Examining reasons for incomplete follow up for HPV vaccination in girls and women in Baltimore, Maryland

Background: Incomplete vaccination may result in suboptimal protection against vaccine-preventable diseases including human papillomavirus (HPV), which may have implications for individual patients and for population health. This project aimed to define why girls and women initiating HPV vaccination in the Baltimore City Health Department vaccination clinics did not complete their vaccination series.

Methods: A list of people who had obtained only 1 or 2 doses of the HPV vaccine at the Baltimore City Health Department and whose last visit was prior to September 1, 2008 was generated from the Baltimore Immunization Registry in January 2009. Up to three attempts by phone were made to contact either the vaccine recipient if ≥18 years or a parent of the vaccine recipient for those <18. Phone interviews were conducted with respondents regarding the reasons for lack of follow up.

Results: Of the 185 people who initiated HPV vaccination from 2007-2009, 115 (62.2%) did not complete the series. Only 23 phone interviews were conducted, since the remainder of clients were not reachable by phone. Of those who were contacted, 4 had completed their vaccination series and 19 had not, of whom 5 (26.3%) had forgotten about following up, 3 (15.8%) were too busy to follow up, and 3 (15.8%) said the clinic timing was inconvenient.

Conclusions: Efforts should be made to improve vaccination series completion. Patients should be informed to return for subsequent vaccine doses to optimize protection, which could be done at the time of the first vaccination or through a reminder or recall system.