HPV vaccines on time via text messaging

Research indicates that while many young women might initiate vaccination for human papillomavirus (HPV), they do not complete the three-injection course of treatment. In a 2010 study of more than 9,600 adolescent and young adult women in the Baltimore area, researchers report that fewer than 30% of those eligible to receive the HPV vaccine chose to get it, and about one-third of those who began receiving the vaccine completed the three-dose course.1

What can clinicians do? Findings from a new study indicate text messaging might serve as an effective reminder.2 In the new study, researchers implemented and evaluated a text message reminder system to promote on-time receipt of the second and third HPV vaccine doses at nine pediatric clinical sites in New York City. Parents of adolescents ages 9-20 years who received the vaccine during the time period of January-June 2009 were offered enrollment cards with instructions to sign up for English or Spanish language text message reminders for the next vaccine dose. Parents who enrolled in the program received up to three weekly text message reminders for their daughter's next vaccine dose. Medical records were reviewed for up to four months after the next vaccine dose was due.

During the intervention period, of 765 eligible HPV vaccine events, enrollment instructions were distributed to parents (56.7% of doses). Parents of 124 adolescent girls (28.6% of those handed instructions) activated text message reminders. On-time receipt of the next HPV vaccine dose occurred in 52% of teens whose parents signed up for reminders, 35% among those whose parents did not sign up, and 38% among those who served as historic controls.2

While the system was effective for those who signed up for the text reminder program, the intervention could be improved if the system were more automated and did not require as much action from the parent to activate the reminders, says Elyse Kharbanda, MD, MPH, who served as lead author of the study while at Columbia University in New York City.

"Next steps would also be to implement similar systems in larger settings with more diverse populations," says Kharbanda, now a research investigator with HealthPartners Research Foundation in Bloomington, MN. "Additionally, we would encourage further studies to implement systems to directly text the teenagers, rather than their parents."

What stops the shots?

Why might young women not complete the course of HPV vaccination? Researchers suspect the answer is related in large part to the fact that the HPV vaccination requires three doses for maximum protection, says Kathleen Tracy, PhD, assistant professor in the Department of Epidemiology and Public Health at the University of Maryland School of Medicine in Baltimore. Tracy presented findings from the Baltimore study at a 2010 national conference of the American Association for Cancer Research.1

Tracy and other Baltimore researchers looked at 9,658 adolescent and young adult women, ages 9 to 26, who potentially were eligible for the vaccine and attended the University of Maryland Medical Center's outpatient gynecology clinics from August 2006 until August 2010. A total of 2,641 young women (27.3%) started the vaccination process; 39.1% completed one dose, 30.1% completed two doses, and 30.78% completed all three doses. Two-thirds of those who began taking the vaccine were African-American.

Young women between ages 18-26 were the least likely to complete more than a single dose of the vaccine, the researchers found. African-American women were less likely than young white women to complete all three doses, findings indicate.1

The researchers don't know why the young women in the study opted not to take the vaccine or failed to complete the three-dose regimen; however, they see the study's results pointing strongly to the need to develop strategies to encourage eligible women to take the vaccine as directed for maximum protection, Tracy notes. Parents might have to take a more active role in making sure their daughters receive all the necessary doses, she states.

"Studies that have looked at compliance with multiple-dose vaccine schedules find relatively poor adherence to dosing schedules that require multiple doses," observes Tracy. "For younger women, we think having parental involvement likely increases adherence rates because parents may be involved in making sure they attend subsequent visits for follow-up doses."


  1. Tracy JK, Terplan M, Lydecker, AD, et al. HPV vaccine adherence in urban youth. Presented at the Ninth Annual American Association for Cancer Research (AACR) International Conference on Frontiers in Cancer Prevention Research. Philadelphia; November 2010.
  2. Kharbanda EO, Stockwell MS, Fox HW, et al. Text message reminders to promote human papillomavirus vaccination. Vaccine 2011; 29:2,537-2,541.