The effect of co-vaccination on HPV vaccine outcomes: Analysis of the National Immunization Survey Teen, 2014 Open Access

Li, Anyie (2016)

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Background: HPV vaccine initiation and completion still lags far behind that of other adolescent vaccines. We evaluated patterns in human papillomavirus (HPV) vaccine initiation.

Methods: This study conducted analysis of the 2014 National Immunization Survey Teen publicly available dataset from the US Centers for Disease Control and Prevention (CDC). The main exposure of interest was co-vaccination status with other adolescent vaccines. We were interested in HPV vaccine outcomes including completion of the second and third dose, the dosing intervals between doses, and the age at first receipt. Vaccine recommendations were based on recommendations from the CDC Epidemiology and Prevention of Vaccine-Preventable Diseases (Pink Book) and Advisory Committee on Immunization Practices (ACIP).

Results: Among adolescents that received at least one dose of HPV vaccine, 26% received all three adolescent vaccines concurrently, 55% received two adolescent vaccines concurrently, and 19% received none of the adolescent vaccines concurrently. Males that received tetanus, diphtheria, and pertussis (Tdap) and meningococcal conjugate (MenACWY) together had higher odds of completion of both the second (odds ratio [OR] 1.5 (95% confidence interval [CI] 1.1, 2.1)) and third (OR 1.5 (95% CI 1.1, 1.9)) dose of HPV vaccine, compared to those that received none of the vaccines concomitantly. Among females, the odds of completion of the series were higher among those that received Tdap and HPV concomitantly (OR 1.8 (95% CI 1.2, 2.9)), compared to those that received none of the vaccines concomitantly. Receiving concomitant vaccination with HPV vaccine at an age greater than 12 years was statistically significant in second and third dose completion of HPV vaccine models for both sexes. Those that initiated older than 12 years old had lower odds of completing the second and third doses.

Conclusions: Appropriate receipt of Tdap vaccine is influential for HPV vaccine outcomes. There needs to be increased efforts in recommending all three adolescent vaccines concurrently, without differentiation, to improve completion and compliance with HPV vaccine recommendations.

Table of Contents

Literature Review 1

Introduction 1

Background on Adolescent Vaccines 1

HPV Dosing Recommendations 5

HPV Vaccine Coverage in the US 7

Barriers and Missed Opportunities 9

Co-Vaccination of Adolescent Vaccines 12

Conclusion 13

Figures 15

Disclaimer 16

Introduction 17

Methods 18

Results 21

Discussion 24

Public Health Implications 29

References 32

Tables and Figures 40

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