The Advisory Committee on Immunization Practices (ACIP) recommends HPV vaccination for females aged 13-26 years and males aged 13-21 years not vaccinated previously, and routine HPV vaccination for 11 or 12 year olds. Well-child visits present the best opportunities for children and adolescents to receive vaccines. The objectives of this study were to estimate HPV vaccine uptake rate in females and males aged 9-21 years during well-child visits from 2007 to 2013 and to compare HPV vaccine uptake in adolescents aged 11-12 years old with Tdap and meningococcal vaccines.
This retrospective database study included 9-21 year old females and males who were continuously enrolled since June 1, 2006 or January 1 of the year when subjects turned to 9 years old, had well-child visits, didn’t have HPV vaccine previously, were not pregnant, did not have a claim related to child birth, cervical cancer, or hysterectomy during the study year. Subjects were assessed for receipt of HPV vaccine during well child care visits. HPV vaccination was identified by CPT4 codes: 90649 and 90650. Subjects who initiated HPV vaccination during well-child care visits were followed for two years to assess 3-dose series completion. HPV vaccine uptake rates and completion rates were reported for the overall study cohort and stratified by age groups, gender, region, health plan type, and provider specialty type. Multivariable logistic regression models were used to analyze factors associated with HPV vaccine uptake and series completion.
Across all years, well-child visit rate was highest among 11-12 year olds (40.1%-58.2%). HPV vaccine uptake rate during well-child visits was highest among adolescents 13-17 years of age (21.5%). Only 18.6% of adolescents between 11 and 12 years received the HPV vaccine. HPV vaccination rates in 11-12 years olds during well-child visits (18.6%) were significantly lower than Tdap (35.5%, p<0.0001) and MCV4 (34.5%, p<0.0001). Compared to other age groups, the 11-12 year olds were most likely to come in for a well-child visit. The 13-17 year olds were most likely to get a HPV vaccine during the well-child visit (OR=1.207; p <0.001).
Though 11-12 year boys and girls were more likely to come in for a well-child visit, they were less likely to receive a HPV vaccine. Well child visits for 11 and 12 years olds are missed opportunities for HPV vaccinations.
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American Academy of Pediatrics. Well-Child Care: A Check-Up for Success. http://www.healthychildren.org/English/family-life/health-management/Pages/Well-Child-Care-A-Check-Up-for-Success.aspx. Accessed Aug 19, 2014.