Coverage from Ontario,Canada's school-based HPV vaccine program: The first three years

Background

In 2007, Ontario implemented a school-based human papillomavirus (HPV) vaccination program targeting grade 8 girls. Girls may complete the series in grade 9 (extended eligibility). Limitations in the existing provincial data sources for assessing HPV vaccine coverage in Ontario prompted the use of two surveys of Health Units (HUs) to calculate provincial vaccine coverage for the first three years of the vaccination program.

Methods

We surveyed Ontario's 36 HUs in March and November 2011 to obtain vaccine coverage information, including source of denominator data, and use of local information systems. The second survey was necessary in order to assess coverage including extended eligibility for the third year. HU-reported HPV vaccine coverage was compared to coverage estimates obtained from two provincial systems: the Immunization Records Information System (IRIS) and the HPV reimbursement database, a system used to remunerate HUs for HPV vaccine doses administered.

Results

100% of HUs participated in the two surveys. The provincial coverage estimates using HU-reported data were: 51% (2007–2008), 58% (2008–2009), and 59% (2009–2010) with large variation by HU. Coverage increased significantly over time. The number of HUs that were able to report on doses given as part of extended eligibility also increased over time (47% in 2007–2008 to 89% in 2009–2010; p = 0.0008). Comparisons across the three data sources (survey, IRIS and reimbursement database) revealed significantly different coverage estimates. Class or school lists were the most common source of denominator data used by HUs (27/36, 75%), however independent schools were not included by all.

Conclusions

As not all HUs were able to report on HPV vaccine coverage including extended eligibility doses these findings likely underestimate the true coverage attained by Ontario's program. Although coverage is below the Canadian Immunization Committee benchmark of 80% within two years of program implementation, the upward trend in coverage is encouraging.     

Human papillomavirus vaccine initiation among adolescent girls in high-risk communities

Background

We assessed human papillomavirus (HPV) vaccine uptake among adolescent girls, parents’ intentions to vaccinate daughters, and barriers and facilitators of vaccination in a population at elevated risk for cervical cancer.

Methods

Between October 2007 and June 2008, telephone surveys were conducted with randomly selected parents/guardians of 11-18 year old girls attending public middle and high schools serving economically disadvantaged populations in Los Angeles County.

Results

We surveyed 509 predominantly Hispanic (81%) and African American (16%) parents; 71% responded in Spanish. Overall, 23% reported their daughter had received ≥1 dose of HPV vaccine. Although 93% of daughters had seen a doctor in the past year, only 30% reported that a provider recommended HPV vaccine. Characteristics positively associated with odds of having initiated HPV vaccine were having heard of the vaccine (adjusted odds ratio [aOR] 2.6), belief in vaccine effectiveness (aOR 2.9), and doctor recommendation (aOR 48.5). Negative attitudes toward HPV vaccine (aOR 0.2) and needing more information about it (aOR 0.1) were negatively associated with vaccine initiation. Of those with unvaccinated daughters (n = 387), 62% said they “probably/definitely will” vaccinate within the next year and 21% were undecided or didn’t know; only 11% said they definitely won’t.

Conclusions

About one-quarter of adolescent girls in this at-risk community had initiated HPV vaccine by mid-2008. Provider recommendation was the single most important factor associated with vaccination. Because a substantial proportion of parents remain undecided about HPV vaccine, health care providers can play a key role by providing needed information and offering HPV vaccine to all eligible adolescents.     

Human papillomavirus vaccine uptake and barriers: association with perceived risk, actual risk and race/ethnicity among female students at a New York State university, 2010

Understanding human papillomavirus (HPV) vaccine uptake patterns is critical to improve vaccination levels. Approximately half (56%) of female undergraduate students surveyed at a large public university reported HPV vaccine series initiation, with 79% of initiators completing the three dose series. Predictors of series initiation included having a conversation with a health-care provider about the vaccine, reporting a history of sexual intercourse and receipt of the meningitis vaccine. Compared to whites, black/African-American women were 33% less likely to have initiated HPV vaccination. Common reasons for not receiving the HPV vaccine included concerns about vaccine safety and doctors’ not recommending vaccination.     

Improving adolescent human papillomavirus (HPV) immunization uptake in school-based health centers through awareness campaigns

PurposeThe aim of this study was to measure the effect of a multicomponent human papillomavirus (HPV) vaccine promotion campaign on adolescent HPV vaccine uptake at school-based health centers (SBHCs) in Seattle, WA.MethodsYouth-led HPV vaccine promotion campaigns were introduced in 2016 in 13 schools with SBHCs in Seattle. Five other schools with SBHCs served as controls. Vaccination records for students were obtained from the Washington Immunization Information System from September 2012 to August 2018. We compared increase in HPV vaccine uptake in SBHCs between 1) intervention and control schools, and 2) pre- and post-intervention periods in intervention schools using generalized estimating equations.ResultsHPV vaccine uptake was high at baseline among students that use SBHCs for vaccines and has steadily increased between 2012 and 2018. Implementing the promotion campaign resulted in 14% higher (95% Confidence Interval (CI): 1%, 30%) HPV vaccine uptake in intervention SBHCs compared to control SBHCs, adjusting for time and confounders. Comparing pre-and post-intervention periods in intervention SBHCs, HPV vaccine uptake was 14% higher (95% CI: −4%, 35%) in the post-intervention period. SBHCs that received more active intervention activities saw 9% higher (95% CI: 1%, 21%) vaccine uptake compared to those that received passive intervention.ConclusionThe vaccination promotion program implemented in a school-based setting resulted in higher HPV vaccine uptake in the post-intervention period compared to pre-intervention period, but this increase was not statistically significant. Even so, schools that received more intervention activities for longer periods of time had higher HPV vaccine uptake.     

Acceptability and uptake of HPV vaccine in Argentina before its inclusion in the immunization program: a population-based survey

In Argentina, human papillomavirus (HPV) vaccination was approved in 2006, but not included in the National Immunization Program. In 2008 a mass media campaign was carried out by a cancer Non-Governmental Organization (NGO), but it was stopped due to criticisms about the publicity. In October 2011 the Ministry of Health (MoH) has introduced HPV vaccination in the National Immunization Program. In this context, to assure high HPV vaccine coverage, evidence is needed on factors both associated to vaccine acceptability and uptake. In 2009-2010 we carried out a population-based survey among a representative sample of 1200 women aged 18-49 years from the Metropolitan Area of Buenos Aires. The objective was twofold: first to analyze socio-demographic determinants of women's knowledge on HPV vaccine and secondly, determinants of actual HPV vaccine uptake and acceptability in Argentina after the above-mentioned vaccine advertising shown in mass media in the year 2008. We analyzed vaccine uptake/acceptability separately for women and for their daughters aged 9-15, and willingness to vaccinate one's daughter younger than 9 to receive future HPV vaccination. Results of the 1200 women interviewed, 438 women (36.5%) knew the HPV vaccine and 303 (25%) remembered the mass media advertisement about HPV vaccination. When asked whether she would get vaccinated after having seen/heard the advertisement, around 75% (n=226) of women answered surely/probably yes. No significant differences in socio-demographic characteristics were found among women who would or not get vaccinated. When surveyed, 6 women had been vaccinated. Main reasons for non-vaccination were: "Doctor did not mention/recommend it" (34.1%) and "Vaccine is too expensive" (15.7%). No woman had had their 9-15 year-old daughter vaccinated. Among women who only had at least one daughter under 9 (n=278), 74% answered that they would get their daughter vaccinated if they were pre-adolescents. The conclusion is that, in Argentina, the potential acceptability of the vaccine is high, given that there is acceptance among the professional community, physicians recommend it, and vaccine is affordable.     

Canadian school-based HPV vaccine programs and policy considerations

BackgroundThe National Advisory Committee on Immunization in Canada recommends human papillomavirus (HPV) vaccination for females and males (ages 9–26). In Canada, the HPV vaccine is predominantly administered through publicly funded school-based programs in provinces and territories. This research provides an overview of Canadian provincial and territorial school-based HPV vaccination program administration and vaccination rates, and identifies foreseeable policy considerations.MethodsWe searched the academic and grey literature and contacted administrators of provincial and territorial vaccination programs to compile information regarding HPV vaccine program administration and vaccination rates in Canada’s 13 provincial and territorial jurisdictions.ResultsAs of October 2016, all 13 Canadian jurisdictions vaccinate girls, and six jurisdictions include boys in school-based publicly funded HPV vaccination programs. Eleven jurisdictions administer the HPV vaccine in a two-dose schedule. The quadrivalent vaccine (HPV4) has been the vaccine predominantly used in Canada; however, the majority of provinces will likely adopt the nonavalent vaccine in the future. According to available data, vaccination uptake among females ranged between 46.7% and 93.9%, while vaccination uptake among males (in programs with available data to date) ranged between 75.0% and 87.4%.ConclusionsFuture research and innovation will beneficially inform Canadian jurisdictions when considering whether to administer the nonavalent vaccine, whether to implement a two or one-dose vaccination schedule, and how to improve uptake and rates of completion. The usefulness of standardizing methodologies for collecting and reporting HPV vaccination coverage and implementing a national registry were identified as important priorities.     

Literature review of HPV vaccine delivery strategies: Considerations for school- and non-school based immunization program

School-based vaccination is becoming a more widely considered method of delivering HPV immunizations to an adolescent population; however, many countries do not have experience with delivering adolescent vaccines or school-based programs. This literature review will summarize the experiences from countries implementing non-health facility-based and health facility-based vaccination programs and assess HPV vaccine coverage. In October 2012, a systematic search in PubMed for studies related to the evaluation of national/regional, pilot, or demonstration HPV immunization programs that worked within existing health system yielded nine articles, representing seventeen countries. School-based programs achieved high HPV vaccination coverage rates in 9 to 13-year-old girls across the different studies and geographic locations, suggesting non-health facility-based programs are possible for HPV vaccine introduction. Grade-based, compared to age-based, eligibility criteria may be easier to implement in school settings. More studies are needed to explore the methods to standardize estimates for HPV vaccine coverage so that programs can be appropriately evaluated.     

An update on human papillomavirus vaccine uptake among 11-17 year old girls in the United States: National Health Interview Survey, 2010

Purpose

A 3-dose human papillomavirus (HPV) vaccine is recommended for adolescents to protect against HPV-related cervical and other cancers. The purpose of this study was to provide an update on HPV vaccine uptake among 11–17 year old girls residing in the US.

Methods

Data from the 2010 National Health Interview Survey (NHIS) were obtained to assess HPV vaccination status and its correlates. Multivariate logistic regression analyses were performed to examine HPV vaccine uptake of ≥1 dose and ≥3 doses among all girls, and completion of the 3-dose series among those who initiated (received ≥1 dose) the vaccine.

Results

Overall, 28.9% and 14.2% received ≥1 dose and ≥3 doses of vaccine: 14.5% and 3.0% among 11–12 year old girls, and 34.8% and 18.7% among 13–17 year olds, respectively. Hispanics had higher uptake of ≥1 dose (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.22–2.17) than whites. Having received an influenza shot in the past year and parents’ awareness of the vaccine were significantly associated with receiving ≥1 dose (OR 1.88, 95% CI 1.51–2.33 and OR 16.57, 95% CI 10.95–25.06) and ≥3 doses (OR 1.48, 95% CI 1.13–1.92 and OR 10.60, 95% CI 5.95–18.88). A separate multivariate model based on girls who initiated the vaccine did not identify any significant correlates of 3-dose series completion. Among parents of unvaccinated girls, 60% were not interested in vaccinating their daughters and mentioned three main reasons: “does not need vaccine” (25.5%), “worried about safety” (19.3%) and “does not know enough about vaccine” (16.6%). Of those who were interested, 53.7% would pay $360–$500 for the vaccination, while 41.7% preferred to receive it at a much lower cost or free.

Conclusions

Only 1 out of 3 girls (11–17 years) have received ≥1 dose of HPV vaccine and much less have completed all 3 doses. Strategies should be taken to improve this vaccine uptake among girls, especially those 11–12 year olds, and to educate parents about the importance of vaccination.     

Human papillomavirus (HPV) vaccine uptake and completion at an urban hospital

Background

Despite the benefit of the human papillomavirus (HPV) vaccine in preventing cervical cancer, fewer than half of eligible young women in the United States have initiated the three-vaccine series. Among those who initiate HPV vaccination, large proportions do not complete the three-dose regimen.

Purpose

To evaluate racial and health insurance-related disparities in HPV vaccination.

Methods

We analyzed outpatient claims data for 8069 patients, ages 9-26 years, who had gynecologic visits at the University of Maryland Medical Center outpatient clinic from August 2006 to January 2010.

Results

Thirty-five percent of our sample initiated the vaccine series, including 91% of those ages 9-13. Only 11% of the sample and 33% of the 9-13 age group completed the 3 dose series. A higher proportion of blacks than whites (38% vs. 32%; p < 0.01) initiated, and 11% and 12%, respectively, of each race completed. Lower age was strongly correlated with uptake. After adjustment for insurance, blacks were less than half as likely as whites to complete the series in all age groups, and had 0.35 the odds (95% CI 0.26-0.46) of adherence. The uninsured had much lower race-adjusted odds than insured groups for initiation, but had similar adherence rates. Publicly insured individuals were more likely than the privately insured to complete all 3 doses.

Conclusions

Of the population of gynecologic service seekers seen at our university-based outpatient practice clinics, a significant minority initiate but do not complete the HPV vaccine series. More blacks than whites initiate the series, but similar proportions of the two races complete. Lack of insurance appears to be a major barrier to initiation, despite free vaccination programs.     

Reported adverse events in girls aged 13-16 years after vaccination with the human papillomavirus (HPV)-16/18 vaccine in the Netherlands

In 2009, human papillomavirus (HPV) vaccination was offered to girls born in 1993-1996 in a catch-up campaign, followed in 2010 by the implementation of the vaccination in the National Immunization Programme (NIP) for girls born in 1997. To monitor the tolerability of the 2009 catch-up campaign, we investigated the occurrence of adverse events within 7 days after vaccination with the bivalent HPV vaccine. A total of 6000 girls were asked to participate, including 1500 from each birth cohort from 1993 to 1996. One week after each of the required three successive doses, the participants received by e-mail a Web-based questionnaire focused on local reactions and systemic events. One or more questionnaires were returned by 4248 girls. Any local reaction was reported by 92.1% of the girls after the first dose, 79.4% after the second dose, and 83.3% after the third dose, and 91.7%, 78.7%, and 78.4% reported any systemic event after the three doses, respectively. Pain in the arm was the most frequently reported local reaction, of which 24.0%, 11.7%, and 14.7% was classified as pronounced. Myalgia was the most often reported systemic event. The proportion of local reactions and most systemic events was significantly lower after the second and third dose compared with the first dose (Odds ratio [OR], 0.33-0.76). Older girls reported a higher proportion of adverse events than younger girls. After vaccination with the bivalent HPV vaccine, girls 13-16 years of age reported a high proportion of short-term adverse events. These are maximum estimates and not necessarily caused by the vaccination itself. Although, girls experienced HPV vaccination as painful, no serious or unexpected adverse events were reported. The results of this survey are being communicated to health care workers and the public.     

Human papillomavirus vaccination and Pap testing profile in Manitoba,Canada

Background

Females who receive the human papillomavirus (HPV) vaccine may believe they are protected from developing cervical cancer and no longer require screening. Concern has also been expressed that vaccinated females are those that would be screened regularly. This study assesses the Pap testing behavior of vaccinated and non-vaccinated females.

Methods

For this population-based retrospective cohort study, vaccination and screening registries were linked for 3540 vaccinated females aged 15 years and over and 9592 matched non-vaccinated females. Conditional logistic regression, the Kaplan–Meier method and Cox regression were used to examine the association between vaccination and Pap testing.

Results

Vaccinated females were more likely to have had a Pap test within the year prior to the index date than non-vaccinated females (15–19 years old: OR = 1.38, 95% CI 1.20–1.59; 20+ years old: OR = 2.34, 95% CI 1.98–2.76). In the three-year period after the index date, vaccinated females had a significantly higher cumulative probability of having a Pap test (83.3%) than non-vaccinated females (66.1%). Females who had a Pap test within three years prior to the index date were more likely to have a Pap test after the index date (vaccinated: HR = 5.03, 95% CI 4.65–5.45; non-vaccinated HR = 3.97, 95% CI 3.70–4.24). Being vaccinated had a significant effect on Pap testing (15–19 years old: HR = 1.54, 95% CI 1.39–1.69; 20+ years old: HR = 1.87, 95% CI 1.52–2.31). 80.1% of vaccinated females who had a Pap test prior to the index date also had one subsequent to it, compared to 70.1% for non-vaccinated females. 41.1% of females had not been vaccinated nor had a Pap test.

Conclusion

The majority of vaccinated females continue to participate in screening, and do so at a higher rate than non-vaccinated females. Renewed efforts need to be made to include the large proportion of non–vaccinated, non–screened females in vaccination and/or screening.     

Human papillomavirus vaccine motivators and barriers among community college students: Considerations for development of a successful vaccination program

BackgroundPrevious interventions in colleges to improve human papillomavirus (HPV) vaccination have not been highly successful. Although barriers have been assessed in traditional colleges, less is known about vaccination barriers in community colleges.MethodsWe approached students aged 18–26 years old enrolled at a community college for an in-person semi-structured qualitative interview on HPV vaccination and health, with questions guided by the Theory of Planned Behavior. Data collection took place between April 2015 and December 2015. Thematic analysis techniques were used to analyze the data.ResultsDuring interviews with 19 students, 4 themes emerged, including: general vaccine attitudes, barriers to HPV vaccination, motivators to HPV vaccination, and social influences. Participants felt that vaccines were beneficial, but were concerned about side effects. They felt that getting the HPV vaccine would be inconvenient, and they did not know enough about it to decide. Most would not trust their friends’ opinions, but would want to know about side effects that their vaccinated friends experienced.ConclusionsSuccessful interventions at community colleges should include several components to increase convenience as well as utilize interactive methods to promote HPV vaccine awareness.     

Disparities in parental human papillomavirus (HPV) vaccine awareness and uptake among adolescents

Trends in HPV vaccine awareness among parents of adolescent girls and boys (ages 13–17) and HPV vaccine uptake (≥1 dose) among girls (ages 13–17) were evaluated in Los Angeles County, California. Between 2007 and 2011, parental HPV vaccine awareness increased from 72% to 77% overall, with significant increases among mothers, Latinos, and respondents with daughters and Medi-Cal insured children. In 2011, parents who were male, older, less educated, Asian/Pacific Islander, and had sons remained significantly less likely to be aware. HPV vaccine initiation among daughters nearly doubled from 25% in 2007 to 48% in 2011, and girls who were older, uninsured, and had access-related barriers showed the largest improvements. In 2011, daughters who were younger and who had older and African American parents were at risk for low uptake. Thus, initiatives targeting male and younger adolescents, culturally-relevant information, and access to vaccination may help to reduce identified disparities.     

The study of human papillomavirus (HPV) vaccine uptake from a parental perspective: a systematic review of observational studies in the United States

Despite widespread information about the human papillomavirus (HPV) vaccine, uptake continues to be low (CDC, 2010). HPV vaccine uptake may be maximized by better understanding factors likely to influence parents' decisions to vaccinate their age-recommended children. Previous reviews have summarized barriers and facilitators likely to influence parents' decision to vaccinate their adolescents (mostly daughters) against HPV; however, less attention has been given to summarize and evaluate the methodology. The aim of this study is to systematically review the methodology used in observational studies of HPV vaccine uptake from a parental perspective. A systematic search of Academic Search Premier, CINAHL, ERIC, Medline and PsycInfo to obtain relevant articles after FDA vaccine approval (2006 to present) yielded 446 studies, of which 17 studies were eligible. Results showed the majority of studies were cross-sectional, with random sampling from list-assisted sources being the most common method for data collection. Most studies used convenience samples and relied on parental self-report. Also, the majority of studies explored vaccine initiation, but only a few explored regimen completion and timely completion of vaccine regimen. Given that the effectiveness of the HPV vaccine is based on established recommendations for a three dose regimen within a timely interval, studies on factors likely to influence regimen completion and timely completion of regimen are essential to maximize the effectiveness and public health benefits of the vaccine. Research with more diverse samples, better and increased use of random sampling techniques, and the use of precise and objective measures of vaccine uptake to supplement parental self-report, is necessary to reduce selection and information biases in future studies. Studies to inform on factors likely to influence parents' decisions to vaccinate their sons against HPV are also needed.     

Cost-effectiveness of a tetravalent human papillomavirus vaccine in Germany

Aim  Clinical trials have demonstrated the efficacy of the tetravalent human papillomavirus (HPV) vaccination in the prevention of cervical cancer and genital warts associated with HPV types 6, 11, 16 and 18. We used an empirically calibrated Markov cohort model of the natural history of HPV to assess the cost-effectiveness of the vaccine administered to 12-year-old girls alongside existing cervical screening programmes in Germany. Subjects and methods  The model estimated cervical cancer (CC), cervical intraepithelial neoplasia (CIN) and genital wart lifetime risks and total lifetime health care costs, life years gained and quality-adjusted life years (QALY) gained. The analysis was conducted from the perspective of the German health care payer. Results  In the base case (considering a lifetime duration of protection and 100% efficacy) it was estimated that 2,835 cervical cancer cases and 679 deaths could be prevented among a cohort of 400,000, at an incremental cost per QALY gained of 10,530 €. A total of 120 girls needed to be vaccinated to prevent 1 case of CC. Cost-effectiveness is sensitive to a duration of protection of less than 20 years and to the discount rate for costs and benefits. Conclusion  A policy of vaccinating adolescent girls has been recommended by the German Standing Committee on Vaccinations. This study has demonstrated that such a policy is cost-effective based on thresholds of cost-effectiveness that apply in Germany.     

Effectiveness of a universal vaccination program with an HPV quadrivalent vaccine in young Brazilian women

We examined human papillomavirus (HPV) vaccine effectiveness in a nationwide sample of women aged 16 to 25 years who utilized the public health system in Brazil. This was a cross-sectional, multicentric survey conducted between September 2016 and November 2017 (POP-Brazil Study). A total of 5,945 young adult women were recruited from 119 public primary care units from all 27 federative units of Brazil by trained health professionals. The participants participated in a face-to-face interview and provided biological samples for genital HPV analysis. HPV genotyping was performed using a Linear Array HPV genotyping test in a central laboratory. Sampling weights were applied to the data. Overall, 11.92% (95% CI 10.65, 13.20) of the participants reported having been vaccinated. The frequency of vaccination was highest in 16- to 17-year-old women, with a decreasing vaccination rate with increasing age, and vaccinated women were more likely to belong to the high socioeconomic status group. The use of a quadrivalent vaccine decreased the HPV types 6, 11, 16, and 18 by 56.78%, from 15.64% in unvaccinated women to 6.76% in vaccinated women (P < 0.01), even after adjustment for age. Those who received the vaccine had lower HPV 16 (2.34% in vaccinated vs 8.91% in unvaccinated, P < 0.01) and 6 rates (2.06% vs 5.77%, P < 0.01). Additionally, a higher rate of high-risk HPV types other than HPV 16 and 18 (40.47% in vaccinated vs 32.63% in unvaccinated, P < 0.01) was observed. In conclusion, the results of this study support the effectiveness of HPV vaccination in Brazil. Continuous surveillance must be assured to monitor the HPV infection rate in the vaccination era.     

Factors associated with HPV vaccine uptake in teenage girls: a systematic review

Background

Since 2006 Human papillomavirus (HPV) vaccination has become available to adolescent girls and women in an increasing number of countries, to protect against the virus causing cervical cancer. The vaccine series is offered in three doses over 6 months, and this study aimed to identify factors associated with initiation and/or completion of the 3 dose series in (pre-) adolescent girls. Previous studies have considered intention to vaccinate rather than actual vaccination uptake.

Methods

A systematic search of Medline, Medline in process, Embase and CINAHL, from 2006 to March 2011 for articles related to HPV-vaccine uptake among adolescent girls and factors potentially associated with uptake yielded 25 studies.

Results

The majority of studies were surveys or retrospective reviews of data, only 5 studies reported data on program completion. Most were conducted in the United States (20/25). Higher vaccine uptake was associated with having health insurance, of older age, receipt of childhood vaccines, a higher vaccine related knowledge, more healthcare utilization, having a healthcare provider as a source of information and positive vaccine attitudes. In US settings, African American girls were less likely to have either initiated or completed the three dose vaccination series.

Conclusions

HPV vaccination programs should focus on narrowing disparities in vaccine receipt in ethnic and racial groups and on providing correct information by a reliable source, e.g. healthcare providers. School-based vaccination programs have a high vaccine uptake. More studies are required to determine actual vaccine course completion and factors related to high uptake and completion, and information from a broader range of developed and developing settings is needed.     

Completion and timing of the three-dose human papillomavirus vaccine series among adolescents attending school-based health centers in Oregon

Objective

Many adolescents do not complete the 3-dose human papillomavirus vaccine series in the recommended time frame, or at all. Given the challenges of administering a multi-dose vaccine to adolescents, especially those in vulnerable populations, we evaluated completion of the human papillomavirus vaccine series in 19 of Oregon's school-based health centers.

Methods

Among persons aged 0-17 who initiated the human papillomavirus vaccine series at a study school-based health center in 2007, we identified all subsequent human papillomavirus doses administered at the school-based health centers, or found in Oregon's immunization information system, in 2007-2008. We describe the proportion completing the vaccine series and mean intervals between doses, stratified by age, race, and insurance status.

Results

Four hundred fifty persons initiated the human papillomavirus series in 2007. By December 2008, 51% of these had received all 3 doses. Series completion increased significantly with age, differed significantly between race groups (highest among white persons (56%); lowest among black persons (38%)), and did not differ significantly by insurance status. Mean intervals between doses did not differ significantly by race or insurance status.

Conclusions

Even in challenging conditions, school-based health centers provide excellent preventive care to vulnerable youth. These results support the importance of maintaining and expanding school-based health center access in vulnerable adolescent populations.     

Human papillomavirus vaccination coverage among Greek higher education female students and predictors of vaccine uptake

One of the biggest public health measures to prevent HPV infection, and consequently, cervical cancer, is the HPV vaccine. Greece introduced HPV vaccines to its National Vaccination Program in 2008.