HPV vaccination is falling in exactly the group head and neck surgeons need it to rise in

Design

Cross-sectional analysis of a US national electronic health record database, 2007-2023

Population

19.6 million HPV vaccinations in patients aged 9 to 45

Primary outcome

Vaccination trends by year, sex, age and administering specialty

Effect

Vaccination in ages 9 to 26 fell 47.1 per cent from 2016 to 2023; males 49.9 per cent of vaccinated ages 9 to 18 in 2023; paediatrics' share of doses fell from 74.8 to 46.6 per cent

Nineteen point six million HPV vaccinations recorded in a US national electronic record database between 2007 and 2023 were analysed by year, demographics and the specialty administering the dose, for patients aged 9 to 45.

The expansion of recommendations worked where it was aimed. Adding males aged 9 to 21 in 2009 was followed by an 836 per cent rise in vaccinations in that group between 2010 and 2016, and by 2023 males made up 49.9 per cent of vaccinated patients aged 9 to 18. Head and neck cancer prevention became a designated indication in 2020. Yet total vaccination in those aged 9 to 26 fell 47.1 per cent between 2016 and 2023. The administering specialty also broadened: paediatrics gave 74.8 per cent of doses in 2012 and 46.6 per cent in 2023, with family medicine at 33.3 per cent, obstetrics and gynaecology 7.1 per cent and primary care 6.8 per cent.

So the sex gap has closed in children while the overall rate has collapsed, and adult vaccination remains skewed towards women - which is the mismatch that matters here, because HPV-related oropharyngeal cancer falls disproportionately on men. The authors attribute part of it to education and marketing still framed around cervical cancer. That framing problem is not confined to the United States: any programme built entirely around cervical screening and cervical cancer will under-reach the population an ENT clinic sees, and the head and neck indication needs saying explicitly rather than assumed to follow.

• Say head and neck cancer prevention out loud when discussing HPV vaccination; the cervical framing does not carry it.
• Ask adult male patients about vaccination status - this is where the gap remains widest.
• Note the catch-up age range rather than assuming the window closed at 18.
• Direct the conversation to whoever actually vaccinates locally, since the administering specialty is shifting.
• Treat the falling rate since 2016 as the problem, not the closing sex gap in children, which is the one thing that improved.

The statistics, in plain English

These are administered-dose counts from an electronic record network, not population coverage rates, so a decline could partly reflect where care is recorded rather than fewer children vaccinated - though a 47 per cent fall is too large to be explained that way alone. The 836 per cent increase is a relative change from a near-zero base and should not be read as a large absolute number. Cross-sectional trend data of this kind describe what happened; they cannot say why.

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