Adolescent HPV vaccination rates lag behind other vaccinations, partly due to missed opportunities for vaccination and lack of provider recommendation. This study evaluated the rates of HPV vaccination among adolescents with physical and mental limitation and controls, and evaluated differences in parental knowledge and reasons for nonvaccination between groups.
Materials and Methods
A retrospective chart review was performed on female patients age 12-18 presenting to pediatric or gynecology clinics in 2012. Those subjects with a diagnosis of mental or physical limitation were classified as “affected”. HPV vaccination rates were compared between affected and control groups. Parents of affected subjects were contacted by phone and surveyed regarding HPV knowledge and reasons for nonvaccination. Parents of controls were contacted at a 2:1 ratio and administered the same survey.
1673 females were included in the study; 72 (4.3%) with mental/physical impairment (affected). Overall, 944 (56.4%) subjects had initiated HPV vaccination and 653 (39%) had completed the three dose series. When comparing affected subjects to controls, the control group was more likely to have received any HPV vaccination (RR 1.32, 95% CI 1.013, 1.73). Parents of 21 affected subjects and 44 control subjects were contacted by phone. No differences were found in parent knowledge of HPV or importance of vaccination to a child’s health. There were no differences in reasons for nonvaccination between groups, but for both groups “lack of provider recommendation” was in the top two choices. That the vaccine was “not needed” was the other main reason given for nonvaccination in the affected group, while the control group main reason for nonvaccination was “concerns for safety”.
Adolescents with mental or physical limitation may be less likely to receive HPV vaccination. Lack of provider recommendation remains one of the primary reasons those in this population do not receive HPV vaccination.
Conflict(s) of Interest
References with DOI
1. Markowitz LE, Dunne EF, Saraiya M, Chesson HW, Curtis CR, Gee J, et al. Human papillomavirus vaccination: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recommendations and reports : Morbidity and mortality weekly report Recommendations and reports / Centers for Disease Control. 2014 Aug 29;63(RR-05):1-30. PubMed PMID: 25167164. https://doi.org/10.1037/e601292007-001
2. Robinson CL, Advisory Committee on Immunization Practices ACAIWG. Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 Through 18 Years-- United States, 2016. MMWR Morbidity and mortality weekly report. 2016;65(4):86-7. PubMed PMID: 26845283. https://doi.org/10.15585/mmwr.mm6504a4
3. Meites E, Kempe A, Markowitz LE. Use of a 2-Dose Schedule for Human Papillomavirus Vaccination - Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morbidity and mortality weekly report. 2016 Dec 16;65(49):1405-8. PubMed PMID: 27977643. https://doi.org/10.15585/mmwr.mm6549a5
4. Munoz N, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM, et al. Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. Journal of the National Cancer Institute. 2010 Mar 3;102(5):325-39. PubMed PMID: 20139221. https://doi.org/10.1093/jnci/djp534
5. Gee J, Naleway A, Shui I, Baggs J, Yin R, Li R, et al. Monitoring the safety of quadrivalent human papillomavirus vaccine: findings from the Vaccine Safety Datalink. Vaccine. 2011 Oct 26;29(46):8279-84. PubMed PMID: 21907257. https://doi.org/10.1016/j.vaccine.2011.08.106
6. Reagan-Steiner S, Yankey D, Jeyarajah J, Elam-Evans LD, Curtis CR, MacNeil J, et al. National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13-17 Years - United States, 2015. MMWR Morbidity and mortality weekly report. 2016;65(33):850-8. PubMed PMID: 27561081. https://doi.org/10.15585/mmwr.mm6533a4
7. Dorell C, Yankey D, Kennedy A, Stokley S. Factors that influence parental vaccination decisions for adolescents, 13 to 17 years old: National Immunization Survey-Teen, 2010. Clinical pediatrics. 2013 Feb;52(2):162-70. PubMed PMID: 23221308. https://doi.org/10.1177/0009922812468208
8. Cody PJ, Lerand SJ. HPV vaccination in female children with special health care needs. Journal of pediatric and adolescent gynecology. 2013 Aug;26(4):219-23. PubMed PMID: 23726139. https://doi.org/10.1016/j.jpag.2013.03.003
9. Blum RW, Kelly A, Ireland M. Health-risk behaviors and protective factors among adolescents with mobility impairments and learning and emotional disabilities. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 2001 Jun;28(6):481-90. PubMed PMID: 11377992. https://doi.org/10.1016/s1054-139x(01)00201-4
10. Mandell DS, Walrath CM, Manteuffel B, Sgro G, Pinto-Martin JA. The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child abuse & neglect. 2005 Dec;29(12):1359-72. PubMed PMID: 16293306. https://doi.org/10.1016/j.chiabu.2005.06.006
11. Sonnex C, Strauss S, Gray JJ. Detection of human papillomavirus DNA on the fingers of patients with genital warts. Sexually transmitted infections. 1999 Oct;75(5):317-9. PubMed PMID: 10616355. Pubmed Central PMCID: 1758241. https://doi.org/10.1136/sti.75.5.317
12. Bacopoulou F, Karakitsos P, Kottaridi C, Stefanaki C, Deligeoroglou E, Theodoridou K, et al. Genital HPV in Children and Adolescents: Does Sexual Activity Make a Difference? Journal of pediatric and adolescent gynecology. 2016 Jun;29(3):228-33. PubMed PMID: 26342734. https://doi.org/10.1016/j.jpag.2015.08.010
13. Stokley S, Jeyarajah J, Yankey D, Cano M, Gee J, Roark J, et al. Human papillomavirus vaccination coverage among adolescents, 2007-2013, and postlicensure vaccine safety monitoring, 2006-2014--United States. MMWR Morbidity and mortality weekly report. 2014 Jul 25;63(29):620-4. PubMed PMID: 25055185.
Rowe, Melissa; Pritt, Audra L.; Stratton, Amanda J.; and Yoost, Jennie L.
"HPV Vaccination Among Females with Mental and Physical Limitation,"
Marshall Journal of Medicine:
2, Article 8.
Available at: https://mds.marshall.edu/mjm/vol3/iss2/8