Improving HPV Vaccination Rates in a Pediatric Group: A Pilot Project
Main Article Content
Abstract
Background: Human Papilloma Virus (HPV) vaccines are safe and effective and provide long-lasting protection against the virus. The Centers for Disease Control and Prevention (CDC) recommends routine HPV vaccination at 11-12 years old, although the series can be started at age 9 years. However, the American Academy of Pediatrics (AAP) and the American Cancer Society (ACS) recommend routinely starting the HPV vaccination series at age 9 years.
Aims: The purpose of this quality improvement project was to improve HPV vaccination rates by 10% in patients ages 9-10 years at a large pediatric group in Salt Lake City, Utah. This purpose was accomplished through pediatric healthcare provider (HCP) education.
Methods: A questionnaire was used to determine the HCPs’ clinical practice and confidence level regarding the HPV vaccine at baseline before the educational presentation. The vaccination education was based on HPV resources from the AAP and ACS and focused on the rationale for initiating the HPV vaccine series at ages 9-10 years. The goal was to increase HPV vaccinations in 9–10-year-olds by 10%.
Results: Prior to HCP education, HCPs were somewhat confident initiating the HPV vaccine series at age 9-10 years old. HCPs reported that parents questioned the need for HPV vaccine at age 9-10 years because it is earlier than the age of typical sexual activity. Because the clinic had not yet adopted the AAP and ACS recommendation to routinely administer HPV vaccination at age 9-10 years, individual HCPs were more likely to follow the recommendations of the CDC. One year after presenting the HCP education, HPV vaccination rates increased by 149 (61%) doses among 9–10-year-old patients.
Discussion: HCPs’ confidence levels in HPV vaccination increase as the child ages. However, there are multiple benefits to initiating HPV vaccination at the age of 9 years, including timely completion, prevention of more cancers, and improved immunogenicity. HCP education is an effective strategy to increase HPV vaccination in 9-10-year-old patients.
Article Details
How to Cite
LUTHY, Karlen E. et al.
Improving HPV Vaccination Rates in a Pediatric Group: A Pilot Project.
Medical Research Archives, [S.l.], v. 13, n. 3, mar. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6390>. Date accessed: 06 apr. 2025.
doi: https://doi.org/10.18103/mra.v3i3.6390.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
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2. Centers for Disease Control and Prevention. Reasons to get HPV Vaccine. November 10, 2021a. Accessed February 18, 2025. https://www.cdc.gov/hpv/vaccines/reasons-to-get.html?CDC_AAref_Val=https://www.cdc.gov/hpv/parents/vaccine/six-reasons.html
3. National Cancer Institute. HPV and Cancer. April 4, 2023. Accessed February 18, 2025. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer
4. American Cancer Society. HPV and Cancer. July 30, 2020a. Accessed February 18, 2025. https://www.cancer.org/cancer/risk-prevention/hpv/hpv-and-cancer-info.html
5. Olsson S, Restrepo JA, Reina JC, Pitisuttithum P, Ulied A, Varman M, Van Damme P, Moreira ED, Ferris D, Block S, Bautista O, Gallagher N, McCauley J, Luxembourg A. Long-term immunogenicity, effectiveness, and safety of nine-valent human papillomavirus vaccine in girls and boys 9 to 15 years of age: Interim analysis after 8 years of follow-up. Papillomavirus Res. 2020;10:100203. doi: 10.1016/j.pvr.2020.100203
6. Centers for Disease Control and Prevention. HPV Vaccination is Safe and Effective. July 23, 2021b. Accessed February 18, 2025. https://www.cdc.gov/hpv/parents/vaccinesafety.html
7. Kaiser Family Foundation. The HPV Vaccine: Access and Use in the U.S. July 12, 2021. Accessed February 18, 2025. https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in-the-u-s/
8. Meites E, Gee J, Unger E, Markowitz L. Human Papillomavirus. In: Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S. ed. Epidemiology and Prevention of Vaccine-preventable Diseases. 14th ed. Washington DC: Public Health Foundation; 2021:165-176.
9. Centers for Disease Control and Prevention. Child and Adolescent Immunization Schedule by Age. April 27, 2023a. Accessed February 18, 2025. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
10. American Academy of Pediatrics. Human Papillomavirus (HPV). January 25, 2023. Accessed February 18, 2025. https://www.aap.org/en/news-room/campaigns-and-toolkits/human-papillomavirus-hpv/
11. American Cancer Society. Prevent 6 Cancers with the HPV Vaccine. 2020b. Accessed February 18, 2025. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
12. Stokley S. National and State-level HPV Vaccination Coverage [PowerPoint]. June 22-23, 2022. Accessed February 20, 2025. https://stacks.cdc.gov/view/cdc/118580
13. Utah Department of Health and Human Services. Important Facts for Immunizations – HPV, Adolescents. January 10, 2023. Accessed February 18, 2025. https://ibis.utah.gov/ibisph-view/indicator/important_facts/ImmHPV.html
14. Domurat P, Nickasch B. Overcoming barriers to human papillomavirus vaccination. J Pediatr Surg Nurs. 2022;11(3):100-105. doi:10.1097/JPS.0000000000000339
15. Zheng L, Wu J, Zheng M. Barriers to and facilitators of human papillomavirus vaccination among people aged 9 to 26 years: A systematic review. J Sex Transm Dis. 2021;48(12): e255-e262. doi: 10.1097/OLQ.0000000000001407
16. Harrington N, Chen Y, O’Reilly AM, Fang CY. The role of trust in HPV vaccine uptake among racial and ethnic minorities in the United States: A narrative review. AIMS Public Health. 2021;8(2):352-368. doi: 10.3934/publichealth.2021027
17. Bernstein TA, Broome M, Millman J, Epstein J, Derouin A. Promoting strategies to increase HPV vaccination in the pediatric primary care setting. J Pediatr Health Care. 2022;36(2):E36-E41. Doi:10.1016/j.pedhc.2021.10.009
18. Oh NL, Biddell CB, Rhodes BE, Brewer NT. Provider communication and HPV vaccine uptake: A meta-analysis and systematic review. Prev Med Rep. 2021;148:106554. doi:10.1016/j.ypmed.2021.106554
19. Centers for Disease Control and Prevention. Cancers Caused by HPV. February 28, 2022a. Accessed February 18, 2025. https://www.cdc.gov/hpv/parents/cancer.html
20. Centers for Disease Control and Prevention. How many Cancers are Linked with HPV each Year? September 12, 2023b. Accessed February 18, 2025. https://www.cdc.gov/cancer/hpv/cases.html?CDC_AAref_Val=https://www.cdc.gov/cancer/hpv/statistics/cases.htm
21. World Health Organization. Human Papillomavirus and Cancer. August 23, 2023. Accessed February 18, 2025. https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer
22. Centers for Disease Control and Prevention. HPV Infection. February 10, 2023c. Accessed February 18, 2025. https://www.cdc.gov/hpv/about/?CDC_AAref_Val=https://www.cdc.gov/hpv/parents/about-hpv.html
23. Priyadarshini M, Prabhu VS, Snedecor SJ, Corman S, Kuter BJ, Nwankwo C, Chirovsky D, Myers E. Economic value of lost productivity attributable to human papillomavirus cancer mortality in the United States. Front Public Health. 2020;8:624092. doi: 10.3389/fpubh.2020.624092
24. Szymonowicz KA, Chen J. Biological and clinical aspects of HPV-related cancers. Cancer Biol Med. 2020;17(4):864-878. doi: 10.20892/j.issn.2095-3941.2020.0370
25. Kamolratanakul S, Pitisuttithum P. Human papillomavirus vaccine efficacy and effectiveness against cancer. Vaccines. 2021; 9(12):1413. doi: 10.3390/vaccines9121413
26. Markowitz LE, Schiller JT. Human papillomavirus vaccines. J Infect Dis. 2021;224(4):S367-S378. doi: 10.1093/infdis/jiaa621
27. Drolet M, Benard E, Perez N, Brisson M, HPV Vaccination Impact Study Group. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: Updated systematic review and meta-analysis. Lancet. 2019;394(10197):497-509. doi: 10.1016/S0140-6736(19)30298-3
28. Centers for Disease Control and Prevention. About HPV Vaccines. November 16, 2021c. Accessed February 18, 2025. https://www.cdc.gov/vaccines/vpd/hpv/hcp/vaccines.html
29. Restrepo J, Herrera T, Samakoses R, Reina JC, Pitisuttithum P, Ulied A, Bekker LG, Moreira ED, Olsson SE, Block SL, Hammes LS, Laginha F, Ferenczy A, Kurman R, Ronnett BM, Stoler M, Bautista O, Gallagher NE, Salituro G, Ye M, Luxembourg A. Ten-year follow-up of 9-valent human papillomavirus vaccine: Immunogenicity, effectiveness, and safety. Pediatrics. 2023;152(4):e2022060993. doi: 10.1542/peds.2022-060993
30. Centers for Disease Control and Prevention. Human Papillomavirus (HPV) Vaccine. September 9, 2020. Accessed February 18, 2025. https://www.cdc.gov/vaccine-safety/vaccines/hpv.html?CDC_AAref_Val=https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html
31. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, Curtis CR, Gee J, Bocchini JA, Unger ER, Centers for Disease Control and Prevention, Louisiana State University Health Sciences Center. Human papillomavirus vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 2014;63(RR05):1-30.
32. Charles, LM, Erickson, D. Increasing HPV vaccination rates in the primary care setting. J Dr Nurs Pract. 2023;16(2):127-138. doi: 10.1891/JDNP-2022-0012
33. Glenn BA, Nonzee NJ, Herrmann AK, Crespi CM, Haroutunian GG, Sundin, P, Chang LC, Singhal R, Taylor VM, Bastani R. Impact of a multi-level, multi-component, system intervention on HPV vaccination in a federally qualified health center. Cancer Epidemiol Biomarkers Prev. 2022;31(10):1952-1958. doi: 10.1158/1055-9965.EPI-22-0156
34. Leung SOA, Akinwunmi B, Elias KM, Feldman S. Educating healthcare providers to increase human papillomavirus (HPV) vaccination rates: A qualitative systematic review. Vaccine X. 2019;3(2019):100037. doi: 10.1016/j.jvacx.2019.100037
35. Berger MH, Haidar YM, Bitner B, Trent M, Tjoa T. Practice patterns and knowledge among California pediatricians regarding human papillomavirus and its relation to head and neck cancer. Am J Otolaryngol. 2019;40(4):525-529. doi:10.1016/j.amjoto.2019.04.011
36. Topazian HM, Kundu D, Peebles K, Ramos S, Morgan K, Kim CJ, Richter KL, Brewer NT, Peris M, Smith JS. HPV vaccination recommendation practices among adolescent health care providers in 5 countries. J Pediatr Adolesc Gynecol. 2018;31(6):575-582. doi: 10.1016/j.jpag.2018.06.010
37. Cataldi JR, O’Leary ST, Markowitz LE, Allison MA, Crane LA, Hurley LP, Brtnikova M, Beaty BL, Gorman C, Meites E, Lindley MC, Kempe A. Changes in strength of recommendation and perceived barriers to human papillomavirus vaccination: Longitudinal analysis of primary care physicians, 2008-2018. J Pediatr. 2021;234:149-157. doi:10.1016/j.jpeds.2021.03.002
38. Office of Disease Prevention and Health Promotion. Increase the Proportion of Adolescents who get Recommended Doses of the HPV Vaccine – IID-08. 2020. Accessed February 20, 2025. https://health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-adolescents-who-get-recommended-doses-hpv-vaccine-iid-08/data
39. Allison MA, Hurley LP, Markowitz L, Crane LA, Brtnikova M, Beaty BL, Snow M, Cory J, Stokley S, Roark J, Kempe A. Primary care physicians’ perspectives about HPV vaccine. Pediatrics. 2016;137(2):e20152488. doi:10.1542/peds.2015-2488
40. Browne S, Feemster KA. Human papillomavirus: Optimizing opportunities for prevention. Curr Opin Pediatr. 2022;34(2):132-139. doi:10.1097/MOP.0000000000001119
41. Meites E, Kempe A, Markowitz LE. Use of a 2-dose schedule for human papillomavirus vaccination – Updated recommendations of the Advisory Committee on Immunization Practices. MMWR. 2016;65(49):1405-1408. doi:10.15585/mmwr.mm6549a5
42. Centers for Disease Control and Prevention. HPV Vaccine. August 16, 2023d. Accessed February 20, 2025. https://www.cdc.gov/hpv/vaccines/?CDC_AAref_Val=https://www.cdc.gov/hpv/parents/vaccine-for-hpv.html
43. Perkins R, Oliver K, Humiston, S. Evidence supporting the initiation of HPV vaccination starting at age 9: Collection overview. Hum Vaccin Immunother. 2023;19(3):2269026. doi: 10.1080/21645515.2023.2269026
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