Increased HPV vaccine uptake for boys failed to increase rate for girls

BOSTON — Immunizing boys against human papillomavirus infection improved overall vaccine uptake for adolescents, but did not increase the female vaccine uptake, according to results of a study presented here at the 2012 Pediatric Academic Societies Annual Meeting.

Between 2010 and 2011, researchers sampled all patients aged 9 to 18 years who visited one of two Oklahoma clinics — the Sooner Pediatric Clinic and affiliated Latino Clinic. Using an electronic medical record system, researchers assessed patients’ immunization statuses. The Sooner Pediatric Clinic offers all vaccines together to adolescents aged at least 11 years, and the Latino Clinic offers human papillomavirus (HPV) vaccination for those aged at least 9 years.

“Our clinic started immunizing boys with HPV vaccine at the end of 2010,” Monique Naifeh, MD, told Infectious Diseases in Children. “We hypothesized that having an overall policy of immunizing everyone would assist us to immunize more girls. However, what we found was that we actually didn’t do such a good job at that.”

“Up-to-date” status was defined in the study as being in receipt of the first HPV vaccine (UTD1) and the completion of the three-dose vaccine series (UTD3). Patients were included in the study if they had not received their first or third HPV vaccine at the start of the year. Outcomes were determined by comparing HPV vaccinations uptake between 2010 and 2011.

According to the researchers, the Sooner Clinic saw 2,193 adolescent patients in 2010 and 2,162 in 2011, and the Latino Clinic saw 807 and 1,063 adolescent patients in those years, respectively. In the Sooner Clinic, 38% of patients were black, 35% white and 19% Hispanic. The Latino Clinic’s patients were 93% Hispanic. At both clinics, more adolescents received at least one HPV vaccination in 2011 than in 2010.

Adolescents were more likely to receive their third vaccine in 2011 from both the Sooner Clinic (4% in 2011, and 2% in 2010) and the Latino Clinic (12% in 2011, and 6% in 2010). More patients received at least one vaccine at the Latino Clinic in both 2010 (22%) and 2011 (35%) vs. the Sooner Clinic (9% in 2010, and 18% in 2011).

“The Latino clinic has a different policy in place which the nurses assess vaccine status, and they cue the doctor via prompts in the patient EMR to administer certain vaccines, while at the Sooner Pediatric Clinic, the physicians assess pediatric immunization status,” Naifeh said. “Our hypothesis is that this is the problem, that vaccine status assessment is not systematized and physicians are not prompted.”

Although boys’ uptake in HPV vaccinations increased from 2010 to 2011, girls did not. The researchers concluded that although immunizing boys improves overall vaccine uptake for adolescents, there appeared no increase in the female vaccine uptake after administering the vaccine to both sexes.

“What is apparent from this study is that teenagers do not complete the three-shot series very often — 53% at the Latino Clinic received one HPV vaccine, but only 21% actually completed the actual three-shot series in our clinics,” Naifeh said.

“The bottom line is that starting to immunize boys did not help us immunize more girls. We are going to look at one more year of data to see what changes; perhaps the policy needs to be enacted for an additional year for people to get used to it. However, I suspect that physicians simply forget half the time to offer vaccine.”

For more information:

Naifeh MM. #1502.97. Presented at: the 2012 PASl Meeting; April 28–May 1, 2012; Boston.

Disclosure: Dr. Naifeh reported no relevant financial disclosures.