Series Completion Rates Research Articles

Society of behavioral medicine supports increasing HPV vaccination uptake: an urgent opportunity for cancer prevention.

Human papillomavirus (HPV) vaccine coverage remains low in the USA. The Society for Behavioral Medicine (SBM) supports the goals outlined by Healthy People 2020, the President's Cancer Panel, and the National Vaccine Advisory Committee to increase vaccination coverage among both males and females. SBM makes the following recommendations in support of efforts to reduce structural and other barriers to HPV vaccination services in order to increase rates of series completion. We encourage legislators and other policymakers to improve administration authority, insurance coverage, and reimbursement rates to healthcare providers who make the HPV vaccine available to adolescents; provide instrumental support to fund the development of school curricula on HPV vaccination; and increase public awareness that HPV vaccination can prevent cancer. We urge healthcare providers and healthcare systems to increase the strength, quality, and consistency of HPV vaccination recommendations for all eligible patients; to treat HPV vaccination as a routine preventive service; employ culturally appropriate communication strategies in clinical settings to educate eligible patients, parents, and guardians about the importance, effectiveness, and safety of HPV vaccination; and to strengthen and better coordinate the use of electronic medical records and immunization information systems.

Using Social Marketing Theory as a Framework for Understanding and Increasing HPV Vaccine Series Completion Among Hispanic Adolescents: A Qualitative Study.

HPV vaccine series completion rates among adolescent Hispanic females and males (~39 and 21 %, respectively) are far below the Healthy People 80 % coverage goal. Completion of the 3-dose vaccine series is critical to reducing the incidence of HPV-associated cancers. This formative study applies social marketing theory to assess the needs and preferences of Hispanic mothers in order to guide the development of interventions to increase HPV vaccine completion. We conducted 51 in-depth interviews with Hispanic mothers of adolescents to identify the key concepts of social marketing theory (i.e., the four P's: product, price, place and promotion). Results suggest that a desire complete the vaccine series, vaccine reminders and preventing illnesses and protecting their children against illnesses and HPV all influence vaccination (product). The majority of Completed mothers did not experience barriers that prevented vaccine series completion and Initiated mothers perceived a lack of health insurance and the cost of the vaccine as potential barriers. Informational barriers were prevalent across both market segments (price). Clinics are important locations for deciding to complete the vaccine series (place). They are the preferred sources to obtain information about the HPV vaccine thus making them ideal locations to deliver intervention messages, followed by television, the child's school and brochures (promotion). Increasing HPV vaccine coverage among Hispanic adolescents will reduce the rates of HPV-associated cancers and the cervical cancer health disparity among Hispanic women. This research can inform the development of an intervention to increase HPV vaccine series completion in this population.

Parental Choice of Recall Method for HPV Vaccination: A Pragmatic Trial.

Completion rates for the human papillomavirus vaccine (HPV) series among adolescents remain low. Effectiveness of recall with parents choosing the method (preference-based recall) for increasing HPV series completion is unstudied. Within a cluster-randomized trial, we examined effectiveness of preference-based recall compared with usual care for increasing series completion and the association of recall choices with completion. All Kaiser Permanente Colorado pediatric practices (n = 7) were randomized to intervention (n = 4) or control (n = 3) by using covariate-constrained randomization. From January to June 2013, parents at intervention practices whose adolescents received HPV 1 were asked the recall method they preferred for subsequent doses and if they also wanted their child reminded. Completion rates were assessed 1 year after HPV 1. At intervention practices, 374 (43%) of 867 patients were enrolled; 39% preferred text, 18% e-mail, 9% auto-dialer, and 34% 2-methods; 19% chose to have adolescent also recalled. Intervention adolescents were more likely to complete (63% vs 38%) than were controls (adjusted risk ratio 1.47 [1.38-1.57]) and less likely to be late in completing the series (45% vs 57%, P = .02). Rates of completion were similar between different recall methods, but significantly higher for those preferring e-mail and phone compared withother methods (90% vs 60%. P = .008). Completion rates were similar for adolescents who also received recalls (62%) versus those who did not (63%). Preference-based recall was effective in increasing HPV series completion rates, with point estimates substantially higher than for most published studies of reminder/recall.

Younger age at initiation of the human papillomavirus (HPV) vaccination series is associated with higher rates of on-time completion

Vaccination rates for human papillomavirus (HPV) have remained disappointingly low. It is critical to identify methods to increase on-time vaccine series completion rates (before 13 or 15years). To determine whether younger age (9 to 10years of age) at HPV vaccine series initiation was associated with improved on-time completion rates compared to initiation at 11 to 12years, we examined the prevalence of on-time HPV vaccine series completion rates from August 2006 through December 2012 in a large, population-based cohort of children and adolescents (aged 9.5 to 27years) residing in Olmsted County, MN on December 31, 2012 (n=36,223). We compared age at vaccine initiation between individuals who successfully completed both 2 and 3 doses of the vaccination series on-time (before age 13.5 or 15.0years) using multivariate logistic regression. On-time completion of both 2 and 3 doses of the vaccine series by age 13.5 or 15.0years was significantly associated with initiation at 9 to 10years as compared to 11 to 12years after adjusting for sex, race, insurance status, frequent health care visits, and year of first vaccination (all p<.01). Interventions focused on beginning the vaccination series at 9 to 10years of age may result in higher rates of timely series completion.

HPV vaccination coverage of teen girls: The influence of health care providers

BackgroundBetween 2010 and 2014, the percentage of 13–17 year-old girls administered ≥3 doses of the human papilloma virus (HPV) vaccine (“fully vaccinated”) increased by 7.7 percentage points to 39.7%, and the percentage not administered any doses of the HPV vaccine (“not immunized”) decreased by 11.3 percentage points to 40.0%. ObjectiveTo evaluate the complex interactions between parents’ vaccine-related beliefs, demographic factors, and HPV immunization status. MethodsVaccine-related parental beliefs and sociodemographic data collected by the 2010 National Immunization Survey-Teen among teen girls (n=8490) were analyzed. HPV vaccination status was determined from teens’ health care provider (HCP) records. ResultsAmong teen girls either unvaccinated or fully vaccinated against HPV, teen girls whose parent was positively influenced to vaccinate their teen daughter against HPV were 48.2 percentage points more likely to be fully vaccinated. Parents who reported being positively influenced to vaccinate against HPV were 28.9 percentage points more likely to report that their daughter's HCP talked about the HPV vaccine, 27.2 percentage points more likely to report that their daughter's HCP gave enough time to discuss the HPV shot, and 43.4 percentage points more likely to report that their daughter's HCP recommended the HPV vaccine (p<0.05). Among teen girls administered 1–2 doses of the HPV vaccine, 87.0% had missed opportunities for HPV vaccine administration. ConclusionResults suggest that an important pathway to achieving higher ≥3 dose HPV vaccine coverage is by increasing HPV vaccination series initiation though HCP talking to parents about the HPV vaccine, giving parents time to discuss the vaccine, and by making a strong recommendation for the HPV. Also, HPV vaccination series completion rates may be increased by eliminating missed opportunities to vaccinate against HPV and scheduling additional follow-up visits to administer missing HPV vaccine doses.

Adolescent Male Human Papillomavirus Vaccination.

Objective. To determine male vaccination rates with quadrivalent human papillomavirus vaccine (HPV4) before and after the October 2011 national recommendation to routinely immunize adolescent males. Methods. We reviewed HPV4 dose 1 (HPV4-1) uptake in 292 adolescent males in our urban clinic prior to national recommendations and followed-up for HPV4 series completion rates. After national recommendation, 248 urban clinic and 247 suburban clinic males were reviewed for HPV4-1 uptake. Factors associated with HPV4-1 refusal were determined with multiple logistic regression. Results. Of the initial 292 males, 78% received HPV4-1 and 38% received the 3-dose series. After recommendation, HPV4-1 uptake was 59% and 7% in urban and suburban clinics, respectively. Variables associated with HPV4-1 uptake/refusal included time period, race, type of insurance, and receipt of concurrent vaccines. Conclusions. HPV4-1 vaccination rates in our urban clinic were high before and after routine HPV vaccine recommendations for adolescent males. Our vaccination rates were much higher than in a suburban practice.

Initiation & completion rates of hepatitis A vaccination among US pediatric populations born between 2005 and 2009

ObjectivesTo estimate hepatitis A vaccine series initiation and completion rates, assess time to vaccination, identify missed opportunities for the hepatitis A vaccine series, and examine factors associated with hepatitis A vaccine series initiation and completion. MethodsWe conducted a retrospective, observational study using three healthcare claims databases separately. The study population was comprised of children born between years 2005 and 2009 that were continuously enrolled for at least three and a half years from the date of birth. Every child was followed from date of birth for three and a half years for hepatitis A vaccination. ResultsThere were 93,735 eligible children from Clinformatics Data Mart, 202,513 from MarketScan Commercial, and 207,545 from MarketScan Medicaid. The overall hepatitis A vaccine series initiation rate was 63.8–79.4% and completion rate was 45.1–66.8% across the three databases. About 62.8–90.1% of the children who never initiated hepatitis A vaccine had at least one well visit from 1 year to three and a half years old. Children were more likely to initiate and complete the hepatitis A vaccine series if they were from more recent birth cohorts, from states with a hepatitis A vaccination recommendation prior to the ACIP universal recommendation, from states with daycare/school entry requirements, were enrolled in an HMO health plan, had pediatricians as primary providers, had more doctor's office/well visits and received MMR/Varicella vaccines. ConclusionIn this study, approximately one in every three to five children remained unvaccinated against hepatitis A. Although the hepatitis A vaccine series initiation and completion improved from 2005 to 2009, vaccine coverage has stabilized in recent years. It is important for providers to identify every opportunity for hepatitis A vaccination and to assure that children get protection from this vaccine-preventable disease.

An In-Depth Interview Study of Immunization Providers to Understand Practice Patterns, Barriers and Facilitators for Administering the 3-Dose HPV Vaccine Series

Background/Aims: Vaccination with the quadrivalent human papillomavirus (HPV) vaccine presents an opportunity to reduce the burden of conditions caused by HPV types 6, 11, 16 and 18. Despite increases in HPV vaccine initiation since its introduction in 2006, the 3-dose series completion rate among age-eligible males and females remains low. Provider recommendation has been identified as one of the strongest influences on HPV vaccine initiation. However, limited research has examined the contribution of provider factors to HPV vaccine completion. The purpose of this study was to gain an understanding of barriers and facilitators to HPV vaccine series completion from the perspective of immunization providers.

Correlates of Human Papillomavirus Vaccine Completion Among Adolescent Girl Initiators.

To examine correlates of vaccine series completion among young adolescent US girls who initiated the human papillomavirus (HPV) vaccine. We analyzed National Immunization Survey-Teens 2012 provider-verified data to examine correlates of HPV vaccine completion among 13- to 17-year-old girls who initiated HPV vaccine in 2012 (N = 4548). The weighted vaccine series completion rate among 13- to 17-year-old girl initiators was 66.7% (95% confidence interval [CI], 64.0-69.3). Adolescent girls who were older, residents of the Northeast (adjusted prevalence ratio [aPR], 1.36; 95% CI, 1.07-1.73), and had provider-verified seasonal influenza vaccination in the past year (aPR, 1.67; 95% CI, 1.32-2.11) and provider recommendation (aPR, 1.40; 95% CI, 1.10-1.77) were more likely to complete the 3-dose vaccine series. Parents of younger adolescent girls need to be educated about the importance of completing the 3-dose HPV vaccine series. Provider recommendation for the vaccine would also facilitate series completion.

School-based HPV immunization of young adolescents: Effects of two brief health interventions

Adolescent immunization rates for human papillomavirus (HPV) are low and interventions within school-based health centers (SBHCs) may increase HPV uptake and series completion. We examined the effect of a parent health message intervention on HPV vaccination intent, first dose uptake and series completion among adolescents who received care at SBHCs. Via computer-assisted telephone interviews (CATI), 445 parents of young adolescents were randomly assigned to 2 two-level interventions using a 2 × 2 design (rhetorical question (RQ) or no-RQ and one-sided or two-sided message). The RQ intervention involved asking the parent a question they were likely to endorse (e.g., “Do you want to protect your daughter from cervical cancer?”) with the expectation that they would then behave in a manner consistent with their endorsement (i.e., agree to vaccinate). For the one-sided message, parents were given information that emphasized the safety and effectiveness of HPV vaccine, whereas the two-sided message acknowledged that some parents might have concerns about the vaccine, followed by reassurance regarding the safety and effectiveness. At CATI conclusion, parents indicated intentions to have their adolescents vaccinated. Parents who endorsed any intent were sent a consent form to return and all adolescents with signed returned consents were vaccinated at SBHCs. Medical records were reviewed for uptake/completion. Parents were 87% female; adolescents were 66% male and racially/ethnically diverse. 42.5% of parents indicated some intention to immunize, 51.4% were unsure, and 6.1% were not interested. 34% (n = 151) of adolescents received their first dose with series completion rates of 67% (n = 101). The RQ component of the intervention increased intention to vaccinate (RR = 1.45; 95%CI 1.16,1.81), but not first dose uptake or series completion. The 1-sided and 2-sided messages had no effect. This brief, RQ health intervention enhanced intent, but did not impact vaccination rates, likely due to the time delay between the intervention and consent form receipt.

Parental education and text messaging reminders as effective community based tools to increase HPV vaccination rates among Mexican American children

ObjectiveLatino populations, particularly Mexican-Americans who comprise 65% of the Latinos in the U.S., are disproportionately affected by HPV-related diseases. The HPV vaccination completion rates remain low, well below the Healthy People 2020 goal. In this study we assessed the effect of parental education and a text messaging reminder service on HPV vaccine completion rates among eligible children of Mexican American parents. Study designNonequivalent group study of Mexican parents of HPV vaccine eligible children attended the Health Window program at the Mexican Consulate in New York City, a non-clinical, trusted community setting, during 2012–2013. 69 parents received HPV education onsite, 45 of whom also received a series of text message vaccination reminders. We measured HPV vaccination completion of the youngest eligible children of Mexican parents as the main outcome. Results98% of those in the education plus text messaging group reported getting the first dose of the vaccine for their child and 87% among those in the educational group only (p=0.11). 88% of those receiving the 1st dose in the text messaging group reported completing the three doses versus 40% in the educational group only (p=0.004). ConclusionsParental text messaging plus education, implemented in a community based setting, was strongly associated with vaccine completion rates among vaccine-eligible Mexican American children. Although pilot in nature, the study achieved an 88% series completion rate in the children of those who received the text messages, significantly higher than current vaccination levels.

Correlates of human papillomavirus vaccine series completion among young adult female initiators

Incomplete human papillomavirus (HPV) vaccination is a public health concern. The objective of this study was to examine the correlates of vaccine series completion among 18–26 year old US women using the Behavioral Risk Factor Surveillance System (BRFSS) data. Using BRFSS data collected during 2008–2010, we conducted multivariable logistic regression analysis to examine the correlates of HPV vaccine completion among HPV vaccine initiators. Among 656 women (18–26 years old) who initiated the HPV vaccine, the overall weighted vaccine series completion rate was 60.7%. It was 32.9%, 65.3%, and 69.9% in 2008, 2009, and 2010, respectively. Black and Hispanic women were less likely to complete the series compared with white women. Higher income, having a college degree and completion of the study in a more recent year were associated with higher completion rates. Thus, the reasons for HPV series non-completion may be multifactorial. Interventions targeting 18–26 year old female vaccine initiators with low income and education, and minority backgrounds may improve HPV vaccine series completion.

Forgotten appointments equals missed opportunities: Exploring the reasons for low HPV vaccine series completion rates

Forgotten appointments equals missed opportunities: Exploring the reasons for low HPV vaccine series completion rates

Tu1002 Non Liver Disease-Related Factors Significantly Impact “Liver Disease-Specific” Quality of Life Scores From the Chronic Liver Disease Questionnaire (CLDQ)

Background: Immunization for Hepatitis A (HAV) and Hepatitis B (HBV) is recommended for Hepatitis C (HCV) patients as superinfection can increase the risk of adverse events. Since immunogenicity increases with each successive dose in the vaccine series, completing the series provides the best chance of maximal protection. Standard of care (SOC) approaches such as provider driven vaccination after serologic testing results in poor series completion rates. Universal vaccination (UV), where patients are vaccinated for HAV/HBV without prior serologic testing, is a commonly identified as an effective vaccination strategy. Patient and provider outreach interventions have also been recommended to improve vaccination rates. Studies of the effectiveness and implementation of these strategies is lacking. Methods: Veteran patients were eligible if they attended a HCV group medical appointment and had evidence of chronic HCV without history of immunization/serologic evidence of immunity to HBV alone or HAV and HBV. Using a 2x2 factorial design assuming no interactions, consenting subjects were randomized to one of four vaccination strategies: 1) UV alone 2) UV plus outreach 3) outreach plus SOC 4) or SOC alone. UV was initiated at enrollment prior to serologic testing. Outreach interventions included a phone and mailed reminder to subjects about the need for vaccination and an electronic reminder sent to subjects' primary care provider. Vaccine series completion rates were compared amongst the two strategies using a chi-square analysis. A series completion failure was defined as failure to receive all three doses of the HBV or combined HAV/HBV series within 14 months of study enrollment. The implementation of each strategy was studied including recording the time per subject required to perform each strategy. Results: Those who received the UV strategy had a reduction in series completion failures compared to SOC RR: 0.46 (0.27; 0.81); p < 0.01. The mean time needed to conduct UV was 7.3 (± 3) minutes. Unnecessary vaccinations based upon follow up serologies were observed. Those receiving UV were more likely to receive an unnecessary vaccination RR: 4.4 (1.7; 12). Subjects receiving the outreach intervention did not experience a reduction in series completion failures compared to SOC RR: 0.82 (0.49; 1.67); p=0.3. The mean time needed to perform outreach interventions was 7.75 (± 2) minutes. Conclusions: The UV strategy resulted in a large reduction of series completion failures compared to SOC, with time required similar to the outreach strategy. Outreach efforts were labor intensive and did not result in lower rates of series completion failures. Further study of clinic workflow is needed to reduce the time required to perform UV and to identify methods to avoid unnecessary vaccinations.

Tu1001 Intensive Vaccination Strategies vs. Standard of Care in the Hepatitis C Clinic: a Pragmatic Randomized 2×2 Factorial Trial

Background: Immunization for Hepatitis A (HAV) and Hepatitis B (HBV) is recommended for Hepatitis C (HCV) patients as superinfection can increase the risk of adverse events. Since immunogenicity increases with each successive dose in the vaccine series, completing the series provides the best chance of maximal protection. Standard of care (SOC) approaches such as provider driven vaccination after serologic testing results in poor series completion rates. Universal vaccination (UV), where patients are vaccinated for HAV/HBV without prior serologic testing, is a commonly identified as an effective vaccination strategy. Patient and provider outreach interventions have also been recommended to improve vaccination rates. Studies of the effectiveness and implementation of these strategies is lacking. Methods: Veteran patients were eligible if they attended a HCV group medical appointment and had evidence of chronic HCV without history of immunization/serologic evidence of immunity to HBV alone or HAV and HBV. Using a 2x2 factorial design assuming no interactions, consenting subjects were randomized to one of four vaccination strategies: 1) UV alone 2) UV plus outreach 3) outreach plus SOC 4) or SOC alone. UV was initiated at enrollment prior to serologic testing. Outreach interventions included a phone and mailed reminder to subjects about the need for vaccination and an electronic reminder sent to subjects' primary care provider. Vaccine series completion rates were compared amongst the two strategies using a chi-square analysis. A series completion failure was defined as failure to receive all three doses of the HBV or combined HAV/HBV series within 14 months of study enrollment. The implementation of each strategy was studied including recording the time per subject required to perform each strategy. Results: Those who received the UV strategy had a reduction in series completion failures compared to SOC RR: 0.46 (0.27; 0.81); p < 0.01. The mean time needed to conduct UV was 7.3 (± 3) minutes. Unnecessary vaccinations based upon follow up serologies were observed. Those receiving UV were more likely to receive an unnecessary vaccination RR: 4.4 (1.7; 12). Subjects receiving the outreach intervention did not experience a reduction in series completion failures compared to SOC RR: 0.82 (0.49; 1.67); p=0.3. The mean time needed to perform outreach interventions was 7.75 (± 2) minutes. Conclusions: The UV strategy resulted in a large reduction of series completion failures compared to SOC, with time required similar to the outreach strategy. Outreach efforts were labor intensive and did not result in lower rates of series completion failures. Further study of clinic workflow is needed to reduce the time required to perform UV and to identify methods to avoid unnecessary vaccinations.

Immune response to the HPV-16/18 AS04-adjuvanted vaccine administered as a 2-dose or 3-dose schedule up to 4 years after vaccination

This randomized, partially-blind study (ClinicalTrials.gov registration number NCT00541970) evaluated the immunogenicity and safety of 2-dose (2D) schedules of the HPV-16/18 AS04-adjuvanted vaccine. Results to month (M) 24 have been reported previously and we now report data to M48 focusing on the licensed vaccine formulation (20 μg each of HPV-16 and -18 antigens) administered at M0,6 compared with the standard 3-dose (3D) schedule (M0,1,6). Healthy females (age stratified: 9–14, 15–19, 20–25 years) were randomized to receive 2D at M0,6 (n = 240) or 3D at M0,1,6 (n = 239). In the according-to-protocol immunogenicity cohort, all initially seronegative subjects seroconverted for HPV-16 and -18 antibodies and remained seropositive up to M48. For both HPV-16 and -18, geometric mean antibody titer (GMT) ratios (3D schedule in women aged 15–25 years divided by 2D schedule in girls aged 9–14 years) at M36 and M48 were close to 1, as they were at M7 when non-inferiority was demonstrated. The kinetics of HPV-16, -18, -31, and -45 antibody responses were similar for both groups and HPV-16 and -18 GMTs were substantially higher than natural infection titers. The vaccine had a clinically acceptable safety profile in both groups. In summary, antibody responses to a 2D M0,6 schedule of the licensed vaccine formulation in girls aged 9–14 years appeared comparable to the standard 3D schedule in women aged 15–25 years up to 4 years after first vaccination. A 2D schedule could facilitate implementation of HPV vaccination programs and improve vaccine coverage and series completion rates.

Increasing HPV Vaccination Series Completion Rates via Text Message Reminders

Human papillomavirus (HPV) is the most frequently diagnosed sexually transmitted infection in the United States. It is associated with the development of cervical, anal-genital, and oral-pharyngeal cancers. The rate of HPV infection among adolescents and young adults in the United States remains high, and completion rates of an HPV vaccine series remain low. At an urban pediatric clinic, adolescent and young adult participants aged 11 to 22 years (n = 37) received text message reminders for their second and third dose of HPV vaccine over an 8-month study period. Of the participants receiving text message reminders, 14% completed the vaccine series at the optimal time, whereas 0% of an interested group (n = 43) and only 3% of a standard care group (n = 232) completed the vaccine series at the optimal time. Findings support the use of text message reminders to improve HPV vaccine series completion rates in a pediatric practice.

Human papillomavirus vaccine in adolescent women

Despite recommendations from the Advisory Committee on Immunization Practices (ACIP) for routine vaccination of adolescents with the human papillomavirus (HPV) vaccine, U.S. coverage among women remains less than 50%, with that of adolescent men below 2%. Ongoing studies document the efficacy and safety of the HPV vaccine. Nevertheless, misconceptions and negative attitudes persist and serve as barriers to vaccine uptake. Additionally, other factors such as age, insurance status, poverty status, and racial or ethnic background have been associated with diminished vaccine uptake and poor completion rates. Internationally, HPV vaccination programs and school-based programs have achieved increased rates of uptake and series completion. HPV vaccination coverage may also be facilitated by improving communication between physicians, parents, and adolescents as well as by addressing common misconceptions about the vaccine. This review highlights significant findings of recent literature on HPV vaccination of adolescent women with a special focus on uptake, series completion, communication, disparities in vaccine coverage, and other health outcomes associated with HPV vaccination.

Patient Adherence to Three Dose Completion of the Quadrivalent Human Papillomavirus (HPV) Vaccine in a Private Practice

The human papillomavirus quadrivalent (types 6, 11, 16, and 18) recombinant vaccine is effective in preventing cervical, vulvar, vaginal and anal cancer. Maximal protection is achieved with completion of all three recommended doses. A retrospective chart review was performed to (1) assess the current vaccine series completion rates in a private practice multispecialty suburban setting and (2) identify factors associated with failure to complete the vaccine series. Chi-square and independent samples t test were used for data analysis. A total of 4,117 patients out of 10,821 eligible patients received at least one dose of the HPV vaccine between October 1, 2006 and April 30, 2010. Overall, 69.5 % (n = 2,863) of patients who received one dose of the HPV vaccine completed all three doses in a valid time frame, representing 26.5 % of all eligible patients. Patients who completed the series were younger (16.8 vs. 18.2, p < 0.05), less likely to have a sexually transmitted disease diagnosis prior to initiation of the series (57.7 vs. 69.8 %, p < 0.05), and more likely to have visited the pediatrics department compared to family medicine, internal medicine, and OB/GYN departments (75.9, 65.7, 57.0, 60.9 %, respectively, p < 0.05). Deaths, pregnancies, and adverse drug reactions were not identified as independent factors impacting completion rates. The results indicate that adolescents, patients visiting the pediatrics department and those without a prior STD diagnosis completed the vaccination series more frequently than adults managed in family medicine, internal medicine, and OB/GYN departments.

Follow-up Analysis of Adolescents Partially Vaccinated Against Human Papillomavirus

To evaluate factors associated with human papillomavirus vaccination among a cohort of female adolescents previously identified as receiving only one or two doses of vaccine. This was a 15-month follow-up analysis of a previously identified cohort of 9-18-year-old female adolescents seen in primary clinics within a university-based health system. Vaccine receipt and associated factors were identified by review of administrative records. Among the 1,714 partially vaccinated female adolescents, 53% eventually completed the vaccination series. There was a wide range of dosing intervals ranging from 31 to 840 days between first and second doses and from 85 to 666 days between second and third doses. Race and insurance type were associated with lower rates of series completion, but not with receiving second doses. Approximately half of the partially vaccinated girls in our cohort eventually completed the series, albeit often over a longer than recommended interval. There were important disparities in human papillomavirus vaccination.