American Journal of Obstetrics and Gynecology
Available online 18 March 2016
Rates of Human Papillomavirus Vaccine Uptake amongst Girls Five Years after Introduction of Statewide Mandate in Virginia
In Press, Accepted Manuscript — Note to users
Ryan D. Cuff, MD1, Tommy Buchanan, MD2, Elizabeth Pelkofski, MD3, Jeffrey Korte, PhD4,
Susan P. Modesitt, MD5, Jennifer Young Pierce, MD2
Abstract
Background
The Commonwealth of Virginia enacted statewide school-entry Human Papillomavirus (HPV) vaccine mandate in 2008 requiring all girls to receive the vaccine prior to starting the 8th grade. The mandate, one of very few in the country, has been in effect for five years. This study assesses the impact that it has had on the rates of HPV uptake.
Objective
To evaluate uptake HPV vaccine amongst girls presenting for well-child care 5 years after introduction of statewide mandate in Virginia in October 2008.
Study Design
This prospective cohort study utilized the Clinical Data Repository (CDR) at the University of Virginia (UVA) to identify girls aged 11-12 who presented for well-child care from January – December 2014. Billing and diagnosis codes were used to establish HPV vaccine administration. Those identified through the CDR were then contacted by advance letter followed by a representative from the UVA Center for Survey Research (CSR) who invited the responsible parent or guardian to complete a 50-item telephone questionnaire. Questionnaire results were used to inform objective findings and to assess parental attitudes related to HPV vaccination.
Findings were compared against those of Pierce, et al (2013), which evaluated HPV vaccination levels in a similar cohort of patients in 2008, prior to mandate enactment in order to assess relative change attributable to vaccine mandate.
Results
Nine hundred eight girls were identified through the CDR, 50.9% received at least one dose of HPV vaccine. White race and private insurance coverage were found to be negatively associated with HPV vaccine uptake (RR 0.74 and 0.71, 95% CI 0.64-0.85 and 0.62-0.81, respectively). Black race and public insurance coverage were found to be positively associated with vaccine uptake (RR 1.35 and 1.39, 95% CI 1.17-1.55 and 1.22-1.58, respectively). When comparing to the previous study, there has been no change in HPV vaccine uptake or distribution of uptake after the introduction of the statewide mandate for HPV vaccination.
Conclusions
Statewide HPV vaccine mandate has had no impact on the overall rate of HPV vaccination, nor has it diminished the previously-described racial or payer disparities in vaccine uptake in school-aged girls presenting for well-child care in the state of Virginia.