Chao Chun, Velicer Christine, Slezak Jeff M, Jacobsen Steven J
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101, USA.
Mayo Clin Proc. 2009 Oct;84(10):864-70. doi: 10.4065/84.10.864.
To examine the rate and correlates of completion of the quadrivalent human papillomavirus vaccine (HPV4) 3-dose regimen because nonadherence to the regimen may adversely affect vaccine efficacy.
Female members of Kaiser Permanente Southern California who were 9 to 26 years old, received the first dose of HPV4 between October 2006 and March 2007, and maintained health plan membership 12 months afterward were identified and followed up for regimen completion. We examined the following: (1) demographics/socioeconomic status, (2) primary care physician characteristics, (3) historical health service utilization, (4) women's health-related conditions, and (5) selected immune-related conditions for their association with completion in 2 age groups: 9 to 17 years and 18 to 26 years. Multivariable log-binomial regression was used to directly estimate relative risk (RR).
Of the 34,193 females who initiated HPV4, the completion rate was 41.9% in the 9- to 17-year-old group and 47.1% in the 18- to 26-year-old group. Black race (RR, 0.70; 95% confidence interval [CI], 0.64-0.77) and lower neighborhood education level were associated with lower regimen completion. However, those in the 9- to 17-year-old group who were covered by the state-subsidized program Medi-Cal were more likely to complete the regimen (RR, 1.14; 95% CI, 1.07-1.22). Historical hospitalizations and emergency department visits (RR, 0.92; 95% CI, 0.87-0.96; and RR, 0.96; 95% CI, 0.94-0.98 per visit, respectively) and having a pediatrician were also predictors of noncompletion. A history of sexually transmitted diseases, abnormal Papanicolaou test results, and immune-related conditions (eg, asthma/infections) were not associated with regimen completion.
These findings suggest that factors such as race or socioeconomic status should be considered when human papillomavirus vaccination programs are being designed and evaluated.
鉴于不遵守四价人乳头瘤病毒疫苗（HPV4）3剂接种方案可能会对疫苗效力产生不利影响，故研究该方案的完成率及其相关因素。
确定了南加州永久医疗集团年龄在9至26岁之间、于2006年10月至2007年3月期间接种了第一剂HPV4且之后12个月仍保持健康计划会员身份的女性成员，并对其进行随访以了解接种方案的完成情况。我们研究了以下方面：（1）人口统计学/社会经济状况，（2）初级保健医生特征，（3）既往医疗服务利用情况，（4）女性健康相关状况，以及（5）选定的免疫相关状况，以了解它们在9至17岁和18至26岁这两个年龄组中与接种方案完成情况的关联。采用多变量对数二项回归直接估计相对风险（RR）。
在34193名开始接种HPV4的女性中，9至17岁组的完成率为41.9%，18至26岁组为47.1%。黑人种族（RR，0.70；95%置信区间[CI]，0.64 - 0.77）以及社区教育水平较低与较低的接种方案完成率相关。然而，9至17岁组中参加州补贴项目“医疗救助”（Medi-Cal）的女性更有可能完成接种方案（RR，1.14；95% CI，1.07 - 1.22）。既往住院和急诊就诊（RR分别为0.92；95% CI，0.87 - 0.96；每次就诊RR为0.96；95% CI，0.94 - 0.98）以及有儿科医生也是未完成接种的预测因素。性传播疾病史、巴氏试验异常结果以及免疫相关状况（如哮喘/感染）与接种方案完成情况无关。
这些发现表明，在设计和评估人乳头瘤病毒疫苗接种项目时，应考虑种族或社会经济状况等因素。
