Human papillomavirus vaccine uptake in boys and girls in a school-based vaccine delivery program in Prince Edward Island,Canada

BackgroundIn 2013, Prince Edward Island was the first province to introduce HPV vaccine universally to grade six boys in a school-based program. Because uptake rates in boys are unknown in this type of vaccination program, uptake of HPV vaccination in boys was measured and compared with uptake rates in girls and then analyzed with factors such as county, urban–rural location of the school, and school board to identify where the vaccine program could be improved.MethodsHPV vaccination records from the provincial childhood immunization registry in PEI were merged with Department of Education data containing all grade six girls and boys in PEI. Vaccine uptakes between years and between sexes were compared using two sample tests of proportions. Logistic regression modeling which accounted for the hierarchical nature of the data was used to analyze associations between factors and uptake rates.ResultsAlthough uptake was high in boys and girls, a significantly greater proportion of girls (85%) received all three doses of the HPV vaccine compared to boys (79%; p = 0.004). The odds of grade six girls being fully vaccinated for HPV were 1.5 times greater than of grade six boys, and the odds of students in the English Language School Board receiving all three doses were more than twice as great as the odds of French Language School Board students.ConclusionsHPV vaccination for boys in PEI has had a successful launch, almost reaching the Canadian Immunization Committee recommendations of >80% for the early years of a program. PEI has a highly organized Public Health Nursing program that is involved in all childhood and school-based vaccinations in PEI and in this context very high coverage rates were obtained. Areas to target for improving uptake include the boys and the students in the French Language School Board.     

HPV vaccination coverage of teen girls: The influence of health care providers

BackgroundBetween 2010 and 2014, the percentage of 13–17 year-old girls administered ≥3 doses of the human papilloma virus (HPV) vaccine (“fully vaccinated”) increased by 7.7 percentage points to 39.7%, and the percentage not administered any doses of the HPV vaccine (“not immunized”) decreased by 11.3 percentage points to 40.0%.ObjectiveTo evaluate the complex interactions between parents’ vaccine-related beliefs, demographic factors, and HPV immunization status.MethodsVaccine-related parental beliefs and sociodemographic data collected by the 2010 National Immunization Survey-Teen among teen girls (n = 8490) were analyzed. HPV vaccination status was determined from teens’ health care provider (HCP) records.ResultsAmong teen girls either unvaccinated or fully vaccinated against HPV, teen girls whose parent was positively influenced to vaccinate their teen daughter against HPV were 48.2 percentage points more likely to be fully vaccinated. Parents who reported being positively influenced to vaccinate against HPV were 28.9 percentage points more likely to report that their daughter's HCP talked about the HPV vaccine, 27.2 percentage points more likely to report that their daughter's HCP gave enough time to discuss the HPV shot, and 43.4 percentage points more likely to report that their daughter's HCP recommended the HPV vaccine (p < 0.05). Among teen girls administered 1–2 doses of the HPV vaccine, 87.0% had missed opportunities for HPV vaccine administration.ConclusionResults suggest that an important pathway to achieving higher ≥3 dose HPV vaccine coverage is by increasing HPV vaccination series initiation though HCP talking to parents about the HPV vaccine, giving parents time to discuss the vaccine, and by making a strong recommendation for the HPV. Also, HPV vaccination series completion rates may be increased by eliminating missed opportunities to vaccinate against HPV and scheduling additional follow-up visits to administer missing HPV vaccine doses.     

Age at HPV vaccine initiation and completion among US adolescent girls: Trend from 2008 to 2012

ObjectiveTo examine the trend of provider-verified HPV vaccine initiation (≥1 dose) and completion (≥3 doses) among adolescent girls at the Advisory Committee on Immunization Practices (ACIP) recommended age (11–12 years).MethodsWe analyzed National Immunization Survey of Teens 2008–2012 data and examined the trend of provider-verified HPV vaccine initiation and completion among <13 year old girls.ResultsData on age at HPV vaccine initiation and completion were available for 24,466 and 15,972 girls, respectively. The weighted proportion of girls who initiated the vaccine at <13 years of age was 14.1%, 24.1%, 35.9%, 47.7% and 55.9% in 2008, 2009, 2010, 2011 and 2012, respectively (p for trend <.001). The similar trend was also observed for mean age at HPV vaccine initiation and completion (p < .001).ConclusionsAdditional efforts are needed to increase HPV vaccine uptake among adolescent girls as only half of them receive this vaccine at ACIP recommended age.     

Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls

BackgroundHPV vaccination is universally recommended for boys and girls, yet vaccination rates remain low nationwide.MethodsWe conducted a provider-focused intervention that included repeated contacts, education, individualized feedback, and strong quality improvement incentives to raise HPV vaccination rates at two federally qualified community health centers. To estimate the effectiveness of the intervention, rates of initiation of vaccination, and completion of the next needed HPV vaccination (dose 1, 2 or 3) among boys and girls ages 11–21 were compared at baseline and two follow-up periods in two intervention health centers (n  4093 patients) and six control health centers (n  9025 patients). We conducted multivariable logistic regression accounting for clustering by practice.ResultsGirls and boys in intervention practices significantly increased HPV vaccine initiation during the active intervention period relative to control practices (girls OR 1.6, boys OR 11; p < 0.001 for both). Boys at intervention practices were also more likely to continue to initiate vaccination during the post-intervention/maintenance period (OR 8.5; p < 0.01). Girls and boys at intervention practices were more also likely to complete their next needed HPV vaccination (dose 1, 2 or 3) than those at control practices (girls OR 1.4, boys OR 23; p < 0.05 for both). These improvements were sustained for both boys and girls in the post-intervention/maintenance period (girls OR 1.6, boys OR 25; p < 0.05 for both).ConclusionsProvider-focused interventions including repeated contacts, education, individualized feedback, and strong quality improvement incentives have the potential to produce sustained improvements in HPV vaccination rates.     

Human papillomavirus vaccination and risk of autoimmune diseases: A large cohort study of over 2 million young girls in France

BackgroundWhether human papillomavirus (HPV) vaccination could induce or trigger autoimmune diseases (AID) has been questioned, and potentially contributes to low immunization coverage in France. This study evaluated the association between HPV vaccination and the risk of AID using routinely collected data sources.MethodsAll girls aged 13–16 years between 2008 and 2012, covered by the general health insurance scheme and without history of HPV vaccination or AID, were included and followed using French nationwide databases. Fourteen neurological, rheumatological, haematological, gastrointestinal or endocrine AID, were identified from ICD-10 codes allocated to hospital stays and long-term illnesses or by marker drugs. Their incidence was compared between girls exposed and non-exposed to HPV vaccination, using a Cox model adjusted for inclusion year, geographic area, socio-economic indicators, healthcare use level and other immunizations.ResultsAmong 2,252,716 girls, 37% received HPV vaccine and 4,096 AID occurred during a mean follow-up time of 33 months. The incidence of AID was not increased after exposure to HPV vaccination, except for Guillain-Barré syndrome (GBS) (incidence rate of 1.4 among exposed [20 cases] versus 0.4 per 100,000 PY among unexposed [23 cases]; adjusted HR: 3.78 [1.79–7.98]). This association persisted across numerous sensitivity analyses and was particularly marked in the first months following vaccination. Under the hypothesis of a causal relationship, this would result in 1–2 GBS cases attributable to HPV vaccine per 100,000 girls vaccinated.ConclusionsOur study provides reassuring results regarding the risk of AID after HPV vaccination, but an apparently increased risk of GBS was detected. Further studies are warranted to confirm this finding.     

The contagious nature of a vaccine scare: How the introduction of HPV vaccination lifted and eroded MMR vaccination in Denmark

BackgroundHuman papillomavirus (HPV) vaccine coverage was high in Denmark until it plunged following negative media coverage. We examined whether the decline in HPV vaccination undermined uptake of another adolescent vaccine, measles, mumps and rubella (MMR).MethodsThe Danish national health register provided data on uptake of MMR vaccine dose 2 (at age 13) for children born from 1991 to 2003 (n = 827,716). The primary exposure variable comprised three time periods: before HPV vaccine introduction, during high HPV vaccine coverage, and after the drop in HPV vaccine coverage. To examine the effect of HPV vaccination on MMR2 uptake, we estimated MMR2 uptake by age 13 using logistic regression, controlling for gender, birth month, birth year, and maternal education.FindingsMMR2 vaccination coverage was high for both girls and boys (86% and 85%) in 2009. Following the introduction of HPV vaccine for girls in 2009, MMR2 coverage increased for girls even as it decreased for boys (gender gap 4·6 percentage points, 95% CI 4·3 to 4·8). Coverage with MMR2 for girls continued to be high over the following four years, and almost all girls (91%) who received MMR2 vaccination also received HPV1 vaccination within the same week. When negative media coverage led to a decline in HPV vaccination, MMR2 uptake for girls also declined. By 2015, MMR2 coverage for girls and boys had become similar again (80% and 79%). Families with the highest level of maternal education showed the strongest decline in MMR2 coverage for girls.InterpretationConcomitant vaccine provision can increase overall vaccine uptake. However, reduced demand for one vaccine may reduce concomitant vaccination and undermine resiliency of a country’s vaccination program.FundingDrs. Gørtz and Ejrnæs appreciate generous funding from the Novo Nordisk Foundation (grant no. NNF17OC0026542) and from the Danish National Research Foundation through its grant (DNRF-134) to the Center for Economic Behavior and Inequality (CEBI) at the University of Copenhagen.     

Cost-effectiveness of HPV vaccination in the context of high cervical cancer incidence and low screening coverage

BackgroundEstonia has high cervical cancer incidence and low screening coverage. We modelled the impact of population-based bivalent, quadrivalent or nonavalent HPV vaccination alongside cervical cancer screening.MethodsA Markov cohort model of the natural history of HPV infection was used to assess the cost-effectiveness of vaccinating a cohort of 12-year-old girls with bivalent, quadrivalent or nonavalent vaccine in two doses in a national, school-based vaccination programme. The model followed the natural progression of HPV infection into subsequent genital warts (GW); premalignant lesions (CIN 1–3); cervical, oropharyngeal, vulvar, vaginal and anal cancer. Vaccine coverage was assumed to be 70%. A time horizon of 88 years (up to 100 years of age) was used to capture all lifetime vaccination costs and benefits. Costs and utilities were discounted using an annual discount rate of 5%.ResultsVaccination of 12-year-old girls alongside screening compared to screening alone had an incremental cost-effectiveness ratio (ICER) of €14,007 (bivalent), €14,067 (quadrivalent) and €11,633 (nonavalent) per quality-adjusted life-year (QALY) in the base-case scenario and ranged between €5367–21,711, €5142–21,800 and €4563–18,142, respectively, in sensitivity analysis. The results were most sensitive to changes in discount rate, vaccination regimen, vaccine prices and cervical cancer screening coverage.ConclusionVaccination of 12-year-old girls alongside current cervical cancer screening can be considered a cost-effective intervention in Estonia. Adding HPV vaccination to the national immunisation schedule is expected to prevent a considerable number of HPV infections, genital warts, premalignant lesions, HPV related cancers and deaths. Although in our model ICERs varied slightly depending on the vaccine used, they generally fell within the same range. Cost-effectiveness of HPV vaccination was found to be most dependent on vaccine cost and duration of vaccine immunity, but not on the type of vaccine used.     

HPV vaccination and risk of chronic fatigue syndrome/myalgic encephalomyelitis: A nationwide register-based study from Norway

BackgroundVaccination has been suggested to be involved in the aetiology of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). HPV vaccine was introduced in the Norwegian Childhood Immunisation Programme and offered 12 year old girls from 2009. We studied the association between HPV vaccination and risk of CFS/ME and also assessed medical history in relation to both risk of CFS/ME and HPV vaccine uptake.MethodsIndividual data from national registries, including the Norwegian Population Registry, the Norwegian Patient Registry and the Norwegian Immunisation Registry were linked using the unique personal identification number. Yearly incidence rates of CFS/ME for 2009–2014 were calculated among the 824,133 boys and girls, aged 10–17 living in Norway during these 6 years. A total of 176,453 girls born 1997–2002 were eligible for HPV vaccination and included in further analyses. Hazard ratios (HRs) of CFS/ME were estimated using Cox regression. Risk differences (RDs) of vaccine uptake were estimated with binomial regression.ResultsA similar yearly increase in incidence rate of CFS/ME was observed among girls and boys, IRR = 1.15 (95% confidence interval (CI) 1.10–1.19) and 1.15 (95% CI 1.09–1.22), respectively. HPV vaccination was not associated with CFS/ME, HR = 0.86 (95% CI 0.69–1.08) for the entire follow-up period and 0.96 (95% CI 0.64–1.43) for the first two years after vaccination. The risk of CFS/ME increased with increasing number of previous hospital contacts, HR = 5.23 (95% CI 3.66–7.49) for 7 or more contacts as compared to no contacts. Girls with 7 or more hospital contacts were less likely to be vaccinated than girls with no previous hospital contacts, RD = −5.5% (95% CI −6.7% to −4.2%).ConclusionsNo indication of increased risk of CFS/ME following HPV vaccination was observed among girls in the first 6 birth cohorts offered HPV vaccine through the national immunisation programme in Norway.     

Using the 4 Pillars™ Practice Transformation Program to increase adolescent human papillomavirus,meningococcal, tetanus-diphtheria-pertussis and influenza vaccination

ObjectivesTo report the results of an intervention using the 4 Pillars™ Practice Transformation Program (4 Pillars™ Program) to increase adolescent vaccinations including human papillomavirus vaccine (HPV) and influenza vaccines, which remain underutilized in this population.Study designEleven pediatric and family medicine practices, previously control sites from a randomized controlled cluster trial, with ≥50 adolescent patients participated. The 4 Pillars™ Program was the foundation of the intervention. De-identified demographic, office visit and vaccination data were derived from electronic medical record extractions for patients whose date of birth was 4/1/1997 to 4/1/2004 (ages 11–17 years at baseline). Vaccination rates for HPV, influenza, tetanus-pertussis-diphtheria (Tdap) and meningococcal (MenACWY) vaccines were determined for all eligible patients pre- and post intervention (i.e., vaccination rates on 4/1/2015 and 4/30/2016).ResultsAmong 9473 patients ages 11–17 years at baseline (4/1/2015), mean pre-intervention vaccination rates for HPV initiation and completion, meningococcal, Tdap and influenza vaccines were below national levels. Rates increased significantly post intervention (P < 0.001) for HPV initiation which increased 17.1 percentage points (PP) from 51.4%; HPV completion increased 14.8 PP from 30.7%, meningococcal vaccine uptake increased 16.6 PP from 79.1%, Tdap vaccine uptake increased 14.6 PP from 76.9%. Influenza vaccine uptake did not increase significantly (2.3 PP from 40.1%). In the regression using generalized estimating equations, odds of vaccination were higher for younger, non-white adolescents for all vaccines; being in a smaller practice decreased the odds of Tdap vaccination but increased the odds of influenza vaccination.ConclusionClinically and statistically significant improvements in HPV series initiation and completion, and meningococcal and Tdap vaccinations were observed in primary care practices implementing the 4 Pillars™ Practice Transformation Program.Clinical Trial Registry Number: NCT02165722.     

Clinician knowledge,clinician barriers,and perceived parental barriers regarding human papillomavirus vaccination: Association with initiation and completion rates

PurposeWe tested the hypothesis that clinician knowledge, clinician barriers, and perceived parental barriers relevant to the human papillomavirus (HPV) vaccination account for the variation in vaccine delivery at the practice-site level.MethodsWe conducted a survey from October 2015 through January 2016 among primary care clinicians (n = 280) in a 27-county geographic region to assess clinician knowledge, clinician barriers, and perceived parental barriers regarding HPV vaccination. Primary care clinicians included family medicine physicians, general pediatricians, and family and pediatric nurse-practitioners. We also used the Rochester Epidemiology Project to measure HPV vaccination delivery. Specifically we used administrative data to measure receipt of at least one valid HPV vaccine dose (initiation) and receipt of three valid HPV vaccine doses (completion) among 9–18 year old patients residing in the same 27-county geographic region. We assessed associations of clinician survey data with variation in vaccine delivery at the clinical site using administrative data on patients aged 9–18 years (n = 68,272).ResultsConsistent with our hypothesis, we found that greater knowledge of HPV and the HPV vaccination was associated with higher rates of HPV vaccination initiation (Incidence rate ratio [IRR] = 1.05) and completion of three doses (IRR = 1.28). We also found support for the hypothesis that greater perceived parental barriers to the HPV vaccination were associated with lower rates of initiation (IRR = 0.94) and completion (IRR = 0.90). These IRRs were statistically significant even after adjustment for site-level characteristics including percent white, percent female, percent ages 9–13, and percent with government insurance or self-pay at each site.ConclusionsClinician knowledge and their report of the frequency of experiencing parental barriers are associated with HPV vaccine delivery rates—initiation and completion. Higher measures of knowledge correlated with higher rates. Fewer perceived occurrences of parental barriers correlated with lower rates. These data can guide efforts to improve HPV vaccine delivery in clinical settings.     

From non school-based,co-payment to school-based,free Human Papillomavirus vaccination in Flanders (Belgium): A retrospective cohort study describing vaccination coverage,age-specific coverage and socio-economic inequalities

School-based, free HPV vaccination for girls in the first year of secondary school was introduced in Flanders (Belgium) in 2010. Before that, non school-based, co-payment vaccination for girls aged 12–18 was in place. We compared vaccination coverage, age-specific coverage and socio-economic inequalities in coverage – 3 important parameters contributing to the effectiveness of the vaccination programs – under both vaccination systems.We used retrospective administrative data from different sources. Our sample consisted of all female members of the National Alliance of Christian Mutualities born in 1995, 1996, 1998 or 1999 (N = 66,664). For each vaccination system we described the cumulative proportion HPV vaccination initiation and completion over time. We used life table analysis to calculate age-specific rates of HPV vaccination initiation and completion. Analyses were done separately for higher income and low income groups.Under non school-based, co-payment vaccination the proportions HPV vaccination initiation and completion slowly rose over time. By age 17, the proportion HPV vaccination initiation/completion was 0.75 (95% CI 0.74–076)/0.66 (95% CI 0.65–0.67). The median age at vaccination initiation/completion was 14.4 years (95% CI 14.4–14.5)/15.4 years (95% CI 15.3–15.4). Socio-economic inequalities in coverage widened over time and with age. Under school-based, free vaccination rates of HPV vaccination initiation were substantially higher. By age 14,the proportion HPV vaccination initiation/completion was 0.90 (95% CI 0.90–0.90)/0.87 (95% CI 0.87–0.88). The median age at vaccination initiation/completion was 12.7 years (95% CI 12.7–12.7)/13.3 years (95% CI 13.3–13.3). Socio-economic inequalities in coverage and in age-specific coverage were substantially smaller.     

Trends and predictors of HPV vaccination among U.S. College women and men

BackgroundHPV vaccination was recommended by the Advisory Committee on Immunization Practices for young adult females in 2006 and males in 2011 to prevent HPV-related cancers and genital warts. As this prevention mechanism continues to disseminate, it is necessary to monitor the uptake of this vaccine. College students represent an important population for HPV vaccination efforts and surveillance due to increased risk for HPV infection and representing a priority population for catch-up HPV vaccination. The purpose of this study was to assess the trends in HPV vaccination among U.S. college females and males from 2009 to 2013, and to examine whether predictors for HPV vaccination differ between males and females.MethodsThe National College Health Assessment-II (Fall 2009–2013) was used to assess trends in HPV vaccination using hierarchical logistic regression across genders and demographics. Data from 2013 were used to assess demographic variables associated with HPV vaccination for males and females, respectively. The analysis was conducted in 2015.ResultsFemales had nearly double the rates of HPV vaccination compared to males over time. All demographic sub-groups had significant increases in vaccine rates over time, with select male sub-groups having more accelerated increases (e.g., gay). Young age (18–21 vs. 22–26 years) was a significant predictor for HPV vaccination among males and females, while race/ethnicity was a predictor of vaccination among females only.ConclusionsThese findings identified specific demographic sub-groups that need continued support for HPV vaccination. Campus health centers may be rational settings to facilitate clinical opportunities for HPV vaccination among unvaccinated college students.     

A novel measles outbreak control strategy in the Netherlands in 2013–2014 using a national electronic immunization register: A study of early MMR uptake and its determinants

BackgroundDuring a large measles outbreak in the Netherlands in 2013–2014, infants aged 6–14 months living in municipalities with low (<90%) measles-mumps-rubella (MMR) coverage were individually invited for an early MMR using the national electronic immunization register, Præventis. We estimated uptake of early MMR prior to and during the 2013–2014 outbreak and assessed determinants for early MMR vaccination.MethodsWe obtained vaccination records from Præventis, and defined early MMR as vaccination before 415 days (13 months) of age. A multi-level multivariable logistic regression model, restricted to infants with three diphtheria-pertussis-tetanus-polio (DPTP) vaccinations was used to examine the association between early MMR uptake and sex, parents’ country of birth, socioeconomic status (SES; at postcode level) and voting proportions for the Reformed Political Party (SGP; at municipal level), used as a proxy for religious objections towards vaccination.ResultsIn the 29 municipalities with low MMR coverage, uptake of early MMR was 0.5–2.2% prior to the outbreak. Between July 2013 and March 2014, 5,800 (57%) invited infants received an early MMR. Among infants with three DPTP, 70% received an early MMR. Only 1% of infants without prior DPTP received an early MMR. Lower early MMR uptake was associated with a higher SGP voter-ship (OR 0.89 per 5% increase, 95%CI 0.83–0.96), parents’ with unknown country of birth (OR 0.66 95%CI 0.47–0.93) and compared with very high SES, high SES had significantly lower early MMR uptake (OR 0.66 95%CI 0.50–0.87).DiscussionThis is the first study describing use of Præventis during an outbreak and to assess determinants of early MMR uptake. More than half of invited infants obtained an early MMR. SES, parents’ with unknown country of birth and religious objections towards vaccination were found to be associated with lower early MMR uptake. In future outbreaks, these determinants could be used to tailor intervention strategies.     

Association of both consistency and strength of self-reported clinician recommendation for HPV vaccination and HPV vaccine uptake among 11- to 12-year-old children

PurposeWe tested the hypotheses that consistency and strength of clinician recommendation of the human papillomavirus (HPV) vaccination would be associated with vaccine delivery rates.MethodsFrom October 2015 through January 2016, we conducted a survey of primary care clinicians (n = 227) in Southeastern Minnesota to evaluate clinician behaviors regarding HPV vaccination. The survey response rate was 41.0% (51 clinical sites). We used the Rochester Epidemiology Project, a clinical data linkage infrastructure, to ascertain clinical site-level HPV vaccination rates. We examined associations of clinician self-reports of both the consistency and strength of their recommendations for HPV vaccination for patients aged 11–12 years (n = 14,406) with site-level vaccination rates.ResultsThe majority of clinicians reported consistently (always or usually) recommending the HPV vaccine to females (79.0%) and to males (62.2%); 71.9% of clinicians reported strongly recommending the vaccine to females while 58.6% reported strongly recommending to males. Consistency and strength of recommending the HPV vaccine was significantly higher among those practicing in pediatrics and board certified in pediatrics compared to family medicine. Higher rates of initiation (1 dose) [Incidence Rate Ratio (IRR) = 1.05; 95% CI (1.01–1.09)] and completion (3 doses) [IRR = 1.08; 95% CI (1.02–1.13)] were observed among clinical sites where, on average, clinicians more frequently reported always or usually recommending the vaccine for females compared to sites where, on average, clinicians reported recommending the vaccine less frequently. Similarly, higher rates of initiation [IRR = 1.03; 95% CI (1.00–1.06)] and completion [IRR = 1.04; CI (1.00, 1.08)] were observed among sites where clinicians reported strongly recommending the vaccine to females more frequently compared to sites where, on average, clinicians reported strongly recommending the HPV vaccine less frequently; similar associations were observed for male initiation [IRR = 1.05; CI (1.02,1.08)] and completion [IRR = 1.05; 95% CI (1.01, 1.09)].ConclusionsConsistency and strength of HPV vaccination recommendation was associated with higher vaccination rates.     

Facteurs associés à la vaccination HPV chez les jeunes filles de 13 à 14 ans dans le canton de Genève,Suisse

BackgroundSchool vaccination programs against human papilloma virus (HPV) have been implemented in most Western countries. Only a few studies have investigated socio-economic factors related to school-based vaccination.MethodA cross-sectional study was conducted using the vaccination cards of 1158 randomized girls aged 13 to 14 years enrolled in the public schools of the canton of Geneva. Several other socio-economic variables (nationality, socio-professional category and marital status of the parents) were collected.ResultsImmunization coverage for three doses of HPV vaccine was 56%. After having controlled the covariates, Portuguese adolescents (adjusted OR [95% CI]: 4.18 [1.76–9.92]), adolescents whose mothers were workers (adjusted OR [95% CI]: 1.91 [1.38–2.65]) or married (adjusted OR [95% CI]: 1.44 [1.06–1.98]) showed significantly higher immunization rates than Swiss adolescents or those whose mothers’ socio-professional category was senior manager or executive.ConclusionThis study shows that the HPV vaccine coverage is not yet optimal in Geneva and varies significantly according to the socio-economic status, thus better promotion of HPV vaccination for certain target groups must be implemented.     

Relationship status impacts primary reasons for interest in the HPV vaccine among young adult women

IntroductionThe HPV vaccine prevents HPV-related cancers and genital warts, which cause significant morbidity and mortality in the US. The vaccine is targeted toward 11–12 year old males and females, but is recommended for “catch-up” vaccination until age 26 for females. Young adult females (18–26 years) represent a unique group that may face distinct barriers to HPV vaccination, one of which is relationship status. The purpose of this study was to assess how relationship status impacts interest in HPV vaccination and primary reasons for non-vaccination among 18–26 year old young adult women.MethodsThe National Health Interview Survey 2010 was examined among unvaccinated females, 18–26 years (N = 1457). A survey-weighted logistic regression analysis with conversion to prevalence ratios assessed how interest in the HPV vaccine (yes/no) was influenced by relationship status (married, living with a partner, other, single) among young adult women. A Rao-Scott chi-square test examined differences between primary reasons for non-vaccination and relationship status among HPV vaccine uninterested women.ResultsAmong unvaccinated women, 31.4% were interested in the HPV vaccine. Women who were living with a partner (PR = 1.45, 95%CI 1.06–1.90) and single (PR = 1.42, 95%CI 1.11–1.76) were significantly more likely than married women to be interested in the HPV vaccine, while controlling for socio-demographic and other known risk factors. Additionally, primary reasons for non-vaccination differed based on relationship status among uninterested women (p < 0.01). Women who were married were more likely to cite not needing the vaccine compared to never married women (p < 0.05).ConclusionRelationship status in young adulthood impacts HPV vaccine interest and decision-making among a national sample of women. Primary reasons for non-interest in the vaccine may be shaped by attitudes and knowledge about the HPV vaccine that differ by relationship status. Future research is needed to elucidate ways to overcome relationship status as a barrier to HPV vaccination.     

Provider communication and HPV vaccination: The impact of recommendation quality

BackgroundReceiving a healthcare provider's recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents.MethodsIn 2014, we conducted a national, online survey of 1495 parents of 11–17-year-old adolescents. Parents reported whether providers endorsed HPV vaccination strongly, encouraged same-day vaccination, and discussed cancer prevention. Using an index of these quality indicators, we categorized parents as having received no, low-quality, or high-quality recommendations for HPV vaccination. Separate multivariable logistic regression models assessed associations between recommendation quality and HPV vaccine initiation (≥1 dose), follow through (3 doses, among initiators), refusal, and delay.ResultsAlmost half (48%) of parents reported no provider recommendation for HPV vaccination, while 16% received low-quality recommendations and 36% received high-quality recommendations. Compared to no recommendation, high-quality recommendations were associated with over nine times the odds of HPV vaccine initiation (23% vs. 74%, OR = 9.31, 95% CI, 7.10–12.22) and over three times the odds of follow through (17% vs. 44%, OR = 3.82, 95% CI, 2.39–6.11). Low-quality recommendations were more modestly associated with initiation (OR = 4.13, 95% CI, 2.99–5.70), but not follow through. Parents who received high- versus low-quality recommendations less often reported HPV vaccine refusal or delay.ConclusionsHigh-quality recommendations were strongly associated with HPV vaccination behavior, but only about one-third of parents received them. Interventions are needed to improve not only whether, but how providers recommend HPV vaccination for adolescents.     

Effectiveness of HPV vaccines against genital warts in women from Valencia,Spain

ObjectivesTo assess the effectiveness of the HPV vaccines in preventing genital warts in young women.DesignPopulation-based study using health databases.SettingValencian Community (Spain).ParticipantsAll girls and women aged 14–19 years who were registered in the Valencian Community between January 2009 and December 2014 (n = 279,787).Main outcome measuresIncident cases of genital warts were defined as the first activation of diagnosis code ICD-9-CM 078.11 (Condyloma acuminatum) in primary care and outpatient clinics during the study period.ResultsThere were 612 cases of genital warts. The overall incidence rate was 75.8/100,000 person-years (95% CrI 69.7–81.8). There was a decrease in genital warts when female candidates to be vaccinated with quadrivalent HPV vaccine reached the age of 18 (in 2012), compared to previous years. Incidence of genital warts in unvaccinated women and those who received the bivalent vaccine was higher than in girls and women who received the quadrivalent HPV vaccine. The effectiveness of a three-dose regimen of the quadrivalent HPV vaccine was 77% (95 CrI: 66–85%), whereas that of a single dose was 61% (95 CrI: 20–87%). No effectiveness was seen with a full vaccination course with the bivalent HPV vaccine.ConclusionsThree doses of the quadrivalent HPV vaccine were effective against genital warts in our population. Moreover, with low vaccine coverage the incidence of genital warts decreased only in the vaccinated.