Most adolescent patients received human papillomavirus vaccination prior to sexual debut, but 12% remained unvaccinated, representing missed opportunities for cancer prevention, according to a research letter published in JAMA Pediatrics.
The researchers — of Children’s Hospital of Philadelphia, Philadelphia — conducted a cross-sectional analysis of 9,491 adolescent patients aged 13 to 18 years within a large pediatric primary care network. All patients had attended a primary care visit and reported sexual activity through a confidential previsit survey. Vaccination records were linked to self-reported sexual debut to assess whether immunization occurred prior to exposure risk.
Overall, 79% of adolescent patients completed the vaccination series prior to sexual debut (a period that maximizes vaccine effectiveness), while 9% had initiated but not completed the series, and 12% had not received any doses prior to sexual activity. Among those unvaccinated prior to sexual debut, 70% remained unvaccinated, 23% later initiated vaccination, and 7% later completed the series.
Missed opportunities were concentrated among non-Hispanic White and commercially insured adolescent patients. Patients living in higher-opportunity neighborhoods and those receiving care at practices located farther from the main hospital were also more likely to be unvaccinated prior to sexual debut.
Practice-level factors were also associated with vaccination timing. Clinics that more frequently initiated human papillomavirus (HPV) vaccination at age 9 years had lower rates of missed opportunities. The findings suggest that earlier vaccination strategies, along with standardized communication and workflow improvements, may help increase timely vaccine uptake.
Because all adolescent patients included in the study had recent primary care visits, the findings suggest that missed opportunities may be related to physician recommendation practices, family decision-making, and clinic processes rather than access to health care.
To the researchers’ knowledge, this is the first study to link adolescent-reported sexual activity with vaccination records across a large primary care network. However, the cross-sectional design, reliance on first reported sexual activity, and data from a single region may limit interpretation and generalizability.
The findings support earlier initiation of HPV vaccination and more consistent clinical workflows to reduce missed opportunities and improve cancer prevention efforts among adolescent patients.
Disclosures can be found in the research letter.
Source: JAMA Pediatrics
