BACKGROUND: The Advisory Committee on Immunization Practices recommends three adolescent vaccines for boys and girls aged 11-12 years: one dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine, two doses of meningococcal vaccine (MCV4), and three doses of HPV vaccine. Preventing HPV infection through immunization protects against HPV-associated cancers in males and females. Despite the safety and effectiveness of the HPV vaccine, less than one third of teens in Texas are fully vaccinated against HPV. The CDC has found that healthcare provider recommendation is the single best predictor of vaccination. Stronger provider recommendation at Texas Vaccines for Children (TVFC) clinics could lead to increased HPV immunization rates in Texas adolescents. The goal of this project was to supply TVFC providers with strategies for making a strong recommendation, as well as providing them with feedback on their ordering habits for adolescent vaccines. Ordering habits were evaluated pre- and post- profile distribution to determine whether an increase in HPV orders was observed.
METHODS: On June 2, 2015, a customized adolescent vaccine ordering profile email was distributed to approximately 2,400 TVFC providers who serve adolescent populations to encourage TVFC providers to make a strong recommendation for HPV vaccine and also make providers aware of their recent ordering history for adolescent vaccines. An overall TVFC program HPV to Tdap vaccine ordering ratio was calculated. The Wilcoxon Signed Rank Test was used to compare the TVFC program HPV to Tdap vaccine ordering ratios from June-September of 2014 to June-September of 2015 to determine whether there was a significant increase. Data analysis was conducted using SAS 9.3.
RESULTS: In the months following distribution of the customized adolescent vaccine ordering profile, the TVFC program as a whole ordered 1.3 doses of HPV vaccine for every one dose of Tdap from June-September of 2015. While still far below the ideal ratio, this was a statistically significant increase from 0.9 doses of HPV for every one dose of Tdap ordered in the same time period of 2014. The ordering data found that 959 TVFC providers increased their HPV to Tdap vaccine ordering ratio in 2015.
CONCLUSIONS: Significant increases in HPV to Tdap vaccine orders were observed among TVFC providers after they received feedback on their adolescent vaccine ordering history for their clinic and guidance on how to give a strong HPV vaccine recommendation. Provider profiles with customized vaccine ordering information for HPV vaccine could be utilized to increase HPV immunization coverage.