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A quality improvement program designed to increase the early uptake of the human papillomavirus (HPV) vaccine has significantly raised vaccination rates, according to a study by researchers at Nemours Children’s Health. This new study, published in Academic Pediatrics, was led by Caitlin J. Miller, a medical student at Sidney Kimmel Medical College of Thomas Jefferson University, and Jonathan Miller, MD, Associate Chief of Primary Care at Nemours Children’s Health, Delaware Valley.
The study aimed to encourage 9-year-old patients to begin the HPV vaccination series, building on research presented earlier this year at the Pediatric Academic Societies Meeting. The HPV vaccine, first approved in 2006, can prevent up to 90% of cervical cancers and a large proportion of vulvar, vaginal, anal, and head and neck cancers. As of 2022, 62.6% of U.S. adolescents aged 13-17 had received both recommended doses, with 76.0% having at least one dose. However, public health experts have raised concerns that not enough adolescents complete the series and that vaccination rates are inconsistent across racial and ethnic groups.
Currently, the U.S. Centers for Disease Control and Prevention recommends that adolescents receive their first HPV vaccine at age 11. However, research has shown that initiating vaccination at age 9 is safe, effective, and increases the likelihood that adolescents will complete the series.
In this study, electronic health records in 20 Nemours Children’s primary care sites were updated to inform healthcare professionals that patients should be offered the HPV vaccine at age 9. Clinicians received updated education on the vaccine and practice-level feedback on ongoing vaccination rates.
Conducted from 2019 to 2022, the study’s primary measure was the Healthcare Effectiveness Data Information Set (HEDIS) rate, defined as the percentage of patients who have had two doses of the HPV vaccine by their 13th birthday. In 2019, the HPV vaccine HEDIS rate in the Nemours Primary Care network was 49.2%. By 2022, the rate had improved to 59.5%, and the following year, although the study had ended, the rate continued to rise to 63.9%.
The researchers also found that early HPV vaccine initiation (starting at age 9) improved from 13.2% in 2019 to 42.2% in 2022. Early initiation improved significantly across all racial and ethnic groups, with an increase from 27.6% to 51.5% for Hispanic or Latino patients; from 19.0% to 45.7% for Black patients; from 4.8% to 44.8% for Asian patients; and from 6.1% to 36.5% for white patients.
Providers reported that many parents are more accepting of HPV vaccination at age 9, possibly due to reduced stigma related to sexual activity. They also suggested that the increased provider education in this quality improvement initiative helped strengthen their communication on cancer prevention, an effective message for many parents.
“Initiating HPV vaccination at age 9 allows us to make leaps in this important public health measure,” said Dr. Jonathan Miller. “We were thrilled to discover that this project led to significant improvements in racial disparities in vaccination rates, even though we did not design the intervention specifically to do that.”
“Our study showed that initiating vaccination at age 9 leads to more adolescents being fully protected against cervical cancer and several other cancer types, which adds to a growing body of evidence and broader national push to begin the series at that age,” added Caitlin Miller.
For more information, see the original study: Caitlin J. Miller et al, Quality Initiative to Increase Early Initiation and Series Completion of HPV Vaccine and its Impact on Health Disparities, Academic Pediatrics (2024). DOI: 10.1016/j.acap.2024.102609.
