Improving HPV Vaccination Coverage
I live in Los Angeles, so this page is somewhat Los Angeles-centric,
but many of the ideas are universal.
HPV Vaccine Uptake: Urgency for Action to Prevent Cancer (President's
Cancer Panel - 2012/2013 report)
How well is Los Angeles vaccinated against HPV?
The County of Los Angeles Public Health department's
estimates that, in 2009, 63.5% of 13-17 year old females in Los Angeles
had received one shot, and 30.9% had received all three shots.
By comparison, they report that 58.3% of kids aged 13-17 had gotten the
required for 7th grade
starting in 2010.
(The more recent 7th Grade Asseessment for 2012-2013
from the state says Los Angeles schools reached 97.85% on Tdap,
so evidently mandating a vaccination is quite effective.)
Papillomavirus Vaccination Coverage Among Adolescent Girls,
"The 2012 NIS-Teen shows that 84% of unvaccinated girls had a health-care
encounter where another vaccine was administered. Had the 3-dose HPV series
been initiated at these visits, coverage for ≥1 dose could be as
high as 92.6%. ...
In 2012, only 53.8% of girls had received ≥1 dose of HPV
vaccine, and only 33.4% had received all 3 doses of the series."
What are the barriers to good vaccine uptake?
Who provides immunizations in Los Angeles?
What is being done to increase vaccination coverage?
- California Immunization
Coalition puts on the California Immunization Summit conference
every year on improving immunization coverage. Presentations are online and good reading.
- One of the presentations from the
2011 California Vaccination Summit
was about how
willing to work with schools to provide vaccinations, and the VFC coordinator
is looking for pharmacies to partner with
Vaccination Week is an annual week in January or February during which the county health
department, school districts, and many health care providers jointly
try to reach many adolescents. For instance, on
January 28-29 2009, free HPV shots were offered at John Muir Middle School.
UCLA is studying whether
delivering vaccination information and referrals to
the existing Office of Women's Health
can increase vaccine uptake.
The CDC, UCLA, and the county have studied vaccine uptake in Los Angeles; see
about school requirements for human papillomavirus vaccine in high-risk
communities of Los Angeles, California",
vaccine initiation among adolescent girls in high-risk communities",
safety-net clinics and HPV vaccine uptake among low-income, ethnic minority
- The LAUSD hosts free Tdap immunization clinics
before 7th grade; could HPV vaccine be offered at the same visit?
about overdue vaccinations can increase vaccination rates,
and the California Immunization Registry
"Generate reminder and recall notices to let patients know
which immunizations are due or overdue".
Los Angeles County Immunization Program
Reminder and Recall Guidelines
recommends this only for children under 3 years of age.
It does "encourage" it for older patients "as resources allow".
Can we provide those resources, and get the health department to
more strongly recommend this practice?
The California Vaccine Registry has
instructions about how to do reminders and recall notices.)
- Combining the two above ideas, could schools identify kids
who do not yet have non-mandatory vaccinations, and invite them
for vaccination at in-school clinics?
- Could HPV vaccination be made mandatory?
California law, Health and Safety code
[schools] shall not unconditionally admit any person as a pupil ...
unless prior to his or her first
admission to that institution, he or she has been fully immunized.
The following are the diseases for which immunizations shall be
(11) Any other disease deemed appropriate by the department,
taking into consideration the recommendations of the Advisory
Committee on Immunization Practices of the United States Department
of Health and Human Services, the American Academy of Pediatrics, and
the American Academy of Family Physicians.
In other words, the state health department is free theoretically to
require HPV vaccination, although
it does not currently do so.
Corrections and suggestions welcome, please send them to dank at kegel com.
Copyright 2013, 2014 Dan Kegel
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