Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles.
Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles.
JAMA Pediatr. 2020 Sep 1;174(9):861-867. doi: 10.1001/jamapediatrics.2020.1852.
Human papillomavirus (HPV) vaccination coverage is suboptimal in the US. The association between HPV vaccination requirements for school entry and HPV vaccination coverage remains to be studied.
To examine the association between HPV vaccination school-entry requirements and vaccination initiation in jurisdictions with such vaccination policies (ie, Virginia, the District of Columbia, and Rhode Island) compared with other regions of the US, as determined by the National Center for Chronic Disease Prevention and Health Promotion.
DESIGN, SETTING, AND PARTICIPANTS: In a population-based, cross-sectional study, 2017 data from the National Immunization Survey-Teen database were used to determine HPV vaccination initiation. Data from 2008 to 2017 were then examined to assess the association between HPV vaccination school-entry policies and vaccination initiation. Data were obtained for adolescents aged 13 to 17 years in the US with health care professional-reported HPV vaccination histories (cross-sectional study, n = 4784; pre-post policy comparisons, n = 42 431). This study was conducted from May 1, 2019, to March 31, 2020.
State-level HPV vaccination school-entry requirements from 2008 to 2017.
Health care professional-confirmed HPV vaccination initiation.
The 2017 cross-sectional study included 4784 adolescents aged 13 to 17 years (2228 [46.6%] girls; 2556 [53.4%] boys; mean [SD] age, 15.0 [1.4] years; interquartile range, 14-16 years). Compared with nonpolicy jurisdictions within the same region, Rhode Island and the District of Columbia, which have HPV immunization school-entry requirements, had higher levels of HPV vaccination initiation (Rhode Island: adjusted odds ratio [aOR], 4.34; 95% CI, 2.16-10.00; District of Columbia: aOR, 2.35; 95% CI, 1.39-4.19). However, compared with regional nonpolicy states, Virginia's HPV vaccination initiation did not differ significantly (aOR, 1.01; 95% CI, 0.72-1.42). The 2008-2017 pre-post policy comparisons involved 42 431 adolescents aged 13-17 years (22 362 [52.7%] girls; 20 069 [47.3%] boys; mean [SD] age, 15.0 [1.4] years; interquartile range, 14-16 years). Postpolicy levels of HPV vaccination initiation in girls was significantly higher in Rhode Island (aOR, 3.12; 95% CI, 1.92-5.07) than prepolicy values. Similar changes were noted for postpolicy HPV vaccination initiation in boys in the District of Columbia (aOR, 6.36; 95% CI, 4.27-9.46) and Rhode Island (aOR, 5.84; 95% CI, 3.92-8.69) compared with prepolicy measures. With respect to regional nonpolicy states during the same period, both girls and boys in Rhode Island and boys in the District of Columbia experienced larger increases in HPV vaccination initiation. For example, in Rhode Island, boys aged 16 to 17 years had 7.32 (95% CI, 3.56-15.06) times the change in pre-post policy HPV vaccination initiation, while girls aged 16 to 17 years had 1.28 (95% CI, 0.60-2.73) times the change. In the District of Columbia, boys had 6.36 (95% CI, 4.27-9.46) times the change in pre-post policy HPV vaccination initiation.
The findings of this study suggest that HPV vaccination school-entry requirements are associated with increases in vaccination initiation. Expanding such policies may increase HPV vaccination in the US.
重要性：人乳头瘤病毒（HPV）疫苗的接种率在美国仍不理想。HPV 疫苗接种的入学要求与 HPV 疫苗接种率之间的关系仍有待研究。
目的：本研究旨在比较有 HPV 疫苗接种入学要求的司法管辖区（弗吉尼亚州、哥伦比亚特区和罗得岛州）与其他美国地区（由国家慢性病预防和健康促进中心确定）之间 HPV 疫苗接种启动与接种的关系。
设计、地点和参与者：在一项基于人群的横断面研究中，使用 2017 年全国免疫调查-青少年数据库的数据来确定 HPV 疫苗接种的起始情况。然后，对 2008 年至 2017 年的数据进行了检查，以评估 HPV 疫苗接种入学政策与接种启动之间的关系。研究对象为美国年龄在 13 至 17 岁、有医疗保健专业人员报告的 HPV 疫苗接种史的青少年（横断面研究，n=4784；前后政策比较，n=42431）。这项研究是在 2019 年 5 月 1 日至 2020 年 3 月 31 日进行的。
暴露：2008 年至 2017 年的 HPV 疫苗接种入学要求。
主要结局和测量：医疗保健专业人员确认的 HPV 疫苗接种启动情况。
结果：2017 年的横断面研究包括 4784 名 13 至 17 岁的青少年（2228 名女孩；2556 名男孩；平均[SD]年龄为 15.0[1.4]岁；四分位间距为 14-16 岁）。与同一地区无政策司法管辖区相比，罗得岛州和哥伦比亚特区（均有 HPV 免疫接种入学要求）的 HPV 疫苗接种启动率更高（罗得岛州：调整后的优势比[OR]，4.34；95%置信区间[CI]，2.16-10.00；哥伦比亚特区：OR，2.35；95%CI，1.39-4.19）。然而，与区域非政策州相比，弗吉尼亚州的 HPV 疫苗接种启动率没有显著差异（OR，1.01；95%CI，0.72-1.42）。2008 年至 2017 年的前后政策比较涉及 42431 名 13 至 17 岁的青少年（22362 名女孩；20069 名男孩；平均[SD]年龄为 15.0[1.4]岁；四分位间距为 14-16 岁）。在女孩中，罗得岛州 HPV 疫苗接种的启动率在政策实施后显著高于政策实施前（OR，3.12；95%CI，1.92-5.07）。在哥伦比亚特区和罗得岛州的男孩中，也注意到 HPV 疫苗接种的启动率在政策实施后有类似的变化（男孩：哥伦比亚特区 OR，6.36；95%CI，4.27-9.46；罗得岛州 OR，5.84；95%CI，3.92-8.69）。与同期的区域非政策州相比，罗得岛州和哥伦比亚特区的男孩以及罗得岛州的女孩的 HPV 疫苗接种率均有显著增加。例如，在罗得岛州，16 至 17 岁的男孩 HPV 疫苗接种的前后政策变化是政策实施前的 7.32 倍（95%CI，3.56-15.06），而 16 至 17 岁的女孩则为 1.28 倍（95%CI，0.60-2.73）。在哥伦比亚特区，男孩 HPV 疫苗接种的前后政策变化是政策实施前的 6.36 倍（95%CI，4.27-9.46）。
结论和相关性：本研究结果表明，HPV 疫苗接种入学要求与接种启动率的增加有关。扩大此类政策可能会增加美国的 HPV 疫苗接种率。
