Assessing HPV Vaccination Trends in the State of Georgia Utilizing the Georgia Registry of Immunization Transactions and Services (GRITS) Data Open Access

Abstract

Human Papillomavirus (HPV) vaccine coverage rates struggled to meet the Healthy People 2020 Goals of 80% of adolescents in the United States up to date for the 2-3 dose vaccine series. While HPV vaccination is cited as the most important prevention measure against HPV-related cancers, parents are often hesitant to vaccinate their children. National level statistics in the United States show, in 2020, 75.1% of adolescents had > 1 dose of the HPV vaccine series and 58.6% of adolescents were up to date. Georgia has consistently fallen short of the national average estimates, and in 2020 was estimated to have 54.9% of adolescents considered up to date on the HPV vaccine series. When assessing the vaccine uptake over the period 2006-2017 for Georgia birth cohorts of 1995-2006, we found an overall increase in HPV vaccine coverage across all birth cohorts with up to 82.25% of the birth cohort of 2003 initiating the vaccine series compared to 32.22% of the birth cohort of 1995. However, there remains a lower proportion of adolescents up to date on the HPV vaccine series compared to those initiating, indicating dropouts before series completion (i.e. 18.80% of the birth cohort of 1995 considered up to date). Additionally, there was heterogeneity observed across the state, with certain health districts having higher proportions of initiation and completion than state and national averages, while other health districts fell far below the averages. Health Districts 3-2 Fulton, 3-5 DeKalb, and 3-4 GNR had the highest proportions of initiation and completion per birth cohort, while Health Districts 9-2 Southeast, 5-1 South Central, and 10 Northeast had the lowest proportions. Further, males had lower proportions of initiation and completion compared to females. This study echoes national level trends of Hispanic/Latino persons having the highest proportions of initiation and completion, with up to 78.41% of Hispanic/Latino persons in one birth cohort initiating the vaccine series by 2017. These descriptive statistics are important for understanding vaccine coverage for HPV vaccines and provide a framework on how to evaluate vaccine coverage within health districts, to support future HPV vaccine outreach efforts.

Table of Contents

CHAPTER 1: INTRODUCTION … 1

A.   Introduction and Rationale … 1

B.   Problem Statement … 2

Rationale… 3

C.   Purpose Statement … 3

D. Research Question … 3

E.    Significance Statement … 4

Definition of terms … 4

Human Papillomavirus (HPV): … 4

Georgia Registry of Immunization Transactions and Services (GRITS): … 5

IIS (Immunization Information System): … 5

Public health-district: … 5

National Immunization Survey - Teen (NIS-Teen): … 5

CHAPTER 2: Literature Review … 6

Introduction … 6

Transmission and related disease … 6

Vaccine recommendation … 7

Vaccine history … 8

Differences between the vaccines … 8

Evolution of the vaccine recommendation … 9

NIS-Teen … 10

Georgia Immunization Registries … 10

National HPV vaccine trends … 11

Georgia-level HPV vaccine trends … 12

Barriers to HPV vaccination … 12

Current efforts … 14

Local-level studies …15

CHAPTER 3: MANUSCRIPT … 18

Abstract … 19

Introduction … 20

Methods … 21

Data cleaning and formatting … 21

Data analysis … 22

Health district data … 23

RESULTS … 24

Male and female cumulative data … 24

Ethnic Distribution of GRITS reported data … 24

Racial Distribution of GRITS reported data … 25

Overall trends of each birth cohort according to combined data (census and GRITS) … 26

Health district specific data … 26

Figures and Data Tables: … 27

Figure 1. Comparing the birth cohort estimates from GRITS to census-derived estimates for the birth cohorts of 1995-2006 showing underestimations of GRITS population data. … 28

Figure 2. Number of census-derived male and female births per birth cohort. …28

Figure 3. Number of GRITS-derived male and female births per cohort. … 28

Figure 4. Racial distribution of each birth cohort according to GRITS data … 29

Figure 5. Proportion of each birth cohort initiating and completing the vaccine series by 2017. …31

Figure 6. Proportion of each birth cohort initiating and completing the vaccine series by age 11. … 32

DISCUSSION … 33

Vaccine coverage … 33

Sex differences … 33

Racial differences … 34

Health district data … 35

Limitations … 37

CHAPTER IV: CONCLUSIONS AND RECOMMENDATIONS … 38

REFERENCES … 40

APPENNDIX I: DATA TABLES AND GRAPHS … 43

Ethnicity Tables and Graphs … 45

Race Tables and Graphs … 49

Health district distribution of each birth cohort … 65

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Immunizations HPV
Committee Chair / Thesis Advisor	Bednarczyk, Robert, Emory University

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