番茄社区

SAN DIEGO -- Despite being at greater risk of infection, few children and young adults with autoimmune diseases such as lupus, psoriatic arthritis, or inflammatory bowel disease are being vaccinated against human papillomavirus -- the cause of cervical and other cancers, according to a study.

After accessing insurance company databases, , of , determined that 8.5% of the individuals diagnosed with autoimmune disease had received at least one dose of an HPV vaccine compared with 9.1% of those without autoimmune disease -- a profoundly low uptake of the vaccine.

And among girls and young women, the group initially targeted for vaccination, just 13.1% with autoimmune diseases received at least one of the three doses of the vaccine and 14.1% without received at least one dose. "These are very low rates," Kim said in a press briefing at the annual meeting of the American College of Rheumatology/Association of Rheumatology Health Professionals.

Less than 5% of both groups received all three of the doses.

"Overall, the vaccination rates were quite similar between these groups but were equally quite bad," she said. "The highest group was 12-14 year old girls." She said 35.5% of these children with autoimmune diseases were vaccinated compared with 36.1% of those without autoimmune diseases in this group.

Because of the large number of individuals included in the study, Kim said, the differences between the groups are statistically significant. "However, in my opinion, clinically these results are equally poor in the uptake of HPV vaccination," she said.

She told 番茄社区 that even though people with autoimmune disease make more visits to physicians and other healthcare practitioners, their vaccination uptake is not greater than people without autoimmune diseases. "Perhaps the clinicians are not offering these patients the vaccine or there may be cultural, religious, or other issues among families that are factors in not getting the vaccination," she suggested.

The HPV vaccines are approved for girls, boys, and young adults from ages 9 to 26. Kim noted that autoimmune diseases are associated with increased rates of persistent infection with HPV -- the most common sexually transmitted disease and the primary cause of cervical cancer. Studies show the HPV vaccine to be safe and effective in people with autoimmune diseases.

Using a U.S. commercial insurance claims database, the research team identified 29,255 children and young adults with autoimmune diseases and 117,020 without and reviewed their healthcare records between 2006 and 2012. The average age of those studied was 19 years, and 59 percent were female.

The team excluded patients with a history of malignant cancers or organ transplants. Those with autoimmune diseases were matched by age, sex, and date they received an autoimmune diagnosis and were compared to those without diagnosed autoimmune diseases. The team accounted for patient characteristics, including coexisting diseases, use of healthcare treatments, and geographic regions when assessing vaccine uptake.

"Our study demonstrated striking low uptake of HPV vaccination among patients both with and without autoimmune diseases," said Candace Feldman, MD, MPH, a rheumatology fellow at Brigham and Women's Hospital, and lead investigator of the study. "While increased efforts are necessary for the entire population, a particular focus should be paid to those at high risk for persistent infection. Further studies are needed to better understand this low uptake and to determine strategies for improved access."

Press briefing moderator, , of the University of Wisconsin-Madison, told 番茄社区, "I think one of the factors involved in this low uptake of vaccine is the question of whose responsibility it is. The general practitioner or the pediatrician or the person prescribing immunosuppressive medications? I think there are disconnects in the care of people with rheumatic diseases. More work needs to be done to fill those gaps in how healthcare needs to be delivered."

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