Tuesday, March 18, 2008

Human Papilloma Virus Vaccine (HPV) in Philadelphia: Strong Provider Uptake but Low Levels of Subsequent Dose Compliance

Edward Thomas Grove, Division of Disease Control, Epidemiology Unit, Philadelphia Department of Public Health, 500 South Broad Street, Philadelphia, PA, USA, C. Victor Spain, Division of Disease Control, Philadelphia Department of Public Health (PDPH), 500 South Broad Street, 2nd Floor, Philadelphia, PA, USA, and Barbara Watson, Philadelphia Department of Public Health,Div. of Disease Control, 500 South Broad Street, VASP, 2nd Floor, Philadelphia, PA, USA.

Learning Objectives for this Presentation:
By the end of this presentation participants will understand the factors influencing uptake and administration patterns of the HPV vaccination in a large urban area.

In 2006, the US FDA licensed the quadrivalent Human Papilloma Virus Vaccine (QHPVV) to protect against HPV serotypes 6, 11, 16, and 18. Currently the FDA recommends that females between the ages of 9 and 26 receive the vaccination. The positive impact of QHPVV will be limited by the uptake and compliance of both the patient and health care provider.

To determine which provider and patient characteristics are associated with QHPVV uptake, off-label administration and compliance with subsequent dose schedule.

Data were extracted from PDPH's VFC vaccine distribution database (Vacman) and administration database (KIDS registry) and were analyzed with respect to uptake, compliance, and off label administration.

QHPVV orders through VFC were initially higher than other newly introduced vaccines, although the number of doses ordered waned after 6 months, particularly among private providers. The number of doses administered increased steadily between January and August 2007. Off label administration (vaccines administered to females outside of the recommended age range, to males, or < 4 weeks from the previous dose) accounted for 2 percent of all doses (preliminary data analyses). Among patients receiving only an initial QHPVV dose before July 1, 2007, 70% were more than 1 month overdue for their second dose, with the highest over-due rates among patients attending public clinics.

The observed rate of off-label QHPVV administration is relatively low, but compliance with the schedule for subsequent doses is poor. The high rates of non-compliance may be due to lacking recall and reminder systems or reflective of the behaviors of the adolescent target population. Further studies are required to determine vaccine effectiveness when the recommended administration series is not followed.