Department of Pediatrics, Columbia University, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA.
Department of Pediatrics, Columbia University, New York, NY, USA; NewYork-Presbyterian Hospital, New York, NY, USA; Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA.
Vaccine. 2014 Apr 7;32(17):1939-45. doi: 10.1016/j.vaccine.2014.01.084. Epub 2014 Feb 14.
Human papillomavirus (HPV) vaccination is recommended in early adolescence. While limited data suggest that patients frequently delay initiation of the three-dose series, age-based variability in initiation of HPV vaccination and its clinical relevance are not well described. Thus, this study aims to characterize HPV vaccination delay among adolescent and young adult females.
This retrospective cohort study examined age at HPV vaccination initiation and missed opportunities for receipt of the first vaccine dose (HPV1) among 11-26 year-old females (n=22,900) receiving care at 16 urban academically-affiliated ambulatory care clinics between 2007 and 2011. Predictors of timely vaccination and post-licensure trends in age at HPV1 receipt were assessed using multivariable logistic regression and a generalized linear mixed model, respectively. Chlamydia trachomatis and Papanicolaou screening before HPV vaccination initiation, as markers of prior sexual experience and associated morbidity, were examined in a subcohort of subjects (n=15,049).
The proportion of 11-12 year-olds who initiated HPV vaccination increased over time (44.4% [2007] vs. 74.5% [2011], p<0.01). Initiation rates also improved among 13-26 year-olds. Thus, the mean age at HPV1 receipt remained unchanged between 2007 and 2011 (16.0 ± 2.7 vs. 15.9 ± 4.0 years, p=0.45). Spanish language was a positive predictor (AOR 1.62, 95% CI 1.05-2.48) of HPV vaccination initiation among 11-12 year-olds in 2011. The majority (70.8-76.4%) of unvaccinated subjects experienced missed vaccination opportunities. Of the subcohort, 36.9% underwent Chlamydia screening before HPV1 receipt (19.1% with ≥ 1 positive result). Of those with prior Papanicolaou screening (16.6%), 32.1% had ≥ 1 abnormal result.
These low-income, minority females frequently delayed initiation of HPV vaccination. Many had evidence of prior sexual experience and associated morbidity, placing them at risk of HPV-related complications. Promoting timely HPV vaccination and reducing missed vaccination opportunities are crucial.
人乳头瘤病毒（HPV）疫苗接种推荐在青少年早期进行。虽然有限的数据表明，患者经常延迟开始接种三剂系列疫苗，但基于年龄的 HPV 疫苗接种起始时间的差异及其临床相关性尚未得到很好的描述。因此，本研究旨在描述青少年和年轻女性 HPV 疫苗接种的延迟情况。
本回顾性队列研究调查了 2007 年至 2011 年间在 16 家城市学术附属门诊保健诊所接受护理的 11-26 岁女性（n=22900）中 HPV 疫苗接种起始年龄和错过第一剂 HPV1 疫苗接种机会（HPV1）的情况。使用多变量逻辑回归和广义线性混合模型分别评估了及时接种疫苗和上市后 HPV1 接种年龄的趋势。在亚组受试者（n=15049）中，使用沙眼衣原体和巴氏涂片筛查作为先前性经验和相关发病率的标志物进行了检查。
11-12 岁开始 HPV 疫苗接种的比例随着时间的推移而增加（2007 年为 44.4%[2007]，2011 年为 74.5%[2011]，p<0.01）。13-26 岁人群的接种率也有所提高。因此，2007 年至 2011 年间 HPV1 接种的平均年龄保持不变（16.0±2.7 岁对 15.9±4.0 岁，p=0.45）。西班牙语是 2011 年 11-12 岁儿童 HPV 疫苗接种启动的正预测因子（OR 1.62，95%CI 1.05-2.48）。大多数（70.8-76.4%）未接种疫苗的受试者错过了接种机会。在亚组中，36.9%的人在接受 HPV1 接种前接受了衣原体筛查（19.1%有≥1 个阳性结果）。在接受巴氏涂片筛查的人群中（16.6%），有 32.1%有≥1 个异常结果。
这些低收入、少数族裔女性经常延迟接种 HPV 疫苗。许多人有过性经验和相关发病的证据，使她们有患 HPV 相关并发症的风险。促进及时接种 HPV 疫苗和减少错过接种机会至关重要。
