Colón-López Vivian, Muñoz-Torres Francisco J, Escabí Wojna Erika, Vega Jimenez Idamaris, Díaz Miranda Olga L, Medina-Laabes Diana T, Wells Katelyn, Ortiz Ana P, Hull Pamela C, Suárez Erick
Cancer Control and Population Sciences, Comprehensive Cancer Center, University of Puerto Rico, San Juan, Puerto Rico.
Association of Immunization Managers, Rockville, MD, United States of America.
PLOS Glob Public Health. 2024 Dec 31;4(12):e0002852. doi: 10.1371/journal.pgph.0002852. eCollection 2024.
This study evaluates the association between immunization program (IP) activities aimed at increasing HPV vaccination among adolescents and their impact on initiation rates. Our data sources are: (i) 2016 AIM Annual Survey and (ii) 2019 National Immunization Survey-Teen. We estimated the prevalence of HPV vaccine initiation using a multilevel Poisson model, combining state-level IP data and individual characteristics of adolescents. We calculated the prevalence ratio (PR) of HPV initiation among adolescents to compare the effects of IP activities, adjusting for state of residence, age, sex, maternal education, and ethnicity. A total of 17,390 teens aged 13 and 17 were evaluated. States with publicly available school-based adolescent coverage rates and/or exemptions (PRw, activity Dadjusted: 1.08, 95% CI: 1.02, 1.14), and those that expanded the number of pharmacies entering HPV vaccination data (PRw, activity Nadjusted; 1.06, 95% CI: 1.02, 1.10) in Immunization Information Systems (IIS), had higher HPV vaccine initiation rates compared to states that did not implement these strategies. When stratifying, these findings were present in the younger group (13-15 years, PRw, activity D adjusted: 1.10, 95% CI: 1.01, 1.18; PRw. activity N adjusted: 1.10, 95% CI: 1.05, 1.16), but not in the older group (16-17 years, PRw, activity D adjusted: 1.05, 95% CI: 0.95, 1.15; PRw. activity N adjusted: 1.00, 95% CI: 0.94, 1.06). States that expanded the number of school-located programs entering HPV vaccine records in IIS (PRw, activity Eadjusted: 1.08, 95% CI: 1.01, 1.15) had higher vaccine initiation prevalence in the younger group but not in the older group. Limitations include a lack of operational definitions for IP activities, potential biases in the NIS-Teen survey, and reliance on provider-reported HPV vaccination. Nonetheless, these results highlight immunization activities that support national efforts to increase HPV vaccine uptake and inform public health programs on effective HPV vaccine promotion.
本研究评估了旨在提高青少年人乳头瘤病毒（HPV）疫苗接种率的免疫规划（IP）活动及其对起始接种率的影响。我们的数据来源为：（i）2016年AIM年度调查和（ii）2019年全国青少年免疫调查。我们使用多水平泊松模型，结合州级IP数据和青少年个体特征，估算了HPV疫苗起始接种率。我们计算了青少年中HPV起始接种率的患病率比（PR），以比较IP活动的效果，并对居住州、年龄、性别、母亲教育程度和种族进行了调整。总共评估了17390名13至17岁的青少年。在免疫信息系统（IIS）中，那些有公开的基于学校的青少年覆盖率和/或豁免率的州（PRw，活动D调整后：1.08，95%置信区间：1.02，1.14），以及那些扩大了录入HPV疫苗接种数据的药房数量的州（PRw，活动N调整后：1.06，95%置信区间：1.02，1.10），与未实施这些策略的州相比，HPV疫苗起始接种率更高。分层分析时，这些结果在较年轻组（13至15岁，PRw，活动D调整后：1.10，95%置信区间：1.01，1.18；PRw，活动N调整后：1.10，95%置信区间：1.05，1.16）中存在，但在较年长组（16至17岁，PRw，活动D调整后：1.05，95%置信区间：0.95，1.15；PRw，活动N调整后：1.00，95%置信区间：0.94，1.06）中不存在。在IIS中扩大录入HPV疫苗记录的学校项目数量的州（PRw，活动E调整后：1.08，95%置信区间：1.01，1.15）在较年轻组中有更高的疫苗起始接种患病率，但在较年长组中没有。局限性包括IP活动缺乏操作定义；NIS - Teen调查中存在潜在偏差；以及依赖提供者报告的HPV疫苗接种情况。尽管如此，这些结果突出了支持国家提高HPV疫苗接种率努力的免疫活动，并为有效的HPV疫苗推广公共卫生项目提供了信息。
