Completion of the Human Papillomavirus Vaccination Series Among Adolescent Users and Nonusers of School-Based Health Centers

Abstract

Objectives: Uptake and completion of the human papillomavirus (HPV) vaccine series among adolescents are suboptimal in the United States. We examined immunization registry data to determine completion of the 3-dose HPV vaccine series among adolescents in Seattle, Washington, born during 1995-2000 who received ≥1 dose of HPV vaccine. Methods: Immunization data included the administrating facility, which identified adolescents who used school-based health centers (SBHCs) for any HPV vaccine dose. We calculated completion of the 3-dose series at any time and on time by the 13th birthday. We stratified analyses by sex and assessed differences in on-time and any-time completion between users and nonusers of SBHCs. Results: Overall, 67.9% (8612 of 12 676) of females and 41.8% (3560 of 8521) of males with ≥1 dose of HPV vaccine completed the 3-dose series. Compared with female SBHC nonusers, female SBHC users had 37% higher odds of completing the series at any time (adjusted odds ratio [aOR] = 1.37; 95% CI, 1.19-1.58) and 33% higher odds of completing the series on time (aOR = 1.33; 95% CI, 1.08-1.64). Compared with male SBHC nonusers, male SBHC users had 45% higher odds of completing the series at any time (aOR = 1.45; 95% CI, 1.23-1.70) and 79% higher odds of completing the series on time (aOR = 1.79; 95% CI, 1.11-2.89). Conclusion: Adolescent SBHC users had higher odds of completing the HPV vaccine series than adolescents who received all doses in traditional health care settings. SBHCs should be leveraged to increase adolescent immunization rates.

A systematic review of human papillomavirus vaccination among US adolescents

“…In a review focused on HPV vaccination in Appalachia, a highrisk region for HPV-associated cancers, low vaccination rates were attributed to low parental knowledge and risk perception of HPV (Ryan et al, 2018). In this review, however, we identified higher vaccine initiation and completion rates among high-risk areas concentrated with healthcare facilities servicing adolescents (Bodson et al, 2017;Moss et al, 2015;Munn et al, 2019 (Walling et al, 2016) and may have implications in improving US vaccination rates.…”

“…In a low-quality study, adolescent girls receiving care from sexually transmitted disease, teen, or school clinics were less likely to achieve vaccine completion by age 12 (Rahman et al, 2017). Adolescents visiting school health centers, however, saw higher vaccine completion rates by age 13 in a moderate-quality study (Munn et al, 2019).…”

Does HPV vaccination initiation at age 9, improve HPV initiation and vaccine series completion rates by age 13?

“…Of those not seen in clinic, improving access to vaccinations outside of traditional clinical settings may be more impactful given the low percent of patients in this age group that regularly seek care. These setting could include schools, dental clinics, 17 pharmacies, school-based health centers 18 and other community-based locations. Studies have also shown that initiation of HPV vaccines at a younger age increases likelihood of vaccine completion by age 13 years.…”

Maternal HPV Infection: Effects on Pregnancy Outcome

“…In order to benefit from the full coverage of the vaccine, two or three doses should be administered, depending on the age of the patient (0, ± 2 months, and at 6 months, especially when the vaccination scheme starts after the age of 15, or for immunocompromised patients) [177,178]. Aiming to achieve high levels of anti-HPV antibodies, thus ensuring long-term immunity, the quadrivalent vaccine is administered in most high-income countries as part of a routine immunization schedule [179,180]. Moreover, current recommendations regarding HPV immunization support the vaccination of women who have already tested positive for HPV, since it will help protect against certain HPV types that they have not been exposed to [181].…”