1. HUMAN PAPILLOMAVIRUS VACCINE SERIES COMPLETION RATES AMONG PEDIATRIC, FAMILY MEDICINE, AND GYNECOLOGY CLINICS IN WEST TEXAS
Joanne Thambuswamy, MD1, Fatma Levent, MD1, and Marcela Nur, MD1. Department of Pediatrics, Texas Tech University Health Sciences Center, Lubbock, Texas, United States1
Purpose of the Study
Results
To compare Human Papillomavirus (HPV) vaccine completion rates among three different academic specialty clinics in West Texas.
A total of 4706 patients initiated HPV vaccination, and 1333 (28.3%) completed the three dose series
The average age of initiation of the vaccine series was years for patients seen in Pediatric clinics, years for Family Medicine clinics, and years for Gynecology clinics
There was a statistically significant difference in HPV vaccine series completion between Family Medicine and the other two specialty clinics (X²= 33.05, p=0.000)
Background
COMPLETION OF 3 OR MORE HPV VACCINES
Clinic
Complete
Incomplete
Total
Family Medicine
192 (20.7%)*
735 (79.3%)
927 (100%)
Gynecology
112 (30.9%)
251 (69.1%)
363 (100%)
Pediatrics
1029 (30.1%)
2387 (69.9%)
3416 (100%)
1333 (28.3%)
3373 (71.7%)
4706 (100%)
*p=0.000
HPV is the most common STD in the world. As of 2014, about 11-12% of people were infected with it worldwide¹, with 79 million Americans infected and about 14 million new infections every year²
HPV causes genital warts, as well as anal, cervical, oropharyngeal, penile, vaginal, and vulvar cancers and is so prevalent that about 85% of American women and 91% of American men will be exposed to HPV in their lifetimes³
A quadrivalent HPV vaccine was approved for women in the USA in and for men in 2009⁴
The HPV vaccine series is considered complete if patients received 3 doses within a year for those ages 11-26⁴
Previous studies have shown a higher completion rate for gynecologists than pediatricians or non-pediatric primary care providers⁶
COMPLETION OF 2 OR MORE HPV VACCINES
Clinic
Complete
Incomplete
Total
Family Medicine
422 (45.5%)*
505 (54.5%)
927 (100%)
Gynecology
190 (52.3%)
173 (47.7%)
363 (100%)
Pediatrics
1958 (57.3%)
1458 (42.7%)
3416 (100%)
2570 (54.6%)
2136 (45.4%)
4706 (100%)
*p=0.000
Population and Methods
After obtaining Institutional Review Board (IRB) approval, patients who initiated HPV vaccination series in any of the Pediatric, Family Medicine, and Gynecology outpatient clinics associated with Texas Tech University Health Sciences Center in Lubbock, Texas, were included in the study
Patients were identified by the Current Procedural Terminology (CPT) code related to HPV vaccination between January 1, 2007 and June 27, from outpatient billing data
Gender, age, race/ethnicity, provider, source of funding, and number of HPV vaccines that each patient received was collected
The HPV vaccine series was considered completed if patients received 3 or more doses of the vaccine.
Statistical analysis was performed using SPSS software version 23. The difference in completion rates among the three specialty clinics was analyzed using Chi Square. A p value of <0.05 was considered statistically significant
Discussion
Completion rates gathered fall far below Healthy 2020 goals of 80% completion⁷
Lack of knowledge of the vaccine, not feeling like it was needed, the child not being sexually active, and lack of provider recommendation were some of the main reasons parents have listed for not vaccinating their children⁵
Text messaging reminders, younger age at initiation, and pairing HPV vaccines with other scheduled vaccines have been shown to improve completion rates⁸⁹
The CDC updated their definition of completed vaccine series in October 2016 to 2 doses of the vaccine for patients 14 and younger. Hopefully the updated recommendations will improve completion rates by themselves. The data in this study was collected and analyzed before the recommendations were updated.
The table and graph above show the comparison between the 3 departments with 2 or more HPV vaccine doses. This shows more closely how the departments would compare under the new CDC guidelines
Future study in progress to analyze provider attitudes and their effects on vaccine series completion
References
1. Forman D, Martel CD, Lacey CJ, et al. Global Burden of Human Papillomavirus and Related Diseases. Vaccine. 2012;30 Suppl 5:F12-F23. doi: /j.vaccine Genital HPV Infection – CDC Fact Sheet. Genital HPV Infection- CDC Fact Sheet. Published March Chesson HW, Dunne EF, Hariri S, Markowitz LE. The Estimated Lifetime Probability of Acquiring Human Papillomavirus in the United States. Sexually Transmitted Diseases. 2014;41(11): doi: /olq HPV (Human Papillomavirus) Gardasil® VIS. Centers for Disease Control and Prevention. Published May 17, Dorell CG, Yankey D, Santibanez TA, Markowitz LE. Human Papillomavirus Vaccination Series Initiation and Completion, Pediatrics. 2011;128(5): doi: /peds Liu G, Kong L, Du P. HPV vaccine completion and dose adherence among commercially insured females aged 9 through 26 years in the US. Papillomavirus Research. 2016;2:1-8. doi: /j.pvr Healthy People Immunization and Infectious Diseases: Objectives. Healthy People U.S. Department of Health and Human Services. Available at: objectives/topic/immunization-and-infectious-diseases/objectives 8. Aragones A, Bruno DM, Ehrenberg M, Tonda-Salcedo J, Gany FM. Parental education and text messaging reminders as effective community based tools to increase HPV vaccination rates among Mexican American children. Preventive Medicine Reports. 2015;2: doi: /j.pmedr Keim-Malpassa J, McKim Mitchella E, Camacho F. HPV vaccination series completion and co-vaccination: Pairing vaccines may matter for adolescents. Vaccine 2015;33(43): 5729–5732