From the 2019 HVPAA National Conference
Ms. Teodora Stoikov (University of South Carolina School of Medicine Greenville), Ms. Irina Geiculescu (University of South Carolina School of Medicine Greenville), Mr. Robert Teasdall (University of South Carolina School of Medicine Greenville), Dr. Paige Nettles (Prisma Health – Upstate Greenville Memorial Hospital), Mr. Matthew Wessinger (University of South Carolina School of Medicine Greenville), Dr. Lauren Demosthenes (Prisma Health – Upstate Greenville Memorial Hospital), Dr. Alex Ewing (Prisma Health – Upstate Greenville Memorial Hospital)
Background
The human papillomavirus (HPV) is the most common sexually transmitted infection in the US, associated with development of genital warts, pre-cancers, anogenital and oropharyngeal cancers. With the development of the HPV vaccine in 2006, there has been a decline in cervical HPV infections, genital warts, and cervical pre-cancers (1). Recently, the FDA expanded the acceptable age range to males and females aged 27-45 (2). Despite the recommendation to vaccinate through age 26 and this new expansion, many females and males remain unvaccinated (3). OB/GYNs have the opportunity to vaccinate this population, as endorsed by ACOG in the postpartum period.
Objective
To determine baseline data regarding documentation of HPV vaccination in women who received maternity care at the OB center; documentation of education and recommendation of the HPV vaccine antepartum or postpartum; documentation of vaccine administration in the postpartum period, and documentation of the number of patients who would be eligible to receive the HPV vaccine.
Methods
This was a retrospective cohort study of 346 participants below the age of 45 who received prenatal care through Prisma Health-Upstate OB Center that delivered between January and April of 2018. Information collected included demographic information on the participants and vaccination status during the prenatal period.
Results
The rate of documented one or more HPV vaccinations was 5.8% (20 patients) within the cohort, with 91% (315 patients) having no documentation of the HPV vaccine or documented conversation between patient and provider regarding the patient’s HPV vaccine status. In regards to the influenza and Tdap vaccine, 48.7% and 57.4% of the patients respectively received these vaccines during the prenatal period. Only 69.9% (242 patients) attended their scheduled postpartum visit. The average age with documentation of the HPV vaccine was 22.289 compared with the average age without documentation of 28.365 (p<0.001).
Conclusions
Although all three vaccine administrations are low, influenza and Tdap are much higher showing there is viable room to increase rates of HPV vaccine education and administration. The low HPV vaccination rate may be due to lack of documentation by provider and the state wide vaccine registry only becoming available in 2014. Most of the patients would have received the vaccine in the pediatric setting prior to 2014. Of the cohort, 145 patients were currently eligible for the vaccine but unable to receive it with SC Medicaid as SC Medicaid does not cover those over age 18. There were 181 patients within the expanded age range that the FDA now approves for receiving the vaccine, though the CDC does not currently recommend it.
Clinical Implications
This baseline HPV vaccination and education rates will serve as a foundation for increasing vaccine coverage in this “catch up” population. In the future, we will add HPV vaccine status to the mandatory prenatal health questionnaire. We will create standardized education on HPV vaccination during the 3rd trimester prenatal visit. We will advocate for HPV vaccination postpartum in the hospital prior to discharge and expanded Medicaid coverage for HPV vaccine in patients over 18.
Sources
1. Markowitz LE, Gee J, Chesson H, Stokley S. Ten years of human papillomavirus vaccination in the United States. Acad Pediatr 2018;18(2S):S3–10
2. FDA Approves expanded use of Gardasil 9 to include individuals 27 through 45 years https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm622715.htm
3.https://www.acog.org/About-ACOG/ACOG-Departments/ACOG-Rounds/March-2015/Clinical-Practice?IsMobileSet=false
