HPV vaccination initiation, completion rates remain low among teen girls

DENVER ¡ª Less than half of a cohort of teen girls in the US had initiated the human papillomavirus series, and just over half of girls who started the series completed it, according to findings presented here at the Pediatric Academic Societies¡¯ Annual Meeting 2011.

Christina G. Dorell, MD, MPH, of the National Center for Immunization and Respiratory Diseases at CDC, said that 40.5% of girls had received ¡Ý1 HPV vaccination dose, and that the completion rate among girls who initiated the series was 53.5%.

The study involved 18,228 girls aged 13 to 17 years from the 2008 and 2009 National Immunization Survey-Teen. Provider recommendation, parental factors and race played a role in initiation and completion rates.

A recommendation from a provider was the factor most strongly linked to initiating the series, according to Dorell (prevalence ratio 2.63; 95% CI, 2.44-2.86). ¡°For many vaccines in general, provider recommendation is strongly associated with initiation,¡± Dorell told Infectious Diseases in Children. ¡°We also saw that with the HPV vaccine series.¡±

Dorell noted that one of the strongest pushes for parents to vaccinate their kids is via a provider recommendation. ¡°Many studies have shown this to be the case, so our findings are not a surprise,¡± she said. ¡°It reinforces the literature, and we want to encourage providers to continue recommending the series.¡±

Racial disparities

The series was completed by 56.7% of white girls, compared with 49.7% of black girls and 47.0% of Hispanic girls.

¡°It should be noted that completion for the whole group was only about 53%,¡± Dorell said. ¡°Having said that, the data indicate that blacks and Hispanics were less likely to complete the series, and we need to understand why. It could be access, it could be simply not returning to the clinic, or it could be that they did not realize that the vaccine is a series. Whatever the case, we are finding that this is happening, and, again, the literature is confirming this disparity.¡±

The series was more likely to be completed by girls with mothers ¡Ý45 years, girls with knowledge of HPV disease and girls who did not receive all vaccines at public facilities.

Parents of unvaccinated girls reported that they were unlikely to have their daughters vaccinated at a rate of 40.5%. Parents who did not intend to have their daughters vaccinated cited lack of knowledge (19.4%), not needed (18.8%), not sexually active (18.3%) and not recommended (13.1%) as reasons for not intending to begin the series.

¡°First and foremost, parents need to know that the vaccine is out there,¡± Dorell said. She also noted that parents need to understand that their daughters are at risk.

¡°From there, it is up to the clinician to dispel myths,¡± she said. ¡°Counseling and education go hand in hand with simply recommending the vaccine.¡±

However, Dorell was realistic about these goals. ¡°We understand that the time it takes for counseling is an obstacle for providers.¡±

More results

Multivariate analysis results indicated several factors that were independently linked to HPV vaccine initiation, including:

• older age
• having a preventive visit at age 11-13
• eligibility for State Children¡¯s Insurance Program or Vaccine for Children (excluding uninsured individuals)
• having a mother aged <34 years
• having a mother who was never married
• not receiving all vaccines at public facilities

Further study should look at how access issues, race and health insurance issues play a role in completion and initiation, according to Dorell.

Disclosures: Dr. Dorell reports no disclosures.

For more information:

• Dorell CG. #1375.2. Human Papillomavirus (HPV) Vaccine Initiation and Series Completion, National Immunization Survey-Teen, 2008-2009. Presented at: Pediatric Academic Societies¡¯ Annual Meeting 2011. Denver. April 30-May 3, 2011.

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