Missed Opportunities for Human Papillomavirus Vaccine Initiation in an Insured Adolescent Female Population

Background. Identifying missed opportunities for human papillomavirus (HPV) vaccination could lead to strategies to improve HPV vaccination rates. This study assessed the initiation of HPV vaccination in insured adolescent females in relation to physician visits and receipt of other vaccines routinely given at the same age. Methods. This was a 2-year observational and descriptive analysis of a female cohort in a fully insured commercial or Medicaid plan that turned 11 years of age between January 1, 2010, and September 31, 2015. Vaccination administration was determined by using Current Procedural Terminology codes. A missed opportunity was defined as the absence of an HPV vaccine at the following encounter types: visits with a 4-valent meningococcal conjugate vaccine (MenACWY) or tetanus, diphtheria, and acellular pertussis (Tdap) vaccine claim; well adolescent visits; or any encounter with a primary care provider (PCP). Missed opportunities were stratified by type of provider (pediatrician or nonpediatrician). Results. Among 14 588 adolescent girls, only 6098 (41.8%) initiated the HPV vaccine series. HPV vaccine was given at 37.1% of visits when a Tdap or MenACWY vaccine was administered, 26.0% of well adolescent visits and 41.8% of PCP visits. Pediatricians had fewer missed opportunities than nonpediatricians to administer HPV (50.7% vs 60.8%), as well as Tdap, although the difference was larger for Tdap (7.0% vs 29.6%). Conclusions. The HPV vaccine was only administered at one in four well adolescent visits and at approximately one-third of vaccine-related visits suggesting substantial missed opportunities. These data indicate that pediatricians and nonpediatricians alike are missing opportunities to administer the HPV vaccine when other adolescent vaccines are given. Efforts should be focused on converting these missed vaccination opportunities into cancer-prevention visits.