HPV Vaccine Coverage Lower in the South

A review of data on vaccine coverage from 2008 to 2010 finds that HPV vaccine uptake among young women was significantly lower in the South than in other parts of the country.

Rates of vaccination against the human papillomavirus (HPV) in young women are lowest in the South compared with other regions of the United States, a new study finds. These results are of particular concern since the South also has the highest rates of cervical cancer in the country.

The HPV vaccine has been shown to be safe and effective and is recommended for all girls aged 11 to 12 and those aged 13 to 26 who have not previously been vaccinated. However, coverage remains low among American adolescents. Data from previous studies have indicated that these rates are even lower in the South. However, the regional difference in these cases was not statistically significant and the data only covered vaccine initiation for 1 year. The current study, published in the November 12, 2013, issue of Vaccine, analyzes the relationship between geographic region and the rate at which women received at least 1 dose or the full 3-dose course of the HPV vaccine from 2008 to 2010.

The researchers studied data from the Behavioral Risk Factor Surveillance System on the HPV vaccination status of women aged 18 to 24 living in 12 states. The states included in the study were grouped into 4 regions: the Northeast (Connecticut, Massachusetts, Pennsylvania, and Rhode Island), the Midwest (Kansas, Minnesota, and Nebraska), the West (Wyoming), and the South (Delaware, Oklahoma, Texas, and West Virginia). Women who reported receiving at least 1 dose of the vaccine were considered to have initiated the vaccine, while those who received all doses were considered to have completed the vaccine.

Of the 2632 women who completed a survey on their vaccination status, 28% reported initiating and 17% reported completing the HPV vaccine course. Among women in the Northeast, who had the highest vaccination rates, 37.2% initiated and 23.1% completed the HPV vaccine course, compared with just 14% initiating and 6.6% completing the HPV vaccine course in the South. The regional differences remained significant after adjusting for age, race, ethnicity, education and income level, health insurance status, and other factors. The results also indicated that women who were unmarried, younger than 18 to 21, college graduates or who had health insurance, an annual household income greater than $75,000, regular check-ups, or received the flu shot were more likely to have been vaccinated against HPV. In addition, white women were more likely to complete the vaccine course than were other races and ethnicities.

The researchers note that the study was limited as only 12 states were included in the analysis and some states did not conduct the survey each year from 2008 to 2010. In addition, the sample size was small for some regions in certain years. Despite these limitations, they note that the results are unsettling as the South has a higher incidence of cervical cancer and poverty than the Midwest, West, and Northeast.

“[T]here is a need to design strategies to improve the HPV vaccine uptake in the South to lower the burden of HPV-related diseases and cancers in the long run,” the researchers conclude.