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. 2020 Apr 1:3:100024.
doi: 10.1016/j.ympdx.2020.100024. eCollection 2020 Summer.

The Impact of the Number of Injections per Visit on the Likelihood of Human Papillomavirus Immunization

Steve G Robison  1
Affiliations

The Impact of the Number of Injections per Visit on the Likelihood of Human Papillomavirus Immunization

Steve G Robison. J Pediatr X. .

Abstract

Objective: To test whether adolescents, who are injection limited, that is, receiving only a limited number of immunization injections per visit, are less likely to complete the human papillomavirus (HPV) immunization series.

Study design: For Oregon adolescents age 13-17 years, HPV series completion rates were assessed based on never receiving >1 injection per visit from age ≥9 years. Among a study subset born and resident in Oregon through adolescence, HPV series rates were assessed based on never receiving >1 or 2 injections per visit from age ≥4 years. Cox proportional hazards regression was used to assess delays owing to limiting injections, controlling for sex and rural location.

Results: Among 241 453 study adolescents, 16.3% had only single-injection visits from age ≥9 years. Their HPV completion rate was 7.7% as compared with 61.7% for those with no limitations of number of injections. Among study adolescents born in Oregon, 10.2% never received >1 or 2 injections per visit from age ≥4 and were less than half as likely to complete the HPV series (28.4% vs 59.1%).

Conclusions: Limiting the number of injections per visit is associated with decreased completion of HPV immunization. As larger cohorts of young children with early injection-limiting characteristics age into adolescence, progress on HPV immunization rates may be challenged.

Keywords: HPV; adolescent immunization; injection limiting; provider immunization practice; vaccine hesitancy.

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Figures

Figure 1
Figure 1
Rates of teens age 13-17 years who only have single-injection immunization visits, by Oregon county, 2019.
Figure 2
Figure 2
Cox regression smoothed hazard rates of HPV series completion per day, Oregon teens age 13-17 years, stratified by never receiving >1 or 2 injections per immunization encounter from age ≥4 years. Circled numbers represent years of age.
Figure 3
Figure 3
Percentage of injection-limited teens age 13-17 years by Oregon private practices reporting to ALERT IIS (n = 596 practices), 2019.
See this image and copyright information in PMC

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