Using school health centers to increase uptake of HPV and other adolescent vaccines

Background: Low uptake of HPV and other adolescent vaccines calls for novel approaches for increasing use. We tested the efficacy of a school health center (SHC) global consent intervention to promote uptake of 4 recommended vaccines. Methods: Participating North Carolina sites had existing SHCs enrolling 3,614 students. Study intervention included a cover letter and enhanced consent form allowing parents to give global consent for all vaccines or to elect individually. Parent confusion regarding vaccine costs and appropriateness of HPV vaccination for boys resulted in additional consent procedures for some students. Researchers collected data through school health records on total numbers of pre- and post-intervention doses administered for the 4 vaccines in September through January 2011 and again in 2012. Results: Among parents who initially provided consent to vaccinate (10%), most provided global consent (79%). Supplemental consent procedures dramatically reduced initial consent rates, largely due to the inability of SHC staff to re-contact families. HPV vaccine coverage increased (OR=1.47; 95% CI=1.02, 2.12; p=.04); Over two-thirds of HPV doses were no cost vaccines through the federal VFC program. Flu vaccination also increased (OR=2.29, 95% CI=1.03, 5.07; p=.04). Meningococcal and Tdap vaccine coverage did not increase (both p>.05). Conclusions: Our low-cost intervention produced modest increases for HPV and flu vaccines, although parent confusion about vaccine costs and HPV vaccination for boys posed barriers to consent. Should these issues be sufficiently addressed in future interventions, SHCs can be a promising avenue for increasing uptake of adolescent vaccines.