Trends in Human Papillomavirus Vaccination in Commercially Insured Children in the United States

Abstract

OBJECTIVES: The human papillomavirus (HPV) vaccine was recommended in 2006 for girls and in 2011 for boys. The Healthy People 2020 goal for 2-dose HPV vaccination coverage is 80% by age 15 for girls and boys. We used nationwide population-based data to describe trends in HPV vaccination in children. METHODS: We conducted a cohort study nested within the MarketScan health care database between January 2003 and December 2017. Children were followed from the year they turned 9 until HPV vaccination, insurance disenrollment, or the end of the year when they turned 17, whichever came first. We estimated the cumulative incidence of at least 1-and 2-dose HPV vaccination, stratified by birth year, sex, and state. In secondary analyses, we evaluated the association between state-level vaccination policies and HPV vaccination coverage. RESULTS: This study included 7 837 480 children and 19.8 million person-years. The proportion of 15-year-old girls and boys with at least a 1-dose HPV vaccination increased from 38% and 5% in 2011 to 57% and 51% in 2017, respectively; the proportion with at least a 2-dose vaccination went from 30% and 2% in 2011 to 46% and 39% in 2017, respectively. By 2017, 2-dose HPV vaccination coverage varied from 80% in Washington, District of Columbia, among girls to 15% in Mississippi among boys and was positively correlated with legislation for HPV vaccine education and pediatrician availability. CONCLUSIONS: Despite the increasing trends in uptake, HPV vaccine coverage among commercially insured children in the United States remains behind target levels, with substantial disparities by state.

Provider Continuity and Human Papillomavirus Vaccine Refusal Among Adolescents

“…All 72 patients in the Adolescent Medicine group had an exact age-sex-race/ethnicity match from the General Pediatrics group, creating a matched sample of 144 patients. The chart of one patient in the Adolescent Medicine group could not be accessed, and after excluding their matched control from the General Pediatrics group, our final analytic sample included 142 patients divided evenly by clinic (76/66 male/female; 69% non-Hispanic Black; median age 15 years [IQR: 14,16]).…”

“…The rise in vaccine hesitancy and resurgence of vaccine-preventable diseases has highlighted the need for more active measures to address these trends. In addition to improved provider communication, system-level initiatives including legislation 16 and school immunization requirements 7 are effective, but not consistently adopted nationwide. Broader changes and institutional policies surrounding HPV vaccination should be explored in the context of varying degrees of provider continuity.…”

HPV vaccine initiation at 9 or 10 years of age and better series completion by age 13 among privately and publicly insured children in the US

“…While our data support the hypothesis that earlier initiation of HPV vaccination correlates with earlier series completion, the overall rates of proactive initiation in the current study populations were extremely low, in line with previous US studies. 17 , 19 , 20 Several studies of physician attitudes to proactive initiation of HPV vaccination have concluded that additional provider education may be needed to encourage timely uptake of HPV vaccines among the target age group. 21 , 24 , 25 , 42 , 48 A recent survey indicated that willingness to recommend proactive HPV vaccination series initiation may be lower among pediatricians than among family medicine practitioners, and also among providers with ≥20 years of practice experience compared to those with ≤9 years of experience.…”

Association of Maternal Cervical Disease With Human Papillomavirus Vaccination Among Offspring

“…This database has been used in prior studies of vaccinations, including the HPV vaccine, in children, adolescents, and adults. 16 , 17 , 18 , 19 , 20 , 21 , 22 Owing to the use of deidentified data, this study was deemed exempt from review by the Harvard Medical School Institutional Review Board. The study followed the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline.…”