More US Youth With Commercial Insurance Getting HPV Vaccination

By Lisa Rapaport

September 21, 2020

(Reuters Health) - While a growing number of U.S. children with commercial insurance are getting the human papillomavirus (HPV) vaccine, inoculation rates remain below target levels, a new study suggests.

The analysis included records for almost 7.84 million children and 19.8 million person-years, based on information gathered in the MarketScan database between 2003 and 2017. Researchers followed children from the year they turned 9 until they received HPV vaccination, disenrolled from insurance, or the year they turned 17.

Overall, the proportion of 15-year-old girls with at least one dose of the HPV vaccine increased from 38% in 2011 to 57% in 2017, the study found. Over that same timeframe, the proportion of 15-year-old boys with at least one dose of the HPV vaccine climbed from 5% to 51%.

Despite this positive trend, HPV vaccination rates still fall short of the Healthy People 2020 goal of 80% by age 15, which is the goal to eliminate HPV infection in the population, said study coauthor Dr. Szu-Ta Chen, a research fellow at the Harvard T. H. Chan School of Public Health in Boston.

The proportion of 15-year-olds who received two doses of the HPV vaccine were even lower, rising from 30% in 2011 to 46% in 2017 among girls, and increasing from 2% to 39% among boys, researchers report in Pediatrics.

"In addition, our results revealed a substantial variation in vaccination rates across states and found that state-level legislation to improve vaccine education and pediatrician density were associated with a higher vaccination rate," Dr. Chen said by email.

As of 2017, the proportion of youth who received two doses of HPV vaccine ranged from as low as 15% in Mississippi to as high as 80% in Washington, D.C. Higher vaccination rates were positively correlated with state legislating promoting HPV vaccine education as well as pediatrician availability.

Legislation to improve vaccination education was associated with an 8.8% increase in vaccination rates among girls and an 8.7% increase for boys, the study found.

Each additional pediatrician per 10,000 children was also associated with a 1.1% estimated increase in vaccination rates.

One limitation of the study is that it only included vaccines received with an insurer paying, which may have resulted in an underestimation of vaccine coverage, the study team notes. Results from commercially insured children also may not be representative of vaccination rates among children with other types of coverage or kids who are uninsured.

Even so, the results underscore a need for better patient education around HPV and the vaccine, said Dr. Cora Collette Breuner, a professor of pediatrics in the adolescent medicine division at Seattle Children's Hospital and the University of Washington who wasn't involved in the study. Educating families and children about the benefits of vaccination, and the risk of HPV, should happen at every visit – and clinicians also need to recommend this vaccine.

"Only a minority of parents choose not to immunize their children against the sexually-transmitted HPV due to concerns that vaccination would encourage or support adolescent sexual intimacy, a reason frequently cited by doctors as a barrier to advocating for this vaccine," Dr. Breuner said by email. "Instead parental concerns are about safety, knowledge about of outcomes of HPV and absence of physician recommendation."

SOURCE: Pediatrics, online September 14, 2020.