'AAP: Intervention Urging Earlier HPV Shots Linked to Better Initiation, Completion Rates'

 

• Initiating HPV vaccination at 9 years of age is endorsed by the American Academy of Pediatrics.
• Use of a best practice alert in the electronic health record combined with a clinician education component was associated with a higher likelihood of early HPV vaccination in a retrospective study.
• The intervention, along with an alert-only intervention, were also linked to increased rates of vaccine series completion.

Use of a best practice alert in the electronic health record (EHR) combined with a clinician education component was associated with a higher likelihood of early human papillomavirus (HPV) vaccination, a retrospective quality improvement study suggested.

Among kids ages 9 to 10 years, those in the alert plus education group had a significantly higher likelihood of initiating HPV vaccination compared with those in the alert-only arm (adjusted HR 1.39, 95% CI 1.17-1.65, P<0.001), reported Jenell Coleman, MD, MPH, of the Johns Hopkins School of Medicine in Baltimore, and colleagues.

HPV vaccine initiation increased from 8.2% before the start of the alert-only intervention to 48.4% during the intervention, and from 21.4% to 66.6%, respectively, in the alert plus clinician education group (P<0.001), they wrote in JAMA Network Open.

The interventions were also linked to increased rates of vaccine series completion. Among those ages 9 to 10 in either intervention group, completion rates climbed from 2.2% pre-intervention to 19.6% during the intervention, while for those ages 11 to 14, completion rates rose from 13.9% to 66.6%, respectively (P<0.001).

By year 3, the 9- to 10-year-old group had a higher cumulative completion rate than the 11- to 14-year-old group (33.9% vs 30.7%, P<0.001).

Because the "brief, scalable clinician education module" added to an EHR best practice alert "required minimal resources and integrated easily into existing workflows, this strategy was highly scalable across diverse settings," Coleman and team concluded.

"Initiating HPV vaccination at 9 years of age offers strategic advantages in cancer prevention and is endorsed by the American Academy of Pediatrics," they wrote. "It increases the likelihood that adolescents are fully vaccinated well before potential sexual exposure, when the vaccine is most effective."

The WHO recommends a single dose of the HPV vaccine at 9 to 14 years of age, while the CDC recommends starting HPV vaccination at ages 11 to 12 years, or as early as age 9. The CDC backs two vaccine doses for most people who start before age 15, though the CDC's Advisory Committee on Immunization Practices has considered the value of a single-dose regimen.

For this study, the researchers included 15,743 patients treated at 21 urban, suburban, or rural primary care practices in Maryland from January 2019 through June 2023. Clinics were nonrandomly assigned to one of two interventions: a best practice alert in the EHR system recommending that HPV vaccination begin at age 9 or the best practice alert along with an education component with webinars about HPV vaccination.

Mean patient age was 9.9 years, 50.5% were boys, 48.4% were white, 32.3% were Black or African American, 8.6% were other race, and 8% were Asian. The alert-only group included 14,077 patients, while the alert plus education group included 1,666 patients. Across both groups, 64.2% of patients received at least one HPV vaccine dose, and 33% completed the vaccine series.

Black or African-American patients were more likely to initiate HPV vaccination compared with white patients (aHR 1.22, 95% CI 1.11-1.35, P<0.001), and more likely to complete vaccination (aHR 1.24, 95% CI 1.11-1.39, P<0.001).

Study limitations included the use of data primarily representing urban populations, which may reduce the findings' generalizability to rural areas. The study sites weren't randomly assigned to the two interventions, which could lead to allocation bias. In addition, the study's intervention phase happened during the COVID-19 pandemic, which affected the number of in-person visits.

Disclosures

This study was supported in part by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme.

Coleman reported no disclosures. A co-author reported a relationship with Pfizer Global Medical.

Primary Source

JAMA Network Open

Source Reference: Kumra T, et al "Electronic health record alerts for early human papillomavirus vaccination" JAMA Netw Open 2026; DOI: 10.1001/jamanetworkopen.2025.59670.

https://www.medpagetoday.com/pediatrics/vaccines/119890