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Dermatologists and HPV vaccination


National report - "My sister died of cervical cancer," says New Orleans-area dermatologist Patricia Farris, M.D., who has a private practice that is overwhelmingly female.

That personal connection led her to follow the development of a vaccine to prevent infection with human papillomavirus (HPV), the principle cause of cervical cancer.

Gardasil (Merck), the first vaccine to prevent HPV infection, was approved by the Food and Drug Administration (FDA) on June 8.

After she thought about it a bit, she says, "It really makes sense. A lot of girls in this age range for vaccination are between the pediatrician and the gynecologist; they really are only seeing dermatologists.

"We are the ones who interact with these patients, so it is reasonable to me that a dermatologist could incorporate vaccination against HPV into our practices."

Amy B. Middleman, M.D., M.P.H., is affiliated with Texas Children's Hospital in Houston and served as the Society for Adolescent Medicine liaison to the Center for Disease Control and Prevention (CDC)'s Advisory Committee on Immunization Practices. She says the ideal situation would be to establish the practice of vaccinating children ages nine to 12 against HPV, meningitis and with a booster for pertussis, much as infants are vaccinated against childhood illnesses. But she readily acknowledges that practice is not in place, and there is a tremendous backlog of older persons who could benefit from this vaccine.

"It makes sense to immunize adolescents when you see them," Dr. Middleman says. "And with the challenge of these multi-dose vaccines (zero, three and six month) there is ample opportunity for the dermatologist to play a leading or supportive role."

The HMO is targeting females 11 to 12, and Dr. Wibbelsman says it will be a challenge to address the catch-up population in their teens and twenties. He can envision where a member might begin the series of shots at the "medical home" and complete them at visits to a dermatology specialist.

One strength of Kaiser is its system of electronic medical records. Automatic prompts alert the staff at each visit if a vaccination is due, and the system sends a notice to the member if another shot in the series is overdue.

Not all dermatologists are jumping on the HPV vaccination bandwagon however.

"To do it just because it is available to us seems unreasonable to me," says Thomas D. Horn, M.D., chairman of the department of dermatology at the University of Arkansas for Medical Sciences, Little Rock.

"We are not the right resource. This is something that every primary care physician should be thinking about."

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