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Order of vaccine administration could influence patient compliance with HPV4 vaccine
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Although adolescent girls reported more arm pain after receiving quadrivalent HPV vaccines, physicians should consider administering it prior to other immunizations in order in increase compliance, according to study findings in The Pediatric Infectious Disease Journal.
Emmanuel B. Walter, MD, MPH, of Duke University School of Medicine, and colleagues randomized 72 adolescent girls to receive a third dose of HPV4 vaccine (Gardasil, Merck) followed by concomitant vaccines (n=33) or concomitant vaccines followed by a third dose of HPV4 vaccine (n=39). Concomitant vaccines included hepatitis A, inactivated influenza, measles-mumps-rubella, meningococcal conjugate, Tdap, and varicella. Study participants, aged 9 through 18 years, were simultaneously enrolled in a larger observational study that assessed HPV4 immunity prior to and following a third dose of HPV4 vaccine.
Using the Faces Pain Scale-Revised, study participants in both groups reported modestly higher initial pain scores in the arm where HPV4 vaccine was administered compared with the arm where concomitant vaccines were administered. Participants were not blinded to the vaccines.
Approximately 82% of those who received concomitant vaccines first had more pain in the arm where HPV4 was received; among those who received the HPV4 vaccine first, 51.5% reported a higher FPS-R score in the arm where HPV4 was received (P=.005).
“Administering HPV4 prior to other [vaccines] mitigates the report of pain severity as 30 percent fewer girls report more pain in the arm where HPV4 was received if they received HPV4 first rather than last,” the researchers concluded. “Increasing HPV4 vaccine tolerability by administering HPV4 first could potentially increase vaccine acceptability and thereby help improve lagging HPV vaccination coverage.
Disclosure: Walter reports financial ties with Merck. The other researchers report no relevant financial disclosures.
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