HPV Vaccine: Bundling, Vaccine Registry Improve Rates in Teens

Jennifer Garcia

October 05, 2016

A system-wide effort that included bundling the human papillomavirus (HPV) vaccine with other vaccines and avoiding missed opportunities for vaccination increased HPV vaccine uptake well above the national average, according to a report published online October 5 in Pediatrics.

"By addressing provider- and system-level barriers, including avoiding missed opportunities and providing a strong recommendation, adolescent vaccination coverage rates at Denver Health have risen well above national rates, especially for HPV," write Anna-Lisa M. Farmar, MD, MPH, from the University of Colorado, Aurora, and colleagues.

The researchers analyzed vaccination rates among adolescents aged 13 to 17 years in the Denver Health system, which is a safety net health system. The analysis included 11,463 patients seen between 2004 and 2014. Patients in this population were more likely to be Hispanic, English speaking, and earn 200% of the federal poverty level (FPL) or less.

By 2013, the rate of HPV vaccination (one dose or more) was 89.8% among females and 89.3% among males compared with national rates of 57.3% and 34.6%, respectively. In 2014, HPV vaccination of three or more doses was 66.8% in girls and 59.9% in boys compared with national rates of 39.7% and 21.6%, respectively.

In a multivariate analysis, the researchers found that Hispanic teenagers (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.53 - 2.11), non–English speaking teenagers (OR, 2.15; 95% CI, 1.67 - 2.77), and teenagers living 200% below the federal poverty level (OR, 1.43; 95% CI, 1.10-1.87) were more likely to have received three or more doses of HPV vaccine.

Among both sexes, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine coverage was 95.9% and meningococcal conjugate vaccine coverage was 93.5% compared with national rates of 86.0% and 77.8%, respectively.

The authors note that efforts used to achieve the high vaccination rates included "use of a vaccine registry, standing orders for vaccines, bundling of vaccines, and [school-based health center] programs."

In addition, providers offered vaccines at all visits, even if families had previously declined vaccination. "These families may require recurring discussion over time with a primary provider to overcome barriers to vaccination," note the authors. "Providing a strong recommendation may create an opportunity for education regarding HPV burden of illness, increased efficacy of the vaccine when given before initiation of sexual activity, and safety of the vaccine."

The researchers acknowledge that these findings from an urban, largely low-income population may not be generalizable to all settings. However, "[a]voiding missed opportunities for vaccination and providing a strong recommendation for the HPV vaccine" are tactics that may be beneficial to providers caring for adolescents in a variety of settings.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online October 5, 2016. Abstract

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