The impact of school-entry mandates on social inequalities in human papillomavirus vaccination

2018 ◽

Cited By ~ 3

Author(s):

Linda M. Niccolai ◽

Anna L. North ◽

Alison Footman ◽

Caitlin E. Hansen

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccination ◽

School Entry ◽

Structured Interviews ◽

Human Papillomavirus Vaccination ◽

Strong Recommendation ◽

Entry Requirements ◽

Design And Methods ◽

Purposive Sample

Background: A strong recommendation from a clinician is one of the best predictors of human papillomavirus (HPV) vaccination among adolescents, yet many clinicians do not provide effective recommendations. The objective of this study was to understand how the lack of school entry requirements for HPV vaccination influences clinicians’ recommendations. Design and Methods: Semi-structured interviews with a purposive sample of 32 clinicians were conducted in 2015 in Connecticut USA. Data were analysed using an iterative thematic approach in 2016-2017. Results: Many clinicians described presenting HPV vaccination as optional or non-urgent because it is not required for school entry. This was noted to be different from how other required vaccines were discussed. Even strong recommendations were often qualified by statements about the lack of requirements. Furthermore, lack of requirements was often raised initially by clinicians and not by parents. Many clinicians agreed that requirements would simplify the recommendation, but that parents may not agree with requirements. Personal opinions about school entry requirements were mixed. Conclusions: The current lack of school entry requirements for HPV vaccination is an important influence on clinicians’ recommendations that are often framed as optional or non-urgent. Efforts are needed to strengthen the quality of clinicians’ recommendations in a way that remains strong and focused on disease prevention yet uncoupled from the lack of requirements that may encourage delays. Additionally, greater support for requirements among clinicians may be needed to successfully enact requirements in the future.

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Association Between Human Papillomavirus Vaccination School-Entry Requirements and Vaccination Initiation

JAMA Pediatrics ◽

10.1001/jamapediatrics.2020.1852 ◽

2020 ◽

Vol 174 (9) ◽

pp. 861 ◽

Cited By ~ 1

Author(s):

Jamie S. Ko ◽

Cameron S. Goldbeck ◽

Eleonore B. Baughan ◽

Jeffrey D. Klausner

Keyword(s):

Human Papillomavirus ◽

School Entry ◽

Human Papillomavirus Vaccination ◽

Entry Requirements

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One-Dose Human Papillomavirus Vaccination and the Risk of Genital Warts: A Danish Nationwide Population-based Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1067 ◽

2020 ◽

Author(s):

Louise Baandrup ◽

Christian Dehlendorff ◽

Susanne K Kjaer

Keyword(s):

Human Papillomavirus ◽

Hpv Vaccination ◽

Age Groups ◽

Genital Warts ◽

Population Based ◽

Incidence Rates ◽

Real World Data ◽

Calendar Time ◽

Human Papillomavirus Vaccination ◽

The Impact

Abstract Background Increasing evidence suggests that 1-dose human papillomavirus (HPV) vaccination may protect significantly against HPV-related disease. We provide nationwide, real-world data on the risk of genital warts (GWs) after <3 vaccine doses. Methods All Danish women born in 1985–2003 were identified, and individual-level vaccination data were retrieved. The cohort was followed up for first occurrence of GWs until 31 December 2016. Using Poisson regression, we calculated incidence rates (IRs) of GWs per 100 000 person-years and IR ratios (IRRs) with corresponding 95% confidence intervals (CIs) for GWs, according to vaccination status, age at first dose, and calendar time. Results The cohort comprised 1 076 945 girls and women, of whom 485 408 were vaccinated. For girls initiating vaccination at age 12–14 years and 15–16 years, 1-dose vaccine effectiveness (VE) was 71% (IRR = 0.29; 95% CI, .22–.38) and 62% (0.38; .29–.49), respectively, compared with unvaccinated girls. In the same age groups, 2-dose VE was 78% (IRR, 0.22; 95% CI, .18–.26) and 68% (0.32; .26–.38), respectively. After 2009, the IRRs for 3 versus 1 dose and 2 versus 1 dose increased towards unity over calendar time, being 0.69 (95% CI, .57–.84) and 0.86 (.68–1.08) in 2016, respectively. Conclusions In this study, 1 or 2 doses of quadrivalent HPV vaccine was associated with substantial protection against GWs in girls vaccinated at age ≤16 years. The 1-dose VE approached that of 3 or 2 doses over calendar time, probably reflecting the impact of herd protection.

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Factors influencing rates of human papillomavirus vaccination

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxz246 ◽

2019 ◽

Author(s):

Kelsey E Palmer ◽

Krystal L Moorman ◽

Nancy A Nickman ◽

David G Owen

Keyword(s):

Human Papillomavirus ◽

Failure Modes ◽

Hpv Vaccination ◽

Care Process ◽

Quality Improvement Initiative ◽

Human Papillomavirus Vaccination ◽

Community Clinic ◽

Process Improvements ◽

The Impact

Abstract Purpose Failure modes and effects analysis (FMEA) was used to identify ways in which community clinic practices related to suboptimal human papillomavirus (HPV) vaccination rates could be improved. Method FMEA is a standardized safety method that helps determine where processes fail, the impact of failures, and needed process changes. In a quality improvement initiative conducted at an academic health center–based community clinic, a multidisciplinary team used FMEA to map HPV vaccination processes and identify areas for improvement of vaccination practices. Risk priority numbers (RPNs) were assigned to identified failure modes based on likelihood of occurrence, likelihood of detection, and ability to correct locally. Failure modes with the highest RPNs were targeted for process improvements. Results High RPN failure modes were related to clinic processes for follow-up, immunization status checks during well-child visits, and vaccination discussions during sick-child visits. New procedures included scheduling follow-up vaccinations and reminders during the initial vaccination appointment. HPV immunization rates improved following implementation of these procedures, indicating that clinic processes focused on patient follow-up can impact vaccination series completion. Conclusion FMEA processes can help health systems identify workflow barriers and locally relevant opportunities for improvement. Team-based approaches to care process improvements can also benefit from standardized problem identification and solving.

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Human papillomavirus vaccination and social inequality: results from a prospective cohort study

Epidemiology and Infection ◽

10.1017/s095026881000066x ◽

2010 ◽

Vol 139 (3) ◽

pp. 400-405 ◽

Cited By ~ 44

Author(s):

S. A. ROBERTS ◽

L. BRABIN ◽

R. STRETCH ◽

D. BAXTER ◽

P. ELTON ◽

...

Keyword(s):

Human Papillomavirus ◽

Ethnic Minority ◽

Social Inequalities ◽

Hpv Vaccination ◽

Vaccine Uptake ◽

Human Papillomavirus Vaccination ◽

Childhood Immunizations ◽

Combining Data ◽

To Come ◽

Minority Girls

SUMMARYWe investigated the effect of social inequalities on the uptake of human papillomavirus (HPV) vaccination, combining data from a feasibility study conducted in 2007–2008 in 2817 secondary schoolgirls in two UK primary-care trusts, with census and child health records. Uptake was significantly lower in more deprived areas (P<0·001) and in ethnic minority girls (P=0·013). The relatively small proportion of parents who actively refused vaccination by returning a negative consent form were more likely to come from more advantaged areas (P<0·001). Non-responding parents were from more deprived (P<0·001) and ethnic minority (P=0·001) backgrounds. Girls who did not receive HPV vaccination were less likely to have received all their childhood immunizations particularly measles, mumps and rubella (MMR). Different approaches may be needed to maximize HPV vaccine uptake in engaged and non-responding parents, including ethnic-specific approaches for non-responders.

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