Does Bundling Matter? The Effect of Providing HPV Vaccination Before Tdap Vaccination on Timely Completion of the HPV Vaccine Series [ID: 1381348

Abstract

INTRODUCTION: The American Academy of Pediatrics and American Cancer Society promote vaccine initiation at age 9 as one way to improve human papillomavirus (HPV) vaccination rates. Studies have noted increased HPV vaccine series completion rates when the series was begun before age 11. We used a national sample to assess the effect of initiating the HPV vaccine series initiation prior to the adolescent platform on timely series completion. METHODS: To explore the effect of initiating the HPV vaccine series prior to other vaccines in the adolescent platform (unbundling) on timely series completion, we created a cohort of children aged 9 in 2015 who were continuously enrolled through the age of 13 (2019) from a national administrative database of employee-sponsored insurance (MarketScan). Logistic regressions were used to predict the odds of HPV vaccine series completion among those who started the series prior to, concurrent with, or after receiving tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination. The cohort included 100,857 eligible children. RESULTS: Compared with adolescents who received their HPV and Tdap vaccinations concurrently, those who received HPV prior to Tdap had higher completion (adjusted odds ratio [aOR], 1.38), whereas those who received their HPV vaccination after Tdap had lower odds of HPV vaccine series completion (aOR 0.68). Other factors associated with series completion included female sex, residing in an urban (versus rural) area, residing in the Northeast, and receiving primary care from a pediatrician (versus family medicine physician). CONCLUSION: These data indicate that beginning the HPV vaccine series prior to the adolescent platform (unbundling) may improve on-time series completion.