STI Quarterly: Improve rates now to finish HPV vaccination
Improve rates now to finish HPV vaccination
Review the records of the girls who have received at least one injection in the three-series vaccination series for human papillomavirus (HPV). How many have completed the series? If new research is any indication, the proportion of those receiving all three shots is low.1
Researchers at the University of Texas Medical Branch in Galveston looked at a large health insurance company's records of 271,976 female patients ages 9 and older who received the first dose of the HPV vaccine between 2006 and 2009. Only 38.2% received all three doses within one year; in all but one age group (27 and older), data indicate a marked drop in the number of females who completed the vaccine. The steepest decline was found among girls and young women ages 9-18, which is the age group that derives the greatest benefit from the vaccine. Labeling calls for the vaccine to be administered in three doses over six months.
"The first generation of women that could benefit from the only HPV-related cancer vaccine in existence is missing the opportunity," said Abbey Berenson, MD, director of the Center for Interdisciplinary Research in Women's Health at the university, in a statement accompanying the published paper. "This vaccine prevents one of the most devastating cancers in women."
HPV is the primary cause of cervical cancer in women, according to the Centers for Disease Control and Prevention (CDC). There are about 12,000 new cervical cancer cases each year in the United States, and the disease is estimated to cause about 4,000 deaths in women each year. According to the CDC, there are about 15,000 HPV-associated cancers in the United States that might be prevented by vaccines each year in women, including cervical, anal, vaginal, vulvar, and oropharyngeal cancers.2
Key to completion?
Researchers report there was an increase in the number of female patients who received only the first vaccine dose, compared to those who received two or three. This change might signify that while clinicians are encouraging initiation of the vaccine series, they might not be following up about the second and third doses, researchers surmise.1
"It appears that patients and parents do not understand that all three shots of the vaccine are required for HPV protection, and that perhaps physicians are not doing a good enough job of educating and reminding patients to ensure completion," Berenson said. The cost of the vaccine (estimated retail price $130 per dose; $390 for full series), one of the commonly cited barriers, was not a likely issue for the group of women studied, as all were covered by health insurance.1
Clinician recommendation is significantly important, as evidenced by results of a 2011 paper. Its data indicate a provider's recommendation is the single most important factor in the decision by adolescents and parents to initiate and complete the HPV vaccination series.3 "We have found that girls who receive a provider recommendation are 2.5 times more likely to initiate the series than those who do not receive a recommendation, says Christina Dorell, MD, MPH, medical officer in the Immunization Services Division of the Centers for Disease Control and Prevention. Dorell served as lead author of the study.
Parental conversations with providers about HPV vaccination, as well as strong recommendations to receive the vaccine, are needed to improve vaccination rates, says Dorell. Additionally, informing parents that all three doses are needed for protection against the virus is needed to increase completion rates, she adds. "Having a reminder/recall system, or contacting parents when a vaccination dose is due, is an extremely important strategy to bring adolescents into their healthcare provider's office to initiate, as well as complete, the HPV series," says Dorell.
Better communication with patients and parents about the required doses and scheduling follow-up visits could be achieved via phone, email, text message, or other methods convenient for both parties, noted Berenson.
Providers at Winthrop University Hospital in Mineola, NY found that use of a red "Gardasil Vaccination Reminder" rubber stamp on patient charts as a reminder about HPV vaccination boosted uptake of the vaccine.4 At the start of the study, charts of eligible patients in the outpatient clinic indicated 11% were following through with the HPV vaccination, but after use of the reminder stamp, the vaccination rate increased to 49%.4
- Hirth JM, Tan A, Wilkinson GS, et al. Completion of the human papillomavirus vaccine series among insured females between 2006 and 2009. Cancer 2012. Doi: 10.1002/cncr.27598.
- Centers for Disease Control and Prevention. HPV Vaccines -- Questions and Answers. Fact sheet. April 2012. Accessed at http://1.usa.gov/dnUYnR.
- Dorell CG, Yankey D, Santibanez TA, et al. Human papillomavirus vaccination series initiation and completion, 2008-2009. Pediatrics 2011; 128(5):830-839.
- Rut K, Kastner E, Kinzler WL. Improving Gardasil vaccination rates. Presented at the 60th annual meeting of the American College of Obstetricians and Gynecologists. San Diego; May 2012.
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.