Abstract
BACKGROUND: Despite the effectiveness of the human papillomavirus (HPV) vaccine, uptake in the United States (US) remains suboptimal, with only about half of US adolescents completing the HPV vaccine series before the recommended age of 13. Adolescents are more likely to be vaccinated at annual well visits, making these visits key opportunities to promote HPV vaccination and improve overall completion rates of the HPV vaccination series. Further, it has been suggested that HPV vaccine initiation at age 9 may increase overall adolescent coverage of HPV vaccine. This study aimed to describe patterns in HPV vaccine administration during adolescent well visits and quantify potential HPV vaccination opportunities at age 9. METHODS: This retrospective descriptive analysis included adolescents aged 9-14 years with continuous enrollment from 2018 to 2022 in the MarketScan Commercial or the Multi-State Medicaid databases. We analyzed percentages of well visits and administered vaccines for each age cohort and calendar year. We assessed potential opportunities for HPV vaccination among adolescents at the 9-, 10-,11-, and 12-year well visits. RESULTS: Most age 9 well visits showed no vaccine claims (89.0-91.7%) while claims for two and three concurrent vaccines at age 11 occurred in 22.2-37.2% of well visits, most often for meningococcal and Tdap vaccines. Claims for HPV vaccine initiation at 11 and 12 years remained suboptimal (17.9-24.3%). We identified several potential opportunities for HPV vaccination. Among adolescents who did not receive the HPV vaccine at their 9- or 10-year well visits, 34.8-36.9% did not have a well visit at 11 or 12 years. Among adolescents with an 11- and 12-year well visit, 20.6-30.0% had claims for vaccination, but not the HPV vaccine. Among adolescents with a well visit at 11 or 12 years who received one or more other vaccinations, but not the HPV vaccine, 40.6-46.1% had a well visit at 9 or 10 years and did not initiate the HPV vaccine then. CONCLUSIONS: Routine HPV vaccination beginning at age 9 well visits could optimize opportunities to improve vaccine coverage.