Human Papillomavirus Vaccine: Continuation, Completion and Missed Opportunities

STUDY OBJECTIVE: To examine HPV series completion in older adolescents and assess vaccination completion opportunities missed by providers.

DESIGN, SETTING, PARTICIPANTS, AND OUTCOME MEASURES: Electronic medical records were queried for women 18-24 years old who initiated the HPV vaccine in the Adolescent Medicine, Young Mother\'s or Family Planning clinics at Children\'s Hospital Colorado from 1/1/2010-12/31/2012. Clinic visits during appropriate dosing intervals of HPV vaccine where the 2(nd) (4-14 weeks after 1(st) dose) or 3(rd) (21-40 weeks after 1(st) dose and >12 weeks after 2(nd) dose) doses were not administered were counted as \"missed opportunities.\"

RESULTS: A total of 1,072 females initiated the HPV series during the study period; 20.9% completed the series within one year. Of these, 33.7% who did not receive their 2(nd) dose had at least one missed opportunity and 25.5% who received the 2(nd) but not 3(rd) had a missed opportunity. Women who initiated the vaccine in the Family Planning clinic were less likely to have missed opportunities than those in other adolescent clinics (36.2% vs. 56.4%; p<0.001).

CONCLUSIONS: A significant number of adolescent females who initiated the HPV vaccine attended clinic visits where opportunities for vaccine continuation and completion were missed. This emphasizes the importance of provider-awareness of vaccine updates at every adolescent visit. Our overall completion rate is significantly lower than published rates and may reflect older adolescents\' inexperience in managing their own preventive health care. Our results clearly identify the need for provider and patient interventions to improve vaccine series completion.