The mean age of initiation of the HPV-9, COVID-19, Tdap, and MenACWY were 11.32( SD 2.14), 13.64( SD 1.32), 11.34( SD 1.19), and 12.1( SD 2.37) years, respectively.
Using HPV-9 as a predictor, the proportion of those not receiving the COVID-19 vaccine was compared. Among all adolescents who did not complete the HPV-9 vaccine series( n = 444), 47.1 % also did not receive any COVID-19 vaccine. Among adolescents who completed the HPV-9 series, 45.3 % did not receive any COVID-19 vaccine( p = 0.52). Similarly, when comparing subjects with no HPV-9 vaccine( n = 280) to those with partial or completed series( n = 1,204), the rates of those not receiving the COVID-19 vaccine were not different( 39.3 % vs. 40.0 % p = 0.84). There was no difference in age of HPV vaccination initiation among subjects who did and did not receive a COVID-19 vaccine( 11.25 SD 2.13 vs. 11.42 SD 2.16).
Vaccine rates were then assessed by gender, which demonstrated no statistically significant difference between groups for either the HPV-9 or COVID-19 vaccines( Table 2). There was also no difference in age of initiation of HPV vaccination between males and females( 11.30 SD 2.18 vs. 11.33 SD 2.10).
HPV-9 Completed Series Unvaccinated
COVID-19 Completed Series Unvaccinated
Unvaccinated for HPV-9
COVID-19 Vaccinated
TABLE 2
TABLE 3
For gender, a similar cross-tabulation analysis was performed using HPV-9 status as the independent variable. When evaluating the 144 females and 136 males who did not receive any HPV-9 vaccination, there were more females than males who also did not receive the COVID-19 vaccination( 44.4 % vs. 33.8 %, p = 0.068, Table 3). The OR of not receiving a COVID-19 vaccine among those who did not receive the HPV-9 vaccination was 0.75( 0.51, 1.1) for males and 1.15( 0.79, 1.66) for females.
DISCUSSION
This study demonstrated no observed differences between HPV-9 vaccination and COVID-19 vaccination among a large adolescent cohort. Similar rates of COVID-19 vaccination were observed among patients who did and did not receive HPV-9 vaccination.
Although not statistically significant, it should be noted that female adolescents who did not receive the HPV-9 vaccine were more likely not to receive a COVID-19 vaccine than their male peers. It is possible that misconceptions about infertility and sexual maturity may have impacted these rates. As scientific misinformation continues to spread with the growing influence of
Males( n = 748) Females( n = 736) P value
522( 69.8) 136( 18.2)
417( 55.7) 294( 39.3)
HPV-9 and COVID-19 Vaccination by Gender
517( 70.2) 144( 19.6)
387( 52.6) 307( 41.7)
COVID-19 Unvaccinated
Females |
|
|
( n = 144) |
80( 55.6) |
64( 44.4) |
Males |
|
|
( n = 136) |
90( 66.2) |
46( 33.8) |
0.79 0.49
0.22 0.35
P value
0.068
Proportion of Subjects by Gender Receiving the COVID-19 Vaccination Among Those Not Vaccinated for HPV-9. social media, addressing this divide with patients will be important in order to combat misconceptions. 14
As expected, rates for state mandated vaccines, Tdap, and MenACWY were high. HPV-9 vaccination was also demonstrated to be higher than previously reported state rates, with 70.1 % of subjects in our cohort completing the series and similar uptake among males and females. The higher rates can possibly be attributed to strength and confidence of provider recommendations for this vaccine, utilization of the state immunization information system, and consistent follow up by medical staff.
While it is reassuring that HPV-9 vaccination is higher than previously reported state levels in this cohort of adolescents, it still falls short of the Healthy People 2030 goal of 80 % and is comparably lower than the high rates of state mandated vaccines( Tdap and MenACWY). 3, 15 Achieving higher vaccinations rates in this state is important, as WV has the eighth highest incidence and the fifth highest mortality rate of cervical cancer nationally. 16 While this study demonstrated an institutional improvement in the rate of HPV-9 vaccination uptake, future public health policies could make even more of an impact.
Limitations to this study include the retrospective review of electronic health records. There was no way to evaluate the specific reason why a patient or parent declined the vaccine. We also did not investigate other factors such as subject location and that vaccine uptake may differ based on urban or rural settings. The large sample size evaluated in this study is a strength to support the data collected; however, even though subjects represented 15 different counties, this data may not be generalizable to the state as a whole. The rates of Tdap and MenACWY vaccines that we report also correlate with those previously reported for WV. This finding supports the accuracy of the data making it less likely to be impacted by falsely incomplete vaccination records. While the WVSIIS in communication with the electronic health record would account for vaccines given in other facilities, it does not import vaccines given out of state which could impact record completeness.
26 • www. wvsma. org