Demographic and Sexual Behavior Characteristics Associated with Human Papillomavirus Vaccine Coverage in United States Females Ages 9-59— National Health and Nutrition Examination Survey, 2007-2008

Background: In 2006, a prophylactic vaccine against human papillomavirus (HPV) types 6, 11, 16, and 18 was licensed for females ages 9-26 years. Routine vaccination with three doses is recommended at ages 11 or 12 years with catch-up vaccination through age 26 years. Ideally, vaccine should be administered before sexual debut.

Objectives: To estimate HPV vaccine coverage and examine vaccination patterns by demographic and sexual behavior characteristics in a nationally representative sample of females 1-2 years after vaccine licensure.

Methods: In 2007-2008, 2,775 females ages 9-59 years responded to questions on HPV vaccination in the National Health and Nutrition Examination Survey (NHANES). Factors associated with HPV vaccine receipt were analyzed.

Results: Overall, 15.2% of 11-26 year-old females reported HPV vaccine initiation, of those 37.2% received all three doses. Vaccine initiation varied significantly by age: 4.4% in 9-10 year-olds, 15.6% in 11-13 year-olds, 21.6% in 14-18 year-olds, 10.5% in 19-26 year olds and 2.0% in 27-59 year-olds (p=0.001). We found no difference in vaccine initiation by race or poverty level in either 11-18 or 19-26 year-olds. Significantly more 19-26 year-olds with private insurance initiated vaccine (16.3%) than those with public insurance (4.0%) (p=0.04). Among 14-18 year-olds, vaccine initiation was higher in those sexually active (28.6%) compared to those who had never had sex (17.8%) (p=0.05).

Conclusions:Our results are similar to estimates from other national surveys but provide additional information on HPV vaccine initiation for a wider age range. A small percentage of females below age 11 or above age 26 received vaccine and initiation was highest in 14-18 year-olds. Vaccine initiation was associated with sexual activity in certain age categories but the temporal relationship could not be assessed. Increased efforts should be made to vaccinate girls at the recommended age of 11 or 12 years.