Initiation of HPV Vaccination Before Age 11 in a US Sample of Pediatric Practices

Davis K, Rand C, Stephens-Shields J, Kelly M, Localio R, Grundmeier R, Steffes J, Albertin C, Abney D, Szilagyi P, Fiks A

Presented at the 2023 Pediatric Academic Societies Annual Meeting

Background: Since 2018, the American Academy of Pediatrics (AAP) recommended the human papillomavirus vaccine series be started “between 9 and 12 years, at an age the provider deems optimal for acceptance and completion of the vaccination series.” The AAP recommendation was issued just a year before many practice disruptions began, resulting from the COVID-19 pandemic. Little current data exists on the age at which children begin their HPV series or how that may vary across pediatric practices.

Objective: Describe rates of HPV vaccine initiation before age 11 from 2018 to 2021 and to examine recent (2021) practice-level variation in vaccine initiation for children before age 11.

Methods: As part of the NIH-funded STOP-HPV trial for children ages 11-17, we extracted relevant data, including complete vaccination history, from electronic health records (EHRs) of 48 pediatric primary care practices in 19 states that are a part of the AAP’s Pediatric Research in Office Settings Network (PROS). The trial itself did not focus on age of vaccination. We used descriptive analyses to assess the percentage of all children in practices randomized to both intervention and control arms who received >1 HPV vaccines before age 11, among children with any visits between 2018 and 2021. We used the number of children (among those seen during this period) turning 11 each year who had 1 dose before their 11th birthday as the numerator and the number of children who turned 11 in the year as the denominator. We also assessed the distribution of practice-level rates of vaccine initiation for children younger than 11 in 2021.

Results: Over the 4 year period, 80,935 patients turned 11 in one of the four years and were included in the analysis (49% Female, 10% Black, 58% White, 5%, Asian or Pacific Islander,1% Native American or Alaskan, 1% mixed race. 17% Hispanic). As shown in Figure 1, the percent of age-eligible children for whom HPV vaccination was initiated under age 11 was 5% in 2018 and 9% in 2021. In 2021, 74% of practices (n=35) initiated HPV vaccination before age 11 for less than 10% of children, while 11% (n=5) did not initiate the series for any patients before age 11 (Figure 2, range 0 to 63%).

Conclusion: During a period that included three years of the COVID-19 pandemic, HPV vaccination initiation for children under 11 increased slightly from 2018 to 2021 in this group of 48 pediatric practices across the US. Few practices routinely initiate HPV vaccine before age 11.

Figure 1. Percentage of children receiving initial HPV vaccination before age 11: 2018 to 2021

Figure 2. Practice distribution of percentage of children receiving an HPV vaccination before Age 11 in 2021 (n=47 practices)