Missed Opportunities for HPV Vaccination Among Patients Diagnosed with Sexually Transmitted Infections in North Dakota, 2010-2014

Background:  Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States. Despite being routinely recommended for adolescents, HPV vaccination coverage lags behind that of its adolescent platform counterparts, Tdap (tetanus, diphtheria, and pertussis) and meningococcal vaccines. While HPV vaccines are most beneficial when administered prior to HPV exposure, sexually active individuals in the recommended age groups would at least partially benefit from vaccination. This study aims to identify missed opportunities for HPV vaccination of those diagnosed with chlamydia, gonorrhea, or syphilis in North Dakota from January 1, 2010, through December 31, 2014.

Methods:  We conducted a database review of patients with a diagnosis of chlamydia, gonorrhea, or syphilis between January 1, 2010, and December 31, 2014, in North Dakota. Data from the immunization information and disease surveillance systems were linked for analysis. For the purposes of this study, a missed opportunity for HPV vaccination was identified when HPV vaccine was not administered on or within five days of the STI diagnosis date.

Results:  Of the 12,748 cases analyzed, 77.0% (n=9814) were age-eligible for HPV immunization, but were not immunized. Of approriately immunized individuals, 20.3% (n=2591) had previously completed the HPV series, whereas only 2.1% (n=262) of all age-eligible individuals were immunized at the time of diagnosis. Individuals diagnosed with an STI in 2010 were more likely to have a missed opportunity than those diagnosed in 2014 (84.2% versus 71.9%, p<0.001). 

Conclusions:  While the percentage of missed opportunities decreased over the five years studied, this was likely reflective of increased HPV vaccine coverage prior to STI diagnosis. Missed opportunities were more likely to occur for older individuals, males, and black/African American individuals. Providers of sexual health services in North Dakota may benefit from further education, training, or resources in order to decrease missed opportunities for HPV vaccination.