1. Karen A. Cullen, Diana L. Bartlett, C. Robinette Curtis
Simultaneous Administration among Females of HPV Vaccine and Other Vaccines Recommended for Adolescents— Immunization Information System Sentinel Sites, United States, 2008–2009
Karen A. Cullen, Diana L. Bartlett, C. Robinette Curtis
2010 National Immunization Conference
Atlanta, Georgia
April 21, 2010
National Center for Immunization and Respiratory Diseases
Immunization Services Division

2. Background – Vaccines Recommended for Adolescents
4 vaccines licensed and recommended for routine administration in adolescents
Tetanus, diphtheria, acellular pertussis vaccine (Tdap)
Meningococcal vaccine
Human papillomavirus vaccine (HPV)
Influenza

3. ACIP Recommendation ACIP: Advisory Committee on Immunization Practices
Recommended routine vaccination of females years of age
Can be administered as young as 9 years
Catch up vaccination years
3 dose schedule with 2nd and 3rd doses administered 2 and 6 months after the 1st dose
ACIP: Advisory Committee on Immunization Practices

4. Simultaneous Administration
ACIP’s HPV recommendations acknowledged the benefits of administering HPV vaccine simultaneously with other recommended vaccines
Increases the likelihood that adolescents will receive each of the recommended vaccines on schedule
ACIP recommends simultaneous administration of all age-appropriate vaccine doses to children without specific contraindications1
ACIP’s initial recommendations for use of the quadrivalent HPV vaccine acknowledged the benefits of administering HPV vaccine simultaneously with other recommended vaccines2

5. Purpose
To describe patterns of simultaneous (or same day) administration of HPV vaccine among adolescent females
Any non-HPV vaccine
Tdap or meningococcal vaccines

6. What are Immunization Information Systems?
Immunization Information Systems (IIS) are confidential, computerized information systems that:
Collect and consolidate vaccination data from multiple health-care providers;
Generate reminder and recall notifications; and
Assess vaccination coverage within a defined geographic area.

7. What are Immunization Information Systems?
Immunization Information Systems may also:
Have functions and features needed by an immunization program (e.g. vaccine inventory management, adverse event reporting etc.);
Have interoperability with other health information systems including Electronic Medical Records (EMR).

8. IIS Sentinel Site Project
Assesses vaccination coverage for persons aged <19 years
Implement enhanced data quality procedures
Usually a subset of the state IIS coverage area with contiguous geographic counties, postal code areas, or census tracts
At a minimum, sites need to have:
At least 85% vaccine provider sites enrolled in the IIS;
At least 85% of the children <19 years of age in the population with at least 2 vaccinations recorded in the IIS
At least 70% of the doses administered from this sentinel site area should be submitted to and processed by the IIS within 30 days of vaccine administration.

9. IIS Sentinel Sites Arizona Michigan New York City Oregon Minnesota
Colorado
n=16,188
Minnesota
n=132,474
North Dakota
n=88,666
Wisconsin
n=135,109

10. Methods
For each quarter and year (Q – Q4 2009) each IIS reported # vaccine recipients years of age
Denominator included all adolescents enrolled in the IIS (i.e. with a demographic record in the database with or without vaccination data)
All data provided by sites in aggregate
Data analyzed by:
Quarter
Sentinel site
Age group
Co-administered adolescent vaccines
Excluded two sites due to missing data

11. Percentage of females with ≥1 dose of HPV vaccine, by quarter and age group
30.1% of adolescent females years of age had received at least one HPV vaccination as of 12/31/09
-Increased 59% from Q to Q4 2009
-Largest increase seen among year old females (81% increase)

12. Percentage of adolescents with ≥1 dose of Tdap, meningococcal, or HPV vaccine, by age group
Data from Quarter

13. Among all adolescent females, percentage with same day administration of HPV and other vaccines
* Categories are not mutually exclusive
Data from Quarter

14. Among females with ≥1HPV, same day administration of HPV and non-HPV vaccine

15. Among females with ≥1 HPV, same day administration of HPV, Tdap and meningococcal vaccine

16. Study Strengths and Limitations
IIS Sentinel Site enrollees exceed 1.3 million adolescents
Timely reporting of vaccine administration
Limitations:
Not generalizable
Data are reported in aggregate
Possible that not all HPV vaccine providers are reporting to IIS

17. Conclusions
Despite the ACIP recommendation to routinely vaccinate year old females with HPV vaccine, the majority of females receiving the vaccine are older
The majority of females who receive an HPV vaccine received another vaccine during the same visit

18. Next Steps
Continue monitoring HPV vaccine uptake during IIS Sentinel Site Project period, particularly series completion
Examine uptake and same day administration in males
Special study to examine uptake of bivalent vaccine

19. Acknowledgements Sentinel Site Colleagues:
Arizona: Lisa Rasmussen and Patty Gast
Colorado: Diana Herrero and Kimberly Dugger
Michigan: Rachel Potter and Bea Salada
Minnesota: Karen White and Emily Peterson
North Dakota: Keith LoMurray and Molly Sander
New York City: Vikki Papadouka and Michael Hansen
Oregon: James Gaudino and Mary Beth Kurilo
Wisconsin: Tom Maerz and Stephanie Schauer
National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention: Lauri Markowitz
National Center for Immunization and Respiratory Diseases: Sharad Aggarwal, Diana Bartlett, Robin Curtis, Laura Pabst

20. Contact: For More Information Karen Cullen KCullen@cdc.gov
(404)
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention

21. Additional Slides

22. Immunization Information Systems Where do the data come from?
Electronic Birth Data
Since IISs are population-based, birth data for all newborns is imported into the IIS from Vital Records (many times this also includes the first dose of Hepatitis B).
Clinical Data
IIS immunization encounter data also comes electronically, by fax, or paper-based from providers and clinical information systems – including EMRs.
Billing Data
Some IIS immunization encounter data comes from electronic clinical billing systems.
Other sources: schools, other public health systems (e.g., metabolic & lead screening)

23. HPV Vaccine Timeline June 2006 October 2006 March 2007
HPV vaccine licensed for use in 9-26 year old females
ACIP recommended approval
October 2006
CDC federal contract with Merck modified to include HPV vaccine
March 2007
ACIP recommendations published in MMWR

24. Recommendations and Guidance – Co-administration with other vaccines
Advisory Committee on Immunization Practices, 2007
“… HPV vaccine is not a live vaccine and has no components that adversely impact safety or efficacy of other vaccinations. Quadrivalent HPV vaccine can be administered at the same visit as other age appropriate vaccines, such as the Tdap and meningococcal conjugate (MVC4) vaccines. Administering all indicated vaccines together at a single visit increase the likelihood that adolescents and young adults will receive each of the vaccines on schedule.
*MMWR 2007; 56 (No. RR-2). Quadrivalent Human Papillomavirus Vaccine. Recommendations of the Advisory Committee on Immunization Practices.

25. Upcoming Issues for HPV Vaccine Recommendations
Bivalent HPV vaccine
HPV vaccine for females >26 years
HPV vaccine for males

26. Percentage of same day administration of HPV and non-HPV vaccine among adolescent females