Influenza Vaccine Visits are an Underutilized Avenue for Increasing Human Papilloma Virus Vaccination Rates: An AAP Pediatric Research in Office Settings (PROS) National Primary Care Research Network Study

Mary Kate Kelly, Abigail Breck, Robert W. Grundmeier, Alisa Stephens, Russell Localio, Laura Shone, Margaret Wright, Jenny Steffes, Christina Albertin, Sharon Humiston, Cynthia M. Rand, Dianna Abney, Greta McFarland, Peter G. Szilagyi, Alexander G. Fiks

Presented at the 2019 Pediatric Academic Societies Annual Meeting.

Background: Despite proven benefits, vaccination rates for HPV remain substantially lower than for other adolescent immunizations. Missed opportunities (MOs) at primary care visits contribute to low HPV vaccine coverage.  Although influenza vaccination is administered often at clinician and nurse-only visits, little is known about MOs for HPV during these visits.

Objective: To examine the extent to which influenza vaccine visits are being utilized to administer the HPV vaccine.

Methods: As part of the NIH-funded STOP HPV trial, we extracted electronic health record (EHR) data from 37 practices across 19 states recruited from the AAP PROS national pediatric primary care network. We extracted all office visits from 2015-2018 in which the influenza vaccine was administered to HPV vaccine-eligible 11 to 17-year-olds. Among those visits, MOs were defined as the proportion in which an HPV vaccine was due but not given. MOs were examined overall and separately by visit type, patient sex and age, and HPV dose due.  A log-linear model, clustered by practice, examined the association of visit type, patient characteristics, and HPV dose with MOs.

Results: A total of 46,073 HPV-eligible influenza vaccine visits among 34,401 patients (median age: 12 yr., 46% female) were analyzed [Table]. Over half (58%) of these HPV vaccination opportunities were missed, and MO rates varied by practice (median: 58%, range: 22%-81%). MOs were far more common at visits during which an initial versus subsequent HPV vaccine dose was due (70% vs. 30%). MOs were also higher at acute/chronic and nurse visits versus preventive visits (74% and 77% vs. 39%). MOs were similar in males and females and slightly higher among younger versus older patients. In the multivariate model, MOs were significantly higher for initial versus subsequent doses (RR: 2.46, 95% CI: 2.22-2.73) and at acute/chronic (RR: 2.03 95% CI: 1.87-2.21) and nurse (RR: 2.08, 95% CI: 1.90-2.29) visits compared to preventive visits.

Conclusion: MOs for HPV vaccination during visits where influenza vaccine is given are frequent, particularly during acute/chronic or nurse-only visits and for the initial HPV vaccine. These MOs are also common for subsequent HPV doses, when vaccine hesitancy is less likely.  Efforts to increase simultaneous administration of HPV and influenza vaccines are warranted.