Investigators from multiple institutions conducted a retrospective study to evaluate trends in human papillomavirus (HPV) vaccination in US children 9-12 years old during the period 2008–2018. For the study they reviewed data from the National Immunization Survey-Teen (NIS-Teen). NIS-Teen is an annual population-based survey used to collect vaccination information on US teens between the ages of 13 and 17. Random digit dialing is used to contact households to collect demographic and immunization data. Dates of vaccinations are verified using a questionnaire mailed to health care providers identified by survey respondents. Data from NIS-Teen are weighted to provide nationally representative estimates. For the current study, data on the cohort of youths who were 13 years old at the time of each survey between 2008 and 2018 were abstracted. Rates of HPV initiation between the ages of 9 and 12 years were determined, and, when full data became available in 2011, annual rates of HPV up-to-date (HPV-UTD) status calculated. HPV-UTD was defined as receipt of 3 doses of HPV vaccine, or receipt of 2 doses at least 5 months (minus 4 days) apart, before a child’s 13th birthday. Results were stratified by sex, race (white or Black), ethnicity, and state. Logistic regression was used to assess the differences in HPV initiation and HPV-UTD rates over time.
During the study period, nationally representative HPV vaccination rates for children 9-12 years old were based on annual number of responses ranging from 3,455 to 4,763. Overall, HPV initiation rates rose from 17.3% in 2008 to 62.8% in 2018 (P < 0.0001 for trend), and HPV-UTD increased from 13.5% in 2011 to 32.8% in 2018 (P < 0.0001). HPV-UTD rates increased by 31.9% between 2011 and 2018 among boys, compared to a 6.6% increase in girls. Throughout the study period HPV-UTD rates were higher in Hispanic children than those in non-Hispanic white and non-Hispanic Black youths. Similarly, HPV-UTD rates were higher in non-Hispanic Black youths than in non-Hispanic whites. By 2018, HPV initiation rates were >60% in 32 US states and >70% in 16. HPV-UTD rates were <50% in all states except Rhode Island (61.6%), Colorado (58.7%), Hawaii (53.5%), and Ohio (50%), as well as the District of Columbia (53.2%). States with the lowest HPV-UTD rates were Mississippi (12.5%), Missouri (14.2%), and Utah (15.7%).
The authors conclude that HPV vaccination status in US children 9-12 years old is suboptimal.
Dr Doolittle has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
The HPV vaccine is unique. It is the first to protect against adult cancers rather than a childhood infectious disease. Cervical cancer is the second leading cause of cancer death of women worldwide.1 Numerous studies have shown that...