Increasing human papillomavirus vaccination at the recommended age

Age at Human Papillomavirus Vaccine Initiation Among Adolescents and Young Adults From 22 Pediatric Practices in the Northeastern United States

PURPOSE

To examine trends in human papillomavirus (HPV) vaccine initiation and its determinants.

DESIGN

This retrospective correlational study involved 12,260 individuals born between 1996 and 2000 receiving care from one of 22 pediatric practices in the northeastern region of the United States between 2016 and 2017.

METHODS

We extracted data about HPV vaccination status and date, birth year, race, ethnicity, language, and geographic regions. Mean age at initiation was estimated using descriptive statistics. Multiple linear regression with weighted least squares was used to examine its correlates.

FINDINGS

Of 12,260 individuals, about 76% initiated the HPV vaccination series at 9 to 17 years of age. While the initiation age decreased overall for both females and males (e.g., 14.3 vs. 16.2 years and 13.8 vs. 14.4 years in the 1996 vs. 2000 birth cohorts, respectively), a greater reduction was noted for males. Individuals tended to delay initiation if they were non-Hispanic or Asian and resided in urban areas.

CONCLUSIONS

Most adolescents in our sample started HPV vaccination later than the recommended age, with variations in different demographic groups. Rapid improvement in on-time HPV vaccination is occurring, especially for males.

CLINICAL RELEVANCE

The findings of this analysis emphasize continuous efforts to increase on-time HPV vaccination rates for all groups, including non-Hispanic whites and female adolescents, to eliminate current and possible disparities.

Disparities in healthcare providers' interpretations and implementations of ACIP's meningococcal vaccine recommendations

Invasive meningococcal disease (IMD) caused by the bacteria Neisseria meningitidis is rare but potentially fatal. For healthy adolescents, the US Advisory Committee on Immunization Practices (ACIP) recommends routine vaccination with MenACWY and recommends MenB vaccination under shared clinical decision-making (previously "Category B"). The recommendation for MenB vaccination was the first category B recommendation in adolescents, and it is unclear how healthcare providers (HCPs) implement these guidelines. This 2017 web-based survey of US HCPs explored characteristics associated with prescribing or receiving MenB and MenACWY vaccines, HCP knowledge of vaccine recommendations, and real-world practice patterns. Of 529 respondents, 436 prescribed MenB vaccines to their eligible adolescent/young adult patients and 93 prescribed MenACWY vaccines only. MenB vaccine prescribers were more likely to be pediatricians compared with MenACWY vaccine only prescribers, and patients who received MenB vaccines were more likely to be non-Hispanic whites living in shared spaces (eg, college dormitories) than those not receiving the vaccine. Seventy-seven percent of HCPs indicated that they prescribe MenACWY vaccines consistently with ACIP recommendations (to all members of an age group), whereas only 7% indicated that they prescribe MenB vaccines consistently with ACIP recommendations (individual clinical decision making). Patient-related factors, disease-related factors, and guidelines all influenced HCP decisions to prescribe meningococcal vaccines. Providing HCPs with clear guidance on how to initiate discussion of MenB vaccines with patients and their caregivers may aid in fully protecting US adolescents against meningococcal disease caused by 5 of the disease-causing serogroups.

Declines in Vaccine-Type Human Papillomavirus Prevalence in Females Across Racial/Ethnic Groups: Data From a National Survey

PURPOSE

To monitor human papillomavirus (HPV) vaccine impact in the U.S., we evaluated quadrivalent vaccine (4vHPV)-type prevalence among females aged 14-34 years in the prevaccine (2003-2006) and vaccine (2013-2016) eras overall and by race/ethnicity in the National Health and Nutrition Examination Survey.

METHODS

We analyzed HPV DNA prevalence in self-collected cervicovaginal specimens, demographic characteristics, sexual behavior, and self-reported/parent-reported vaccination status. We compared prevaccine to vaccine era 4vHPV-type prevalence, using unadjusted and adjusted prevalence ratios (PR and aPR) and 95% confidence intervals (CIs). PRs were calculated by race/ethnicity (non-Hispanic white [NHW], non-Hispanic black [NHB], and Mexican American [MA]). Overall aPRs were adjusted for race/ethnicity, lifetime sex partners, and poverty.

RESULTS

Overall, 4,674 females had HPV typing results; 3,915 reported NHW, NHB, or MA race/ethnicity. Vaccination coverage of ≥1 dose was 53.9% among 14- to 19-year-olds (NHW 52.6%, NHB 58.1%, and MA 59.5%) and 51.5% among 20- to 24-year-olds (NHW 58.8%, NHB 45.0%, MA 33.8%). Among 14- to 19-year-olds, 4vHPV-type prevalence decreased overall (11.5% to 1.8%; aPR = .14 [CI: .08-.24]) and in NHW (PR = .14 [CI: .06-.29]), NHB (PR = .26 [CI: .12-.54]), and MA (PR = .13 [CI: .03-.53]). In 20- to 24-year-olds, 4vHPV-type prevalence decreased overall (18.5% to 5.3%; aPR = .29 [CI: .15-.56]) and in NHW (PR = .27 [CI: .11-.67]) and NHB (PR = .38 [CI: .18-.80]). No significant declines were observed in older age groups.

CONCLUSIONS

Within 10 years of vaccine introduction, 4vHPV-type prevalence declined 86% among 14- to 19-year-olds, with declines observed in NHW, NHB, and MA females, and 71% among 20- to 24-year-olds, with declines in NHW and NHB females. These extraordinary declines should lead to substantial reductions in HPV-associated cancers.