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McKeithen MC, Gilkey MB, Kong WY, Oh NL, Heisler-MacKinnon J, Carlson R, James G, Grabert BK. Policy Approaches for Increasing Adolescent HPV Vaccination Coverage: A Systematic Review. Pediatrics 2024; 153:e2023064692. [PMID: 38623635 PMCID: PMC11035154 DOI: 10.1542/peds.2023-064692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 04/17/2024] Open
Abstract
CONTEXT US jurisdictions have enacted a wide range of policies to address low human papillomavirus (HPV) vaccination coverage among adolescents, but it is unclear which policies are effective. OBJECTIVE To systematically review the impact of governmental policies on adolescent HPV vaccination coverage. DATA SOURCES PubMed, Embase, and Scopus databases. STUDY SELECTION Eligible studies, published from 2009 to 2022, evaluated the impact of governmental policies on HPV vaccination coverage among adolescents ages 9 to 18. DATA EXTRACTION Two investigators independently extracted data on study sample, study design and quality, policy characteristics, and HPV vaccination outcomes. We summarized findings by policy type: school-entry requirements (SERs), federally-funded policies related to the Vaccines for Children program and Medicaid, educational requirements, and others. RESULTS Our search yielded 36 eligible studies. A majority of studies evaluating HPV vaccine SERs found positive associations between SERs and HPV vaccination coverage (8 of 14), particularly for SERs in Rhode Island and Washington, DC. All studies evaluating SERs for other adolescent vaccines observed positive spillover effects for HPV vaccination (7 of 7). Federally-funded policies related to Vaccines for Children and Medicaid were consistently associated with higher HPV vaccination coverage (7 of 9). Relatively few studies found associations between educational requirements and HPV vaccination coverage (2 of 8). LIMITATIONS Studies used limited vaccination data sources and non- or quasi-experimental designs. Some studies had no or poorly matched comparison groups. CONCLUSIONS Our findings suggest promise for SERs and federally-funded policies, but not educational requirements, for increasing HPV vaccination coverage among adolescents.
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Affiliation(s)
| | - Melissa B. Gilkey
- Gillings School of Global Public Health
- Lineberger Comprehensive Cancer Center
| | | | - N. Loren Oh
- Gillings School of Global Public Health
- School of Medicine
| | | | - Rebecca Carlson
- Health Sciences Library
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Greeshma James
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Brigid K. Grabert
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Brooks EM, Fugate-Laus K, Webel B, Naavaal S. Perceptions of a State-Level HPV Vaccine Mandate and Exemption Option in Rural Virginia: A Qualitative Study. Vaccines (Basel) 2024; 12:401. [PMID: 38675783 PMCID: PMC11054131 DOI: 10.3390/vaccines12040401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States; yet, despite the availability of safe and effective HPV vaccines, only half of eligible adolescents have completed the vaccine series. School-entry requirements are one proven strategy to increase vaccination rates among children and youth and reduce the burden of HPV-related cancer. This study investigated community perceptions of an HPV vaccine school-entry mandate in Virginia and the consequences of a low threshold exemption option included in the legislation. We conducted 40 interviews with community members including 15 interviews with parents, 19 with healthcare providers, and 6 with community leaders. Interviews asked about knowledge, beliefs, and attitudes concerning the HPV vaccine and mandate. Interviews were recorded, transcribed, and thematically analyzed. Despite healthcare provider support for the mandate, there was widespread confusion over the school-entry policy and concern that the exemption option undermined vaccination efforts. Understanding variations in community-level perceptions and response to school-based vaccination mandates is crucial for designing effective public health strategies. Findings suggest statewide vaccination initiatives should preemptively identify low uptake areas and provide targeted information to communities. Future mandates should avoid the use of ambiguous and contradictory language in vaccine-related legislation.
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Affiliation(s)
- E. Marshall Brooks
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Kendall Fugate-Laus
- Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Ben Webel
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA 23284, USA
| | - Shillpa Naavaal
- Dental Public Health and Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA 23298, USA
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Osaghae I, Chandra M, Talluri R, Shete S. Individual, systemic and state factors associated with provider recommendation of HPV vaccination: Findings from NIS-Teen, 2020. Hum Vaccin Immunother 2023; 19:2239678. [PMID: 37550623 PMCID: PMC10408691 DOI: 10.1080/21645515.2023.2239678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/28/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
The most important determinant of HPV vaccination uptake is healthcare provider recommendation, yet not all eligible patients receive HPV vaccination recommendations. We used data from the 2020 National Immunization Survey-Teen to determine individual, systemic, and state factors associated with provider recommendation of HPV vaccination. A total of 18,534 teens were included, with 81.4% receiving provider recommendations for HPV vaccination. HPV vaccination recommendation was higher among females compared to males (AOR: 1.57; 95% CI: 1.27-1.93), teens who received a well-child exam at 11 or 12 years compared to those who did not (AOR: 2.10; 95% CI: 1.61-2.74), and teens whose mothers had college, some college or at least a high school education compared to those with less than high school education. In addition to individual factors, provider recommendation of HPV vaccination was higher in hospitals (AOR: 1.51; 95% CI: 1.00-2.29) and STD/school/teen clinics (AOR: 2.47; 95% CI: 1.05-5.78) compared to public facilities. However, the odds of provider recommendation were lower when none of the teen's providers ordered vaccines from the state compared to when all teen providers ordered vaccines from the state (AOR: 0.69; 95% CI: 0.52-0.93). Moreover, the state's mean prevalence of provider recommendations of HPV vaccination was 7.2% lower (Coefficient: -0.072; 95% CI: -0.107 - -0.036) in states with high religious ideology compared to those with low religious ideology. Interventions to increase provider recommendation of HPV vaccination should take a multiprong and comprehensive approach that addresses religious and systemic barriers to HPV vaccination recommendation.
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Affiliation(s)
- Ikponmwosa Osaghae
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Monalisa Chandra
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajesh Talluri
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sanjay Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Shin MB, Sloan K, Baezconde-Garbanati L, Dang E, Garcia S, Palinkas LA, Unger JB, Willgerodt M, Crabtree BF, Tsui J. Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates. Hum Vaccin Immunother 2023; 19:2251815. [PMID: 37666253 PMCID: PMC10478734 DOI: 10.1080/21645515.2023.2251815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 09/06/2023] Open
Abstract
School-based HPV vaccination programs have improved vaccine uptake among adolescents globally. However, school-based HPV vaccination strategies in the United States (US) have mainly focused on school-entry mandates for vaccination, which have passed in only five states/jurisdictions. Many schools and school-based health centers (SBHCs) already provide health services to medically underserved adolescents and opportunities to improve disparities in HPV vaccine education and uptake are underexplored. This qualitative study of clinic and community members assessed potential opportunities within and outside schools to increase HPV vaccination. Data were generated from a larger mixed-methods study designed to understand experiences with HPV vaccination evidence-based strategies in medically underserved communities. The parent study included interviews and focus groups conducted with clinic (providers, clinic leaders, staff) and community (racial/ethnic minority parents, advocates, payers, policy representatives) members in Los Angeles and New Jersey between December 2020-January 2022. We created a reduced dataset of text related to schools/SBHCs (30 in-depth interviews, 7 focus groups) and conducted a directed content analysis. Participants indicated that schools and SBHCs are ideal venues for reaching medically underserved adolescents experiencing barriers to primary care access. Parents/providers expressed mutual interest in HPV vaccine administration/education in schools, but some advocates/policy participants experienced challenges due to increasing politicization of vaccines. Participants highlighted policies for expanding HPV vaccine education and administration in schools, including minor consent and increasing SBHC funding for HPV vaccines. More research is needed to explore existing infrastructure, partner motivation, and opportunities to improve HPV vaccination among medically underserved adolescents within schools beyond vaccine mandates.
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Affiliation(s)
- Michelle B. Shin
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WAUSA
| | - Kylie Sloan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Emily Dang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samantha Garcia
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lawrence A. Palinkas
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Mayumi Willgerodt
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WAUSA
| | | | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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Kahn BZ, Huang Q, Thompson P, Gilkey MB, Alton Dailey S, Brewer NT. Getting Human Papillomavirus Vaccination Back on Track: A National Survey. J Adolesc Health 2023; 72:950-957. [PMID: 36922312 PMCID: PMC10010471 DOI: 10.1016/j.jadohealth.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 12/01/2022] [Accepted: 01/04/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE Adolescent human papillomavirus (HPV) vaccine uptake in the United States dropped during the COVID-19 pandemic due to a decrease in well visits. This study sought to identify opportunities for primary care professionals (PCPs) to get adolescent vaccination back on track. METHODS In early 2021, we recruited 1,047 PCPs (71% physicians) who provided adolescent vaccines in the United States from an existing panel. Participants completed an online survey about changes in adolescent HPV vaccine uptake and actions taken to promote vaccination during the pandemic, as well as intentions to engage in activities to increase adolescent vaccination in the next 3 months. RESULTS A substantial proportion of PCPs (43%) reported that HPV vaccine uptake decreased in the first year of the pandemic; few (7%) PCPs reported an increase in uptake. PCPs reporting increased uptake were more likely to have used nurse-only vaccination visits, held drop-in and drive-through vaccination clinics, and used telehealth visits to recommend vaccination (all p < .05). Nearly two-thirds (62%) of all PCPs planned to promote adolescent vaccine uptake in the next 3 months. Planning was more common among PCPs who believed HPV vaccine uptake at their clinics increased during the pandemic, who saw more than 10 adolescent patients per week, who had ever reviewed their clinic's vaccination rates, and were nurses (all p < .05). DISCUSSION Many PCPs saw HPV vaccination drop during the pandemic. Several interventions could help clinics get HPV vaccination back on track, including increasing the availability of nurse-only vaccination visits and vaccination-only clinics.
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Affiliation(s)
- Benjamin Z Kahn
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
| | - Qian Huang
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Peyton Thompson
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa B Gilkey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Susan Alton Dailey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
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6
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Harris JN, Mauro C, Andresen JA, Zimet GD, Rosenthal SL. COVID-19 vaccine uptake and attitudes towards mandates in a nationally representative U.S. sample. J Behav Med 2023; 46:25-39. [PMID: 35486335 PMCID: PMC9051757 DOI: 10.1007/s10865-022-00317-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/29/2022] [Indexed: 11/07/2022]
Abstract
Widespread uptake of COVID-19 vaccination is vital to curtailing the pandemic, yet rates remain suboptimal in the U.S. Vaccine mandates have previously been successful, but are controversial. An April 2021 survey of a nationally representative sample (N = 1208) examined vaccine uptake, attitudes, and sociodemographic characteristics. Sixty-seven percent were vaccine acceptors, 14% wait-and-see, and 19% non-acceptors. Compared to wait-and-see and non-acceptors, acceptors were more likely to have a household member over age 65, have received a flu shot, have positive COVID-19 vaccine attitudes, and view COVID-19 vaccination as beneficial. Mandate support was higher among respondents who were vaccine acceptors, had positive views about COVID-19 vaccines, believed in COVID-19 preventive strategies, perceived COVID-19 as severe, were liberal, resided in the Northeast, were non-White, and had incomes < $75,000. Public health campaigns should target attitudes that appear to drive hesitancy and prepare for varying mandate support based on demographics, COVID-19 vaccine attitudes, and the scope of the mandate.
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Affiliation(s)
- Julen N Harris
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th St, 17th Fl Room 102A, New York, NY, 10032, USA
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Christine Mauro
- Department of Biostatistics at the Mailman School of Public Health at, Columbia University Irving Medical Center, New York, NY, USA
| | - Jane A Andresen
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th St, 17th Fl Room 102A, New York, NY, 10032, USA
| | - Gregory D Zimet
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Susan L Rosenthal
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th St, 17th Fl Room 102A, New York, NY, 10032, USA.
- Department of Psychiatry at Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
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7
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Fish LJ, Harrison SE, McDonald JA, Yelverton V, Williams C, Walter EB, Vasudevan L. Key stakeholder perspectives on challenges and opportunities for rural HPV vaccination in North and South Carolina. Hum Vaccin Immunother 2022; 18:2058264. [PMID: 35439108 PMCID: PMC9248957 DOI: 10.1080/21645515.2022.2058264] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to identify factors at the individual, provider, and systems levels that serve as challenges or opportunities for increasing adolescent vaccination-including Human Papillomavirus (HPV) vaccination-in rural communities in the southern United States (US). As part of a broader study to increase HPV vaccine uptake in the southern US, we conducted in-depth interviews with vaccination stakeholders representing public health and education agencies in North Carolina (NC) and South Carolina (SC). Fourteen key stakeholders were recruited using purposive sampling to obtain insights into challenges and solutions to rural-urban disparities in HPV vaccination coverage. Stakeholders were also queried about their experiences and attitudes toward school-based vaccination promotion programs and campaigns. We used a rapid qualitative approach to analyze the data. Stakeholders identified factors at the individual, provider, and systems levels that serve as challenges to vaccination in rural communities. Similar to previous studies, stakeholders mentioned challenges with healthcare access and vaccine-related misconceptions that pose barriers to HPV vaccination for rural residents. Systems-level challenges identified included limited access to high-speed internet in rural areas that may impact providers' ability to interface with state-level digital systems such as the vaccination registry. Stakeholders identified a number of opportunities to increase HPV vaccination coverage, including through school-based health promotion programs. Stakeholders strongly supported school-based programs and approaches to strengthen confidence and demand for HPV vaccination and to help address persistent social determinants and system level factors that pose challenges to HPV vaccination coverage in many rural areas.
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Affiliation(s)
- Laura J. Fish
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Cancer Institute, Durham, NC, USA
| | - Sayward E Harrison
- Department of Psychology, Barnwell College, University of South Carolina, Columbia, SC, USA
- South Carolina Smart State Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | | | - Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, Columbia, SC, USA
| | - Charnetta Williams
- Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Emmanuel B. Walter
- Duke Human Vaccine Institute, Durham, NC, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | - Lavanya Vasudevan
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Duke Human Vaccine Institute, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
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Browne S, Feemster KA. Human papillomavirus: optimizing opportunities for prevention. Curr Opin Pediatr 2022; 34:132-139. [PMID: 35152231 DOI: 10.1097/mop.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide and is a precursor to anogenital and oropharyngeal cancers. Effective prevention is available through HPV vaccination and emerging evidence demonstrates the potential to significantly impact HPV-associated disease through reductions in the incidence of genital warts, precancerous cervical lesions, and cervical cancer. Indications have also recently expanded to include the prevention of oropharyngeal cancer, an outcome that has been increasing in incidence for men and women. Yet despite demonstrated effectiveness, the potential for broader impact and well-established routine recommendations for administration to adolescents, barriers to vaccine uptake persist. The purpose of this review is to provide an update on HPV prevention in the US, including trends in disease burden, HPV vaccine effectiveness, evolving vaccine recommendations and opportunities and barriers to their implementation. RECENT FINDINGS Several studies have demonstrated that HPV vaccination has the potential to prevent most HPV-attributable cancers. Ongoing research addresses questions related to duration of protection, effectiveness in vulnerable populations, vaccine schedules and strategies to improve access and optimize uptake. SUMMARY To ensure continued impact on the prevention of HPV-associated disease and subsequent cancer, it is crucial to address gaps in vaccine uptake. A strong recommendation for all persons for whom HPV vaccines are indicated, alongside initiatives to increase awareness of HPV vaccination and address specific concerns, can improve uptake among hesitant populations. Globally, efforts to bolster immunization programs are needed to broaden access to HPV vaccination.
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Affiliation(s)
- Safa Browne
- Vaccine Education Center, The Children's Hospital of Philadelphia
| | - Kristen A Feemster
- Vaccine Education Center, The Children's Hospital of Philadelphia
- Department of Pediatrics, Division of Infectious Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
- Global Medical and Scientific Affairs, Merck Research Laboratories, Merck & Co., Inc., Kenilworth, New Jersey, USA
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Colón-López V, Hull PC, Díaz-Miranda OL, Machin M, Vega-Jimenez I, Medina-Laabes DT, Soto-Abreu R, Fernandez M, Ortiz AP, Suárez-Pérez EL. Human papillomavirus vaccine initiation and up-to-date vaccine coverage for adolescents after the implementation of school-entry policy in Puerto Rico. PLOS Glob Public Health 2022; 2:e0000782. [PMID: 36962595 PMCID: PMC10021633 DOI: 10.1371/journal.pgph.0000782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022]
Abstract
The human papillomavirus (HPV) vaccine has been proven effective in the prevention of infection with high-risk HPV types, which can lead to the development of six HPV-related cancers. Puerto Rico (PR) adopted a mandatory HPV vaccination school-entry policy that took effect in August 2018. While school-entry requirements are generally accepted as an effective approach for increasing vaccination rates, there are few studies that have documented their impact on improving HPV vaccination rates. The objective of this study was to evaluate the impact of the HPV school-entry policy in PR on HPV vaccine coverage. We used a pre-post natural experiment. The study population included adolescents registered in the PR Immunization Registry during 2008-2019. We calculated HPV vaccine initiation and up-to-date (UTD) vaccine coverage rates. We estimated age-standardized rates (ASR) and standardized rate ratio with 95%CI. Vaccine data corresponding to a total of 495,327 adolescents were included for analysis; 50.9% were male and 49.1% were females. After policy implementation, a marked increase in raw HPV vaccine initiation among 11- to 12-year-old adolescents was observed across years 2017 (a pre-policy year), 2018, and 2019 (58.3%, 76.3%, and 89.8%, respectively). UTD coverage also showed a moderate increase after policy implementation among 11- to 12-year-old adolescents. The gap between sexes in vaccine initiation and UTD coverage narrowed over time; the ASRs in 2019 showed an increase of 19% in initiation and 7% increase in UTD relative to 2017 for males and females combined (both significant at p<0.05). This study demonstrated evidence of improvement in HPV vaccination rates following implementation of the school-entry policy and a narrowed sex gap in vaccine rates over time in PR. Future analyses should assess how the policy continues to affect vaccine coverage in subsequent years and how the COVID-19 pandemic has impacted HPV vaccination uptake.
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Affiliation(s)
- Vivian Colón-López
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Pamela C Hull
- Department of Behavioral Science, College of Medicine, Markey Cancer Center, University of Kentucky, Lexington, Kentucky, United States of America
| | - Olga L Díaz-Miranda
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Mark Machin
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Idamaris Vega-Jimenez
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Diana T Medina-Laabes
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Roxana Soto-Abreu
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - María Fernandez
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center, Houston, Texas, United States of America
| | - Ana P Ortiz
- Department of Cancer Control and Population Sciences, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Epidemiology and Biostatistics, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Erick L Suárez-Pérez
- Department of Epidemiology and Biostatistics, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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