Human papillomavirus vaccine initiation and up-to-date vaccine coverage for adolescents after the implementation of school-entry policy in Puerto Rico

Vivian Colón-López; Pamela C. Hull; Olga L. Díaz-Miranda; Mark Machin; Idamaris Vega-Jimenez; Diana T. Medina-Laabes; Roxana Soto-Abreu; María Fernandez; Ana P. Ortiz; Erick L. Suárez-Pérez

doi:10.1371/journal.pgph.0000782

Human papillomavirus vaccine initiation and up-to-date vaccine coverage for adolescents after the implementation of school-entry policy in Puerto Rico

Vivian Colón-López
, Pamela C. Hull
, Olga L. Díaz-Miranda
, Mark Machin
, Idamaris Vega-Jimenez
, Diana T. Medina-Laabes
, Roxana Soto-Abreu
, María Fernandez
, Ana P. Ortiz
, Erick L. Suárez-Pérez

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

The human papillomavirus (HPV) vaccine has been proven effective in the prevention of infection with high-risk HPV types, which can lead to the development of six HPV-related cancers. Puerto Rico (PR) adopted a mandatory HPV vaccination school-entry policy that took effect in August 2018. While school-entry requirements are generally accepted as an effective approach for increasing vaccination rates, there are few studies that have documented their impact on improving HPV vaccination rates. The objective of this study was to evaluate the impact of the HPV school-entry policy in PR on HPV vaccine coverage. We used a pre-post natural experiment. The study population included adolescents registered in the PR Immunization Registry during 2008–2019. We calculated HPV vaccine initiation and up-to-date (UTD) vaccine coverage rates. We estimated age-standardized rates (ASR) and standardized rate ratio with 95%CI. Vaccine data corresponding to a total of 495,327 adolescents were included for analysis; 50.9% were male and 49.1% were females. After policy implementation, a marked increase in raw HPV vaccine initiation among 11- to 12-year-old adolescents was observed across years 2017 (a pre-policy year), 2018, and 2019 (58.3%, 76.3%, and 89.8%, respectively). UTD coverage also showed a moderate increase after policy implementation among 11- to 12-year-old adolescents. The gap between sexes in vaccine initiation and UTD coverage narrowed over time; the ASRs in 2019 showed an increase of 19% in initiation and 7% increase in UTD relative to 2017 for males and females combined (both significant at p<0.05). This study demonstrated evidence of improvement in HPV vaccination rates following implementation of the school-entry policy and a narrowed sex gap in vaccine rates over time in PR. Future analyses should assess how the policy continues to affect vaccine coverage in subsequent years and how the COVID-19 pandemic has impacted HPV vaccination uptake.

Original language	English
Article number	e0000782
Journal	PLOS Global Public Health
Volume	2
Issue number	11
DOIs	https://doi.org/10.1371/journal.pgph.0000782
State	Published - Nov 2022

Bibliographical note

Publisher Copyright:
© 2022 Colón-López et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding

This work was supported by National Cancer Institute (NCI) (URL: https://www.cancer. gov), grant R01CA232743 (\u201CImplementation of School-Entry Policies for Human Papillomavirus Vaccination\u201D) within University of Puerto Rico Comprehensive Cancer Center to VCL. The National Cancer Institute had no role in the study design; collection, analysis, and interpretation of the data; writing of the manuscript; or decision to publish. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCI. The content is entirely the responsibility of the authors and does not necessarily represent the official views of the Comprehensive Cancer Center UPR. We thank Vilnery Rivera Figueroa, Glizette Arroyo Morales and the personnel of the Division of Vaccination of the Department of Health of PR for your support and collaboration.

Funders	Funder number
Department of Health and Social Care
University of Michigan Comprehensive Cancer Center
University of Puerto Rico Medical Sciences Campus and Comprehensive Cancer Center
National Childhood Cancer Registry – National Cancer Institute	R01CA232743
National Childhood Cancer Registry – National Cancer Institute

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine
Public Health, Environmental and Occupational Health

Access to Document

10.1371/journal.pgph.0000782

Cite this

Colón-López, V., Hull, P. C., Díaz-Miranda, O. L., Machin, M., Vega-Jimenez, I., Medina-Laabes, D. T., Soto-Abreu, R., Fernandez, M., Ortiz, A. P., & Suárez-Pérez, E. L. (2022). Human papillomavirus vaccine initiation and up-to-date vaccine coverage for adolescents after the implementation of school-entry policy in Puerto Rico. PLOS Global Public Health, 2(11), Article e0000782. https://doi.org/10.1371/journal.pgph.0000782

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title = "Human papillomavirus vaccine initiation and up-to-date vaccine coverage for adolescents after the implementation of school-entry policy in Puerto Rico",

abstract = "The human papillomavirus (HPV) vaccine has been proven effective in the prevention of infection with high-risk HPV types, which can lead to the development of six HPV-related cancers. Puerto Rico (PR) adopted a mandatory HPV vaccination school-entry policy that took effect in August 2018. While school-entry requirements are generally accepted as an effective approach for increasing vaccination rates, there are few studies that have documented their impact on improving HPV vaccination rates. The objective of this study was to evaluate the impact of the HPV school-entry policy in PR on HPV vaccine coverage. We used a pre-post natural experiment. The study population included adolescents registered in the PR Immunization Registry during 2008–2019. We calculated HPV vaccine initiation and up-to-date (UTD) vaccine coverage rates. We estimated age-standardized rates (ASR) and standardized rate ratio with 95\%CI. Vaccine data corresponding to a total of 495,327 adolescents were included for analysis; 50.9\% were male and 49.1\% were females. After policy implementation, a marked increase in raw HPV vaccine initiation among 11- to 12-year-old adolescents was observed across years 2017 (a pre-policy year), 2018, and 2019 (58.3\%, 76.3\%, and 89.8\%, respectively). UTD coverage also showed a moderate increase after policy implementation among 11- to 12-year-old adolescents. The gap between sexes in vaccine initiation and UTD coverage narrowed over time; the ASRs in 2019 showed an increase of 19\% in initiation and 7\% increase in UTD relative to 2017 for males and females combined (both significant at p<0.05). This study demonstrated evidence of improvement in HPV vaccination rates following implementation of the school-entry policy and a narrowed sex gap in vaccine rates over time in PR. Future analyses should assess how the policy continues to affect vaccine coverage in subsequent years and how the COVID-19 pandemic has impacted HPV vaccination uptake.",

author = "Vivian Col{\'o}n-L{\'o}pez and Hull, \{Pamela C.\} and D{\'i}az-Miranda, \{Olga L.\} and Mark Machin and Idamaris Vega-Jimenez and Medina-Laabes, \{Diana T.\} and Roxana Soto-Abreu and Mar{\'i}a Fernandez and Ortiz, \{Ana P.\} and Su{\'a}rez-P{\'e}rez, \{Erick L.\}",

note = "Publisher Copyright: {\textcopyright} 2022 Col{\'o}n-L{\'o}pez et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

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Colón-López, V, Hull, PC, Díaz-Miranda, OL, Machin, M, Vega-Jimenez, I, Medina-Laabes, DT, Soto-Abreu, R, Fernandez, M, Ortiz, AP & Suárez-Pérez, EL 2022, 'Human papillomavirus vaccine initiation and up-to-date vaccine coverage for adolescents after the implementation of school-entry policy in Puerto Rico', PLOS Global Public Health, vol. 2, no. 11, e0000782. https://doi.org/10.1371/journal.pgph.0000782

TY - JOUR

T1 - Human papillomavirus vaccine initiation and up-to-date vaccine coverage for adolescents after the implementation of school-entry policy in Puerto Rico

AU - Colón-López, Vivian

AU - Hull, Pamela C.

AU - Díaz-Miranda, Olga L.

AU - Machin, Mark

AU - Vega-Jimenez, Idamaris

AU - Medina-Laabes, Diana T.

AU - Soto-Abreu, Roxana

AU - Fernandez, María

AU - Ortiz, Ana P.

AU - Suárez-Pérez, Erick L.

N1 - Publisher Copyright: © 2022 Colón-López et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2022/11

Y1 - 2022/11

N2 - The human papillomavirus (HPV) vaccine has been proven effective in the prevention of infection with high-risk HPV types, which can lead to the development of six HPV-related cancers. Puerto Rico (PR) adopted a mandatory HPV vaccination school-entry policy that took effect in August 2018. While school-entry requirements are generally accepted as an effective approach for increasing vaccination rates, there are few studies that have documented their impact on improving HPV vaccination rates. The objective of this study was to evaluate the impact of the HPV school-entry policy in PR on HPV vaccine coverage. We used a pre-post natural experiment. The study population included adolescents registered in the PR Immunization Registry during 2008–2019. We calculated HPV vaccine initiation and up-to-date (UTD) vaccine coverage rates. We estimated age-standardized rates (ASR) and standardized rate ratio with 95%CI. Vaccine data corresponding to a total of 495,327 adolescents were included for analysis; 50.9% were male and 49.1% were females. After policy implementation, a marked increase in raw HPV vaccine initiation among 11- to 12-year-old adolescents was observed across years 2017 (a pre-policy year), 2018, and 2019 (58.3%, 76.3%, and 89.8%, respectively). UTD coverage also showed a moderate increase after policy implementation among 11- to 12-year-old adolescents. The gap between sexes in vaccine initiation and UTD coverage narrowed over time; the ASRs in 2019 showed an increase of 19% in initiation and 7% increase in UTD relative to 2017 for males and females combined (both significant at p<0.05). This study demonstrated evidence of improvement in HPV vaccination rates following implementation of the school-entry policy and a narrowed sex gap in vaccine rates over time in PR. Future analyses should assess how the policy continues to affect vaccine coverage in subsequent years and how the COVID-19 pandemic has impacted HPV vaccination uptake.

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Human papillomavirus vaccine initiation and up-to-date vaccine coverage for adolescents after the implementation of school-entry policy in Puerto Rico

Abstract

Bibliographical note

Funding

UN SDGs

ASJC Scopus subject areas

Access to Document

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Cite this