Associated Disease in the United States.” Vaccine 41, no. 14 (March 2023): 2376–81. https://doi.org/10.1016/j.vaccine.2023.02.049.

Meites, Elissa, Peter G. Szilagyi, Harrell W. Chesson, Elizabeth R. Unger, José R. Romero, and Lauri E. Markowitz. “Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices.” MMWR. Morbidity and Mortality Weekly Report 68, no. 32 (August 16, 2019): 698–702. https://doi.org/10.15585/mmwr.mm6832a3.

Pingali, Cassandra, David Yankey, Laurie D. Elam-Evans, Lauri E. Markowitz, Charnetta L. Williams, Benjamin Fredua, Lucy A. McNamara, Shannon Stokley, and James A. Singleton. “National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years — United States, 2020.” MMWR. Morbidity and Mortality Weekly Report 70, no. 35 (September 3, 2021): 1183–90. https://doi.org/10.15585/mmwr.mm7035a1.