Promising new vaccine strategy

Bundling may boost HPV vaccine uptake, study finds

Stephanie Soucheray, MA

Human papillomavirus vaccination (HPV) rates are at suboptimal levels across the United States, but a study published today in Pediatrics suggests a bundled intervention can raise vaccinations during well-child visits by almost 5%. 

In 2021, only 77% of US adolescents ages 13 to 17 years had initiated and 62% had completed the HPV vaccine series, which is highly effective in preventing cervical cancer. 

The series is recommended for children ages 9 to 12, but uptake has suffered since the pandemic disrupted routine well-child care and further promoted vaccine hesitancy across the country. 

The study authors said about 14 million Americans are infected with HPV, leading to 36,500 new cancers, 3,800 cervical cancer deaths, and $9.6 billion in medical costs annually. 

Three main barriers

Several previous studies have identified three main barriers to HPV vaccination: (1) parental vaccine hesitancy or infrequent well-child care visits, (2) a lack of vaccine communication by clinicians and staff or missed vaccination opportunities at office visits, and (3) a lack of feedback to clinicians about HPV vaccination rates.

In this study, the authors bundled an intervention to address all three of these barriers. They compared rates for a 12-month period before versus during a 6-month period (February 23, 2022 to August 9, 2022) in which the bundled intervention was employed. The bundled intervention was implented in 24 US primary care pediatric practices.

"The bundled intervention involved 3 components: online clinician training on HPV vaccine communication, performance feedback on missed HPV vaccination opportunities, and clinician prompts for HPV vaccination," the authors wrote. 

Previous studies had shown that each of those interventions had reduced missed HPV vaccine opportunities, but they had never been tried together. 

Fewer missed vaccine opportunities 

During the intervention, missed vaccination opportunities improved by 4.8 percentage points (95% confidence interval [CI], −7.2% to −2.4%) for initial vaccine doses and 2.2 percentage points (95% CI, −4.4% to −0.0%) for subsequent doses. 

Notably, the authors found no reduction in missed vaccination opportunities during acute or chronic care visits, only for well-child visits. 

"Our study was implemented during an unusually busy respiratory season in 2022 and the COVID-19 Omicron variant, making it challenging to implement changes at acute care visits, even for subsequent vaccinations for which parental vaccine hesitancy is uncommon," the authors explained. 

"Given these real-world challenges, we feel HPV vaccination efforts should focus primarily on WCC [well-child care] visits, plus perhaps chronic care visits when more time may be available, and nursing visits for influenza vaccination, which focus on vaccination.