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Kelly MK, Stephens-Shields AJ, Hannan C, Rand CM, Localio R, Shone LP, Steffes J, Davis K, Grundmeier RW, Humiston SG, Albertin C, McFarland G, Abney DE, Szilagyi PG, Fiks AG. Missed Opportunities for Adolescent Immunizations at Well-Care Visits During the COVID-19 Pandemic. J Adolesc Health 2023; 73:595-598. [PMID: 37389529 PMCID: PMC10307534 DOI: 10.1016/j.jadohealth.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/04/2023] [Accepted: 05/07/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE The Coronavirus Disease 2019 pandemic disrupted healthcare, but the impact on vaccination missed opportunities (MOs, vaccine-eligible visits without vaccination) is unknown. We evaluated pandemic-related trends in MOs at adolescent well-care visits for three vaccines: human papillomavirus; quadrivalent meningococcal conjugate; and tetanus, diphtheria, and acellular pertussis (Tdap). METHODS We analyzed electronic health record data from 24 pediatric primary care practices in 13 states from 1/1/2018 to 12/31/2021. Segmented logistic regression estimated risk differences for MOs during the pandemic relative to prepandemic trends. RESULTS Among 106,605 well-care visits, we observed decreases in MOs prepandemic followed by an increase in MOs during the pandemic for all three vaccines. Relative to prepandemic, MOs increased for human papillomavirus (+15.9%, 95% confidence interval [CI]: 11.7%, 20.1%), meningococcal conjugate (+9.4%, 95% CI: 5.2%, 13.7%), and tetanus, diphtheria, and acellular pertussis (Tdap) (+ 8.2%, 95% CI: 4.3%, 12.1%). DISCUSSION Increases in vaccine MOs during the pandemic equaled or exceeded pre-pandemic decreases. Reducing MOs in adolescent well-care could raise vaccine coverage.
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Affiliation(s)
- Mary Kate Kelly
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alisa J Stephens-Shields
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chloe Hannan
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Cynthia M Rand
- Department of Pediatrics, University of Rochester, Rochester, New York
| | - Russell Localio
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Laura P Shone
- Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois; Primary Care Research, American Academy of Pediatrics, Itasca, Illinois
| | - Jennifer Steffes
- Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois; Primary Care Research, American Academy of Pediatrics, Itasca, Illinois
| | - Kristin Davis
- Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois; Primary Care Research, American Academy of Pediatrics, Itasca, Illinois
| | - Robert W Grundmeier
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sharon G Humiston
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | - Christina Albertin
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California
| | - Greta McFarland
- Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois
| | - Dianna E Abney
- Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois
| | - Peter G Szilagyi
- Department of Pediatrics, UCLA Mattel Children's Hospital, University of California at Los Angeles, Los Angeles, California
| | - Alexander G Fiks
- Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Pediatric Research in Office Settings, American Academy of Pediatrics, Itasca, Illinois.
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Gilkey MB, Heisler-MacKinnon J, Boynton MH, Calo WA, Moss JL, Brewer NT. Impact of Brief Quality Improvement Coaching on Adolescent HPV Vaccination Coverage: A Pragmatic Cluster Randomized Trial. Cancer Epidemiol Biomarkers Prev 2023; 32:957-962. [PMID: 36480272 PMCID: PMC10244480 DOI: 10.1158/1055-9965.epi-22-0866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/21/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Health departments in the United States routinely conduct quality improvement (QI) coaching to help primary care providers optimize vaccine delivery. In a prior trial focusing on multiple adolescent vaccines, this light-touch intervention yielded only short-term improvements in HPV vaccination. We sought to evaluate the impact of an enhanced, HPV vaccine-specific QI coaching intervention when delivered in person or virtually. METHODS We partnered with health departments in three states to conduct a pragmatic cluster randomized trial in 2015 to 2016. We randomized 224 primary care clinics to receive no intervention (control), in-person coaching, or virtual coaching. Health department staff delivered the brief (45-60 minute) coaching interventions, including HPV vaccine-specific training with assessment and feedback on clinics' vaccination coverage (i.e., proportion of patients vaccinated). States' immunization information systems provided data to assess coverage change for HPV vaccine initiation (≥1 doses) at 12-month follow-up, among patients ages 11 to 12 (primary outcome) and 13 to 17 (secondary outcome) at baseline. RESULTS Clinics served 312,227 patients ages 11 to 17. For ages 11 to 12, coverage change for HPV vaccine initiation was higher in the in-person and virtual coaching arms than in the control arm at 12-month follow-up (1.2% and 0.7% point difference, both P < 0.05). For ages 13 to 17, coverage change was higher for virtual coaching than control (1.4% point difference, P < 0.001), but in-person coaching did not yield an intervention effect. CONCLUSIONS Our brief QI coaching intervention produced small long-term improvements in HPV vaccination. IMPACT Health departments may benefit from targeting QI coaching to specific vaccines, like HPV vaccine, that need them most.
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Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | | | - Marcella H Boynton
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- North Carolina Translational & Clinical Sciences Institute, University of North Carolina, Chapel Hill, North Carolina
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - William A Calo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Jennifer L Moss
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | - Noel T Brewer
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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3
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Real FJ, Ollberding NJ, Meisman AR, DeBlasio DJ, Pero MB, Davis D, Cruse B, Klein MD, Kahn JA, Rosen BL. Impact of a Virtual Reality Curriculum on Human Papillomavirus Vaccination: A Pilot Trial. Am J Prev Med 2022; 63:865-873. [PMID: 35778065 PMCID: PMC9639394 DOI: 10.1016/j.amepre.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/18/2022] [Accepted: 05/04/2022] [Indexed: 11/01/2022]
Abstract
Although the strongest predictor of human papillomavirus (HPV) vaccination is a high-quality recommendation, physicians often provide weak recommendations. Thus, the authors developed Virtual Immersive Communication Training on Recommending Immunizations (VICTORI), a virtual reality (VR)‒based intervention that provided physicians the opportunity to deliberately practice recommendation behaviors. VICTORI included VR simulations during which participants counseled caregiver avatars hesitant to vaccinate. Before participation in VICTORI, participants reviewed a smartphone application on recommendation behaviors. A nonrandomized control trial of VICTORI was conducted with licensed and resident physicians. The intervention group completed the application and VICTORI simulations, whereas a comparison group completed only the application. The hypothesis was that HPV vaccination rates would increase for patients in the intervention group. The preintervention period was defined as the 6 months before allocated training (February 1, 2020-July 31, 2020), and the postintervention period was the 6 months after (October 1, 2020-March 31, 2021). The primary outcome was a change in the rates of human papillomavirus vaccine initiation among eligible patients presenting to clinic before and after. Of 142 eligible physicians, 134 (94%) chose to participate, with 93 of /97 (96%) intervention and 30 of 37 (81%) comparison participants completing study protocols. There was a statistically significant increase in patients' HPV vaccine initiation rates after training within the intervention group (54.3%‒72.4%; 18.1% difference [95% CI=11.0, 25.8]; p<0.001) but not within the comparison group (59.5%‒63.4%; 3.9% difference [95% CI= -11.0, 19.0]; p=0.609). In conclusion, HPV vaccine initiation increased after VR training, and further study is warranted.
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Affiliation(s)
- Francis J Real
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrea R Meisman
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Dominick J DeBlasio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mary Beth Pero
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David Davis
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bradley Cruse
- Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Melissa D Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jessica A Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Brittany L Rosen
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Gilkey MB, Grabert BK, Heisler-MacKinnon J, Bjork A, Boynton MH, Kim K, Alton Dailey S, Liu A, Todd KG, Schauer SL, Sill D, Coley S, Brewer NT. Coaching and Communication Training for HPV Vaccination: A Cluster Randomized Trial. Pediatrics 2022; 150:e2021052351. [PMID: 35818840 PMCID: PMC9535352 DOI: 10.1542/peds.2021-052351] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES US health departments routinely conduct in-person quality improvement (QI) coaching to strengthen primary care clinics' vaccine delivery systems, but this intervention achieves only small, inconsistent improvements in human papillomavirus (HPV) vaccination. Thus, we sought to evaluate the effectiveness of combining QI coaching with remote provider communication training to improve impact. METHODS With health departments in 3 states, we conducted a pragmatic 4-arm cluster randomized clinical trial with 267 primary care clinics (76% pediatrics). Clinics received in-person QI coaching, remote provider communication training, both interventions combined, or control. Using data from states' immunization information systems, we assessed HPV vaccination among 176 189 patients, ages 11 to 17, who were unvaccinated at baseline. Our primary outcome was the proportion of those, ages 11 to 12, who had initiated HPV vaccination at 12-month follow-up. RESULTS HPV vaccine initiation was 1.5% points higher in the QI coaching arm and 3.8% points higher in the combined intervention arm than in the control arm, among patients ages 11 to 12, at 12-month follow-up (both P < .001). Improvements persisted at 18-month follow-up. The combined intervention also achieved improvements for other age groups (ages 13-17) and vaccination outcomes (series completion). Remote communication training alone did not outperform the control on any outcome. CONCLUSIONS Combining QI coaching with remote provider communication training yielded more consistent improvements in HPV vaccination uptake than QI coaching alone. Health departments and other organizations that seek to support HPV vaccine delivery may benefit from a higher intensity, multilevel intervention approach.
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Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior
- Lineberger Comprehensive Cancer Center
| | - Brigid K Grabert
- Department of Health Behavior
- Lineberger Comprehensive Cancer Center
| | | | - Adam Bjork
- Immunization Services Division, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Marcella H Boynton
- North Carolina Translational & Clinical Sciences Institute
- Division of General Medicine and Clinical Epidemiology
| | | | | | - Amy Liu
- Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Karen G Todd
- WakeMed Health and Hospitals, WakeMed Physician Practices, Raleigh, North Carolina
| | - Stephanie L Schauer
- Immunization Program, Division of Public Health, Wisconsin Department of Health Services, Madison, Wisconsin
| | - Danielle Sill
- Immunization Program, Division of Public Health, Wisconsin Department of Health Services, Madison, Wisconsin
| | - Scott Coley
- Bureau of Immunization, New York State Department of Health, Albany, New York
| | - Noel T Brewer
- Department of Health Behavior
- Lineberger Comprehensive Cancer Center
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5
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Silva TMRD, Nogueira de Sá ACMG, Beinner MA, Abreu MNS, Matozinhos FP, Sato APS, Vieira EWR. Impact of the COVID-19 Pandemic on Human Papillomavirus Vaccination in Brazil. Int J Public Health 2022; 67:1604224. [PMID: 35431762 PMCID: PMC9008128 DOI: 10.3389/ijph.2022.1604224] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022] Open
Abstract
Objective: To analyze the number of applied HPV vaccine doses before (from April 2019 to March 2020) and after (from April 2020 to September 2020) social distancing measures in response to the COVID-19 pandemic in states and regions of Brazil. Methods: Ecological time-series study, using data from the Brazilian National Immunization Program (PNI). Using the Mann-Whitney test, we evaluated the difference between the median number of applied doses during the periods April 2019 to March 2020 and from April 2020 to September 2020. Spatial analysis identified clusters with a high or low percentage reduction in the median applied doses. Prais-Winsten regression models identified temporal trends in the applieddoses from both periods. Results: There was a significant reduction in the median HPV vaccine doses applied, formation of spatial clusters and, after a sharp drop in the number of applieddoses during the months following social distancing. There was a tendency to increase the applied vaccines doses. Conclusion: The COVID-19 pandemic resulted in reduction of the number of HPV vaccine doses applied as a possible effect of restrictive measures caused by the pandemic.
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Affiliation(s)
- Tércia Moreira Ribeiro Da Silva
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Mark Anthony Beinner
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Fernanda Penido Matozinhos
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Ed Wilson Rodrigues Vieira
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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6
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Amend KL, Turnbull B, Zhou L, Marks MA, Velicer C, Saddier P, Seeger JD. Vaccine initiation and 3-dose series completion of 4vHPV vaccine among US insured males 2012-2016. Vaccine 2021; 40:682-688. [PMID: 34794821 DOI: 10.1016/j.vaccine.2021.10.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/30/2021] [Accepted: 10/26/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The quadrivalent human papillomavirus vaccine (4vHPV, GARDASIL®), was approved in the US in 2009 for use in males aged 9 to 26 for the prevention of HPV-related genital warts, and in 2010 for the prevention of certain HPV-related anogenital diseases. A regimen was approved in 2016 for those who initiate the vaccine series between the ages of 9 to 14 years. We describe patterns of 4vHPV administration among US males before this modification. METHODS The study used a US health insurance claims database, and included males, age 9 to 26 years, who initiated 4vHPV between 2012 and 2016. Time from first dose to subsequent doses was estimated. Logistic regression identified factors associated with regimen completion. RESULTS Among 100,786 males who initiated 4vHPV (corresponding to ∼ 13% of male birth cohorts), 50,573 (50.2%) and 25,763 (25.6%) received a second and third dose, respectively. Annual administration was common, with 47% of males receiving 3 doses over 3 years (1 dose per year) as compared to 12% receiving the 3-dose series in the recommended 6-month timeframe. Receipt of 4vHPV was 2.2 (range 1.5 to 2.9) times as likely to occur in summer months compared to other times of the year. Individuals aged 18 to 21 years and those living in Western states or rural regions were less likely to complete the 3-dose regimen. CONCLUSIONS The real-world patterns of 4vHPV vaccination observed, particularly the low uptake and regimen completion, suggest that better strategies are needed for males to improve 4vHPV vaccine use in males.
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Affiliation(s)
| | | | - Li Zhou
- Epidemiology, Optum, Boston, MA, USA
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7
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McGee LU, Ressler KS, Boom JA, Bulsara S, Sangi-Haghpeykar H, Jibaja-Weiss ML, Montealegre JR. Incomplete Records as a Leading Cause of Missed Opportunity for Human Papillomavirus Vaccine Initiation in a Safety Net Health System. Acad Pediatr 2021; 21:1118-1125. [PMID: 33359360 DOI: 10.1016/j.acap.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 11/25/2020] [Accepted: 12/15/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The goal of this study was to categorize reasons behind missed opportunities for human papillomavirus (HPV) vaccine initiation in an under-resourced population and to identify associated patient and clinic characteristics. METHODS Manual chart review was performed for patients aged 11 to 18 years who visited a primary care clinic in a health system in Texas, USA between 06/01/18 and 08/31/18 and were due for an initial HPV vaccine dose but did not receive it. Reasons for HPV vaccine noninitiation were categorized as follows: incomplete immunization record, no documentation of discussion (no documentation that the HPV vaccine was offered or ordered), refusal, staff/provider error, and medical. Multinomial logistic regression was used to examine factors associated with each category. RESULTS Of 4467 adolescents seen in the study period, 575 (12.9%) were due for the first dose of HPV vaccine but did not receive it. The most common reason for noninitiation was incomplete immunization record (37%), followed by no documentation of discussion (24%), refusal (20%), staff/provider error (15%), and medical (4%). The highest odds of incomplete immunization were among older adolescents. The highest odds of no documentation of discussion were during sick visits. The highest odds of staff/provider error were among patients with commercial insurance. The lowest odds of refusal were in patients with county/indigent insurance. CONCLUSIONS The most common reason for missed opportunity visits for HPV vaccine initiation was lack of adequate immunization records. Our study highlights the importance of immunization record access and bidirectional reporting as important targets for future interventions.
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Affiliation(s)
- Lindy U McGee
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex.
| | - Kelly S Ressler
- Department of Medical Education, Baylor College of Medicine (KS Ressler), Houston, Tex
| | - Julie A Boom
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex
| | - Shaun Bulsara
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine (H Sangi-Haghpeykar), Houston, Tex
| | - Maria L Jibaja-Weiss
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex; School of Health Professions, Baylor College of Medicine (ML Jibaja-Weiss), Houston, Tex
| | - Jane R Montealegre
- Department of Pediatrics, Baylor College of Medicine (LU McGee, JA Boom, and JR Montrealegre), Houston, Tex; Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine (LU McGee, S Bulsara, ML Jibaja-Weiss, and JR Montealegre), Houston, Tex
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8
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Yih WK, Kulldorff M, Dashevsky I, Maro JC. A Broad Safety Assessment of the 9-Valent Human Papillomavirus Vaccine. Am J Epidemiol 2021; 190:1253-1259. [PMID: 33558897 PMCID: PMC8245868 DOI: 10.1093/aje/kwab022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/14/2022] Open
Abstract
Parents indicate that safety is their top concern about human papillomavirus (HPV) vaccination. A data-mining method not requiring prespecification of health outcome(s) or postexposure period(s) of potentially increased risk can be used to identify possible associations between an exposure and any of thousands of medically attended health outcomes; this method was applied to data on the 9-valent HPV vaccine (HPV9) to detect potential safety problems. Data on 9- to 26-year-olds who had received HPV9 vaccine between November 4, 2016, and August 5, 2018, inclusive, were extracted from the MarketScan database and analyzed for statistically significant clustering of incident diagnoses within the hierarchy of diagnoses coded using the International Classification of Diseases and temporally within the 1 year after vaccination, using the self-controlled tree-temporal scan statistic and TreeScan software. Only 56 days of postvaccination enrollment was required; subsequent follow-up was censored at disenrollment. Multiple testing was adjusted for. The analysis included 493,089 doses of HPV9. Almost all signals resulted from temporal confounding, not unexpected with a 1-year follow-up period. The only plausible signals were for nonspecific adverse events (e.g., injection-site reactions, headache) on days 1–2 after vaccination, with attributable risks as low as 1 per 100,000 vaccinees. Considering the broad scope of the evaluation and the high statistical power, the findings of no specific serious adverse events should provide reassurance about this vaccine’s safety.
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Affiliation(s)
- W Katherine Yih
- Correspondence to Dr. W. Katherine Yih, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215 (e-mail: )
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9
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Gilkey MB, Bednarczyk RA, Gerend MA, Kornides ML, Perkins RB, Saslow D, Sienko J, Zimet GD, Brewer NT. Getting Human Papillomavirus Vaccination Back on Track: Protecting Our National Investment in Human Papillomavirus Vaccination in the COVID-19 Era. J Adolesc Health 2020; 67:633-634. [PMID: 32933839 PMCID: PMC7834295 DOI: 10.1016/j.jadohealth.2020.08.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Melissa B Gilkey
- Department of Health Behavior and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
| | - Robert A Bednarczyk
- Department of Global Health and Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Mary A Gerend
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, Florida
| | - Melanie L Kornides
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca B Perkins
- Department of Obstetrics and Gynecology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Debbie Saslow
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Jennifer Sienko
- Cancer Control Department, American Cancer Society, Atlanta, Georgia
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Noel T Brewer
- Department of Health Behavior and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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10
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Finney Rutten LJ, Radecki Breitkopf C, St Sauver JL, Croghan IT, Jacobson DJ, Wilson PM, Herrin J, Jacobson RM. Evaluating the impact of multilevel evidence-based implementation strategies to enhance provider recommendation on human papillomavirus vaccination rates among an empaneled primary care patient population: a study protocol for a stepped-wedge cluster randomized trial. Implement Sci 2018; 13:96. [PMID: 30001723 PMCID: PMC6043954 DOI: 10.1186/s13012-018-0778-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Each year, human papillomavirus (HPV) causes 30,000 cancers in the USA despite the availability of effective and safe vaccines. Uptake of HPV vaccine has been low and lags behind other adolescent vaccines. This protocol describes a multilevel intervention to improve HPV vaccination rates. Methods Using a cluster randomized trial, we will evaluate the independent and combined impact of two evidence-based implementation strategies with innovative enhancements on HPV vaccination rates for female and male patients. The clusters are six primary care sites providing care to pediatric populations. We will use a stepped-wedge cluster randomized design, including process evaluation, to test the hypothesis that compared with the current course of care and a practice-level intervention using reminder-recall interventions coupled with provider-level audit and feedback with education increases HPV vaccination rates in exposed clusters. The factorial design allows us to use a single trial to test these two interventions and to assess each individually and in combination. Our design has four 12-month steps. The first step will be a baseline period; data collected during it will provide a within-practice control group for each cluster. Second, two clusters will be randomly assigned to receive intervention 1 (reminder and recall), and two clusters will be randomly selected to receive intervention 2 (audit and feedback with education). Third, the other two clusters will be randomly allocated to intervention 1 or 2. Clusters initially with intervention 1 will be randomly allocated to 1 + 2 or 1; clusters initially with intervention 2 will be randomly allocated to 1 + 2 or 2. Fourth, all clusters will receive both interventions. To ensure balance of patient numbers across interventions, we will use block randomization at the first step, with the six clusters grouped into three pairs according to volume. Our primary outcome will be vaccination rates. Discussion Results of our clinical trial and process evaluation will provide evidence showing whether practice- and provider-level interventions improve HPV vaccination rates and will offer insight into contextual factors associated with direction and magnitude of trial outcomes. Trial registration ClinicalTrials.gov, NCT03501992, registered April 18, 2018. Electronic supplementary material The online version of this article (10.1186/s13012-018-0778-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lila J Finney Rutten
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA. .,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | | | - Jennifer L St Sauver
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | - Ivana T Croghan
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Division of Epidemiology, Mayo Clinic, Rochester, MN, USA.,Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | - Robert M Jacobson
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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Vielot NA, Butler AM, Brookhart MA, Becker-Dreps S, Smith JS. Patterns of Use of Human Papillomavirus and Other Adolescent Vaccines in the United States. J Adolesc Health 2017; 61:281-287. [PMID: 28739327 PMCID: PMC10530656 DOI: 10.1016/j.jadohealth.2017.05.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/08/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of the study was to describe the patterns of use of universally recommended adolescent vaccines in the United States. METHODS We identified 11-year-olds using the MarketScan insurance claims database (2009-2014). Human papillomavirus (HPV), tetanus-diphtheria-acellular pertussis (Tdap), and meningococcal (MenACWY) vaccination claims were identified using diagnosis and procedure codes. Generalized linear models estimated vaccination incidence rates and correlates of adolescent vaccination and timely vaccination. RESULTS Among 1,691,223 adolescents, receipt of Tdap (52.1%) and MenACWY (45.8%) vaccinations exceeded receipt of HPV vaccination (18.4%). While both sexes had similar Tdap and MenACWY vaccination proportions, girls received HPV vaccination more frequently than boys (21.9% vs. 15.1%). Adolescents received HPV vaccination later (mean age: 11.8 years) than Tdap or MenACWY vaccination (mean age: 11.2 years for both). Half of vaccinated adolescents received Tdap and MenACWY vaccination only; however, coadministration with HPV vaccine increased with birth cohort. Western adolescents had the highest incidence rates of HPV vaccination, and Southern adolescents had the lowest. Rural adolescents were less likely than urban adolescents to receive each vaccination except in the Northeast, where they were more likely to receive HPV vaccination (incidence rate ratio: 1.09, 95% confidence interval: 1.2005-1.13). Timely HPV vaccination was associated with female sex, urbanicity, Western residence, and later birth cohort. CONCLUSIONS HPV vaccination occurred later than Tdap or MenACWY vaccination and was less frequent in boys and rural adolescents. Girls, Western and urban residents, and younger birth cohorts were more likely to receive timely HPV vaccination. Vaccine coadministration increased over time and may encourage timely and complete vaccination coverage.
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Affiliation(s)
- Nadja A Vielot
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Anne M Butler
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - M Alan Brookhart
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sylvia Becker-Dreps
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer S Smith
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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12
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Moss JL, Reiter PL, Truong YK, Rimer BK, Brewer NT. School Entry Requirements and Coverage of Nontargeted Adolescent Vaccines. Pediatrics 2016; 138:peds.2016-1414. [PMID: 27940689 PMCID: PMC5127065 DOI: 10.1542/peds.2016-1414] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/09/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Low human papillomavirus (HPV) vaccination coverage is an urgent public health problem requiring action. To identify policy remedies to suboptimal HPV vaccination, we assessed the relationship between states' school entry requirements and adolescent vaccination. METHODS We gathered data on states' school entry requirements for adolescent vaccination (tetanus, diphtheria, and pertussis [Tdap] booster; meningococcal; and HPV) from 2007 to 2012 from Immunization Action Coalition. The National Immunization Survey-Teen provided medical record-verified vaccination data for 99 921 adolescents. We calculated coverage (among 13- to 17-year-olds) for individual vaccinations and concomitant vaccination. HPV vaccination outcomes were among female adolescents. Analyses used weighted longitudinal multivariable models. RESULTS States with requirements for Tdap booster and meningococcal vaccination had 22 and 24 percentage point increases in coverage for these vaccines, respectively, compared with other states (both P < .05). States with HPV vaccination requirements had <1 percentage point increase in coverage for this vaccine (P < .05). Tdap booster and meningococcal vaccination requirements, respectively, were associated with 8 and 4 percentage point spillover increases for HPV vaccination coverage (both P < .05) and with increases for concomitant vaccination (all P < .05). CONCLUSIONS Ensuring all states have meningococcal vaccination requirements could improve the nation's HPV vaccination coverage, given that many states already require Tdap booster but not meningococcal vaccination for school entry. Vaccination programs and clinicians should capitalize on changes in adolescent vaccination, including concomitant vaccination, that may arise after states adopt vaccination requirements. Additional studies are needed on the effects of HPV vaccination requirements and opt-out provisions.
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Affiliation(s)
| | - Paul L. Reiter
- College of Medicine, The Ohio State University, Columbus, Ohio
| | | | - Barbara K. Rimer
- Departments of Health Behavior and,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; and
| | - Noel T. Brewer
- Departments of Health Behavior and,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina; and
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