HPV vaccination program shows increasing impact on preventing HPV among vaccinated and unvaccinated females

1. HPV vaccination program shows increasing impact on preventing HPV among vaccinated and unvaccinated females

Note : HD soundbites of the author explaining study findings are available for download at Https://www.dssimon.com/MM/ACP-HPV/.

Abstract: https://www.acpjournals.org/doi/10.7326/M21-3798 

Editorial: https://www.acpjournals.org/doi/10.7326/M22-1309 

URL goes live when the embargo lifts

A new analysis of nationally representative data shows the increasing impact of human papillomavirus (HPV) vaccination efforts that started more than a decade ago. The findings suggest direct protection as well as herd effects from the vaccine. The findings are published in Annals of Internal Medicine.

HPV is the most common sexually transmitted infection in the United States. Persistent infection of some HPV types can cause cancer, which may develop years or decades after infection. HPV vaccination aims to prevent these complications. Prevalence monitoring for HPV infection is used to assess the early impact of HPV vaccination programs and can provide measurements of vaccine impact. Prevalence monitoring in the United States is possible through NHANES (National Health and Nutrition Examination Survey); the Centers for Disease Control and Prevention (CDC) incorporated HPV testing for female genital HPV before the HPV vaccination program began and data from the survey have provided strong evidence of impact of the HPV vaccination program.

Epidemiologists from CDC analyzed NHANES data to track pre- and post-vaccination era HPV prevalence for both vaccinated and unvaccinated females. The authors also analyzed data for male HPV prevalence, but only one four-year data cycle (2013-2016) was available. The authors found that compared to pre-vaccine years, the overall prevalence of cancer-causing HPV decreased by 85% among females. They report that among vaccinated females, prevalence decreased by 90%, and among unvaccinated females, prevalence decreased by 75%. HPV types not targeted by HPV vaccination did not change during this time period.  The authors caution that vaccination program disruption during the COVID-19 pandemic could threaten strides made in the previous decade.

The authors of an accompanying editorial from Boston University Medical Center suggest that these findings show that vaccine-type HPV infections are not being replaced with other oncogenic HPV infections, contrary to concerns expressed early in the HPV vaccination era. The findings also indicate that the decreases seen in vaccine-type infections are related to vaccination. The authors offer 4 suggestions for improving vaccine uptake post-pandemic: providers unambiguously stating that a child is due for vaccination at a visit; nurses and licensed medical assistants having standing orders to give due vaccinations; healthcare systems and professionals implementing remind and recall programs; and healthcare systems and clinicians implementing multilevel interventions to improve outcomes for patients.

Media contacts: For an embargoed PDF or to speak with someone from ACP, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Hannah G. Rosenblum, MD, please contact media@cdc.gov.

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2. Hospital medicine top career choice among newly certified internal medicine physicians

Trend suggests a physician shortage crisis looming in outpatient care

Abstract: https://www.acpjournals.org/doi/10.7326/M21-4636      

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An extensive study found that hospital medicine is a top career choice among internists newly certified by the American Board of Internal Medicine (ABIM). In contrast, more senior physicians increasingly see patients only in the outpatient setting. With little crossover between the two groups, these findings suggest a physician shortage looming in outpatient care as older physicians begin to retire. The study is published in the Annals of Internal Medicine.

Researchers from ABIM, Beth Israel Deaconess Medical Center and Harvard Medical School studied Medicare fee-for-service claims and ABIM data for nearly 70,000 general internists certified between 1990-2017 to measure changes in practice stetting for general internists. They found that there was a large increase from 2008 to 2018 in the percentage of the workforce employed as hospitalists (25% to 40% of the internist workforce) with a similar growth in physicians who limited their practice only to outpatient settings, from 23% to 38% of internists. The two extremes contributed to a big decline in mixed practice where physicians see patients in both the hospital and outpatient settings, dropping from 52% to 23%. The data suggests hospitalist outpatient only career choices tend to stick.  For example, 86% of hospitalists in 2013 were in the same type of practice 5 years later.

The researchers express concern over the trends revealed by this study. Their findings suggest that outpatient primary care physician shortages will accelerate as outpatient-only physicians begin to retire and the ability to shift from hospital to outpatient care by mixed practice physicians diminishes

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Bradley M. Gray, PhD, please contact Aaron Cohen at aaroncohenpr@gmail.com.

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3. Academic medical center offers blueprint for improving vaccine uptake among underserved populations

Abstract: https://www.acpjournals.org/doi/10.7326/M22-0028     

URLs go live when the embargo lifts

A new report provides a detailed blueprint for how academic medical centers can play an important role in increasing access to and uptake of SARS-CoV-2 vaccines, especially in Black and Latino communities that have been disproportionately affected by the pandemic. The report is published in Annals of Internal Medicine.

Boston Medical Center (BMC) is the largest safety-net health system in New England. As a safety-net hospital, BMC cares for patients regardless of their ability to pay or their immigration status. Boston claims both the highest per-capita National Institutes of Health (NIH) funding and the largest racial gaps in health outcomes in the United States. Boston residents of color are also disproportionately affected during COVID-19 surges, with Black and Latino persons infected at approximately 1.5 times the rate of White persons.

BMC’s program was based on a conceptual framework for community interventions and aimed to increase equitable access to vaccination through community-based sites in churches and community centers, mobile vaccination events, and vaccination on the BMC campus. The authors’ strategies for implementation included communication campaigns featuring trusted messengers, a focus on health equity, established partnerships with community leaders and community health centers, and strong collaboration with state and local health departments to ensure equitable allocation of the vaccine supply. The authors report that challenges to the implementation of this program included mistrust of the health system given the long history of economic disinvestment in the surrounding community.  Authors also believe that potential challenges to implementing similar programs would include the need for a robust operational infrastructure to support initiatives.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Sabrina A. Assoumou, MD, MPH, please contact Jazmin Holdway at Jazmin.Holdway@bmc.org.

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Also new in this issue:

Promoting Safety, Transparency, and Quality in Xenotransplantation

Peter P. Reese, MD, PhD; and Brendan Parent, JD

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/M22-0539

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Peter P. Reese, MD, PhD, please contact Eileen Fisher at eileenbe@pennmedicine.upenn.edu.