HPV vaccine initiation at 9 or 10 years of age and better series completion by age 13 among privately and publicly insured children in the US

The US Advisory Committee on Immunization Practice recommends routine human papillomavirus (HPV) vaccination at 11–12 years of age, but states that vaccination may be initiated as early as 9 years. Our primary goal was to assess whether initiating HPV vaccination at 9–10 years of age, compared to 11–12, was associated with a higher rate of series completion by 13 years of age, and to identify factors associated with series completion by age 13. The study used vaccine claims and other data from the IBM MarketScan Commercial Claims and Encounters (privately insured) and IBM MarketScan Multi-State Medicaid (publicly insured) databases. Participants were 9–12 years of age and initiated HPV vaccination between January 2006 and December 2018 (publicly insured) or February 2019 (privately insured). Among 100,117 privately insured individuals, those initiating the HPV vaccination series at 9–10 years of age had a significantly higher series completion rate by 13 years of age than did those initiating at 11–12 years of age (76.2% versus 48.1%; <i>p</i> &lt; .001). The same pattern was observed for 115,863 publicly insured individuals (70.4% versus 40.0%; <i>p</i> &lt; .001). Provider and health care plan type, female sex, race/ethnicity, and wellness checks or non-HPV vaccinations during the baseline period were significantly associated with series completion by 13 years of age. Proactive initiation of HPV vaccination at 9–10 years of age was associated with higher rates of series completion by 13 years of age. These findings can inform provider education and other interventions to encourage timely HPV vaccination series completion.

美国免疫实践咨询委员会（Advisory Committee on Immunization Practice）推荐于11~12岁常规接种人乳头瘤病毒（human papillomavirus, HPV）疫苗，同时指出接种可最早于9岁启动。本研究的首要目标为评估：相较于11~12岁启动接种，于9~10岁启动人乳头瘤病毒疫苗接种，是否与13岁前完成完整接种疗程的更高比例相关，并识别13岁前完成完整接种疗程的相关影响因素。本研究采用IBM MarketScan商业理赔与就诊（私营医保）数据库以及IBM MarketScan多州医疗救助（公共医保）数据库中的疫苗理赔及其他相关数据。研究对象为年龄9~12岁，且于2006年1月至2018年12月（公共医保人群）或2019年2月（私营医保人群）间启动人乳头瘤病毒疫苗接种的参与者。在100117名私营医保个体中，于9~10岁启动人乳头瘤病毒疫苗接种疗程者，其13岁前完成完整接种疗程的比例显著高于11~12岁启动接种者（76.2% vs 48.1%；p<0.001）。针对115863名公共医保个体的分析也观察到了相同趋势（70.4% vs 40.0%；p<0.001）。医疗服务提供者类型、医保计划类型、女性性别、种族/族裔，以及基线期内的健康体检或非人乳头瘤病毒疫苗接种，均与13岁前完成完整接种疗程显著相关。于9~10岁主动启动人乳头瘤病毒疫苗接种，与13岁前更高的完整接种疗程完成率存在关联。本研究结果可为医师教育及其他相关干预措施提供参考，以推动人乳头瘤病毒疫苗接种疗程的及时完成。