Human Papillomavirus Vaccination Coverage Among Female Adolescents in Managed Care Plans — United States, 2013 

We are pleased to share the following report with our immunization partners from the MMWR publication October 30, 2015/64(42); 1185–1189, the Centers for Disease Control and Prevention (CDC) published the Human Papillomavirus Vaccination Coverage Among Female Adolescents in Managed Care Plans — United States, 2013. To review the entire report and data visit: Morbidity and Mortality Weekly Report (MMWR).

In the United States there are 79 million people infected with the Human papillomavirus (HPV), with approximately 14 million new cases being diagnosed each year. There are approximately 27,000 cancer cases attributed to HPV annually. HPV vaccination is an effective primary prevention strategy that can reduce many of the HPV infections that lead to cancer and is routinely recommended for adolescents aged 11–12 years.

To determine whether the recommended HPV vaccination series is currently being administered to adolescents with health insurance, CDC and the National Committee for Quality Assurance (NCQA) assessed 2013 data from the Healthcare Effectiveness Data and Information Set (HEDIS). The HEDIS HPV vaccine for female adolescents performance measure evaluates the proportion of female adolescent members in commercial and Medicaid health plans who receive the recommended 3-dose HPV vaccination series by age 13 years.

There were 367 commercial plans and 153 Medicaid plans submitted to the HEDIS HPV vaccination measure data, representing a total of 626,318 female adolescent plan members, aged 13 years, eligible for the measure. Approximately 31% of the U.S. female population aged 13 years.

Results:

• Commercial plans provided 3 doses of HPV vaccine to a median of 12% of female adolescent members by age 13 years.
• Medicaid plans reported significantly higher rates of 3-dose HPV coverage compared with commercial plans, with a median of 19% of female adolescents receiving 3 dos

Most female adolescents in commercial and Medicaid health plans are not receiving the recommended doses of HPV vaccine by age 13 years. The HEDIS HPV vaccination measure was publicly reported for the first time in 2013, approximately seven years after the quadrivalent HPV vaccine was licensed in the United States and recommended by the Advisory Committee on Immunization Practices (ACIP) for use in female adolescents, allowing health care providers time to adapt to the recommendations. Despite this, results from this study indicate that health plans are performing poorly overall with regard to HPV vaccination rates in female adolescents aged 13 years.

Studies have identified that clinicians are less likely to make a strong recommendation for HPV vaccination for adolescents aged 11-12 years compared with older adolescents. Because a clinician recommendation greatly influences parental acceptance, the CDC has developed resources to help clinicians respond to parents' questions and communicate strong, clear HPV vaccination recommendations. The HPV clinician resources are available at: https://www.cdc.gov/hpv.

Improving HPV vaccination coverage among female adolescents and understanding how the highest-performing health plans support HPV vaccination are needed. Knowledge of barriers and attitudes of clinicians or family members that might contribute to low vaccination coverage, and incentives that might contribute to differences in vaccination coverage between Medicaid and commercial plans, are needed. Characterizing the strategies and best practices used by higher performing plans will be important for improving HPV vaccination coverage in the United States. Increasing delivery of HPV vaccination at the recommended ages of 11 or 12 years, before most adolescents are exposed to the virus, can ensure adolescents are protected against HPV infections and associated cancers.