The District of Columbia has made significant progress in increasing HPV vaccination rates for both males and females from 2013 to 2014. Based on the data in the table below (extracted from the MMWR published 7/31/2015), HPV vaccination rates among females – first dose – increased by 22.8%, second dose – increased by 27.2%, and the third dose increased by 28.6%. Progress has also been made among males for the same time period – first dose increased by 0.8%, second dose – 15.4%, third dose – 10.9%.
For females, the District ranked 4th for overall for 1st dose of HPV vaccination, tied for 3rd place for the 2nd dose and 2nd place for the third dose of HPV vaccinations. For males, the District was in 2nd place for both the 1st and 2nddose of HPV, 3rd for the 3rd dose of HPV. Data published in the MMWR revealed that for 2014 HPV vaccination coverage and series completion were higher among older female teens compared with females aged 13 years; these findings appear to be less consistent among males.
The data showed that for 2014, the District’s HPV vaccination rates are well above the US National average and the average for HHS Region III for both females and males for all three doses (View table). There are many factors that have contributed to improvement in rates. The District has an HPV law requiring female students to get the vaccine or to opt-out of the vaccination that became effective in 2007. In the earlier years there was much resistance from parents to have their children vaccinated because many parents did not recognize that vaccination in early adolescence optimizes protection before HPV exposure. This changed in 2013 when the DC Immunization Program received funding for an HPV initiative from the Prevention and Public Health Funds (PPHF) through the Centers for Disease Control and Prevention (CDC) to conduct activities to increase HPV vaccination coverage. One component of the initiative was the launch of a communications campaign which helped to promote community awareness of the importance of the HPV vaccine and to notify parents of the impending implementation of an expanded school requirement. In late 2014, DC expanded its existing school requirement for HPV vaccination to include males and females through 12th grade with a requirement for submitting exemption forms annually (https://immunization.doh.dc.gov/imm/2014_Dec_19_HPV_Final_Rulemaking.pdf). There has also been a shift in exemption requirements from a permanent exemption to an annual exemption.
Partnerships with managed care organizations, public school systems, community immunizers and clinical professional organizations like the local AAP chapter have played a pivotal role in increasing immunization rates. Other factors that have contributed to the improvement in rates are activities and work being conducted in the Vaccines for Children (VFC) provider practices, they include but are not limited to the following:
- Utilization of the immunization information system (IIS) for reminder/recall;
- Assessment and feedback (AFIX) intervention conducted by the Immunization staff to identify missed opportunities for vaccination;
- Education of key clinical and administrative staff about the importance of timely routine HPV vaccination and the significance of using all opportunities to immunize; and
- Provision of practice-focused strategies to aid clinicians to effectively communicate to parents about the importance of immunizing on-time immunization and completion of the HPV vaccination series.