Human Papilloma Virus Vaccine in Philadelphia: Strong Provider Uptake but Low Levels of Subsequent Dose Compliance

In 2006, the US FDA licensed the Gardasil® Vaccine to protect against HPV serotypes 6, 11, 16, and 18. Recommended for females age 9-26 – 3 doses needed.

To determine which provider and patient characteristics are associated with Gardasil uptake, off-label administration and compliance with subsequent dose schedule.

Data were extracted from the Philadelphia Department of Public Health (PDPH) vaccine distribution database and administration database and were analyzed with respect to Gardasil uptake, compliance, and off label administration.

Out of an eligible population of 96,927 adolescents, 10,986 (11.33%) have received at least one dose, and 801 (7.3%) have completed the vaccine series. Among patients receiving an initial dose before Oct 31, 2007, 69.8% were overdue for their second dose (“on schedule (OS)”). Black adolescents had 55% lower OS rates than whites. For each year older at onset of vaccination series, however, the OS rates increased by 7.2%. Children receiving vaccine from hospitals and private providers demonstrated 40% and 23% higher OS rates than children utilizing public providers. Children born to mothers with a college education had a 36% higher OS rates.

Conclusions: The observed rate of off-label administration is relatively low, but compliance with the schedule for subsequent doses is poor. Large disparities in OS exist across racial and educational groups. The high rates of non-compliance may be due to lacking recall and reminder systems or reflective of the behaviors of the adolescent target population. Further studies are required to determine vaccine effectiveness when the recommended administration series is not followed.