Missed Opportunities for Human Papillomavirus Vaccine Initiation in an Insured Adolescent Female Population

J Pediatric Infect Dis Soc. 2017 Nov 24;6(4):360-365. doi: 10.1093/jpids/pix067.


Background: This study assessed the initiation of HPV vaccination in insured adolescent females in relation to physician visits and receipt of other vaccines routinely given at the same age.

Methods: January 1, 2010, and September 31, 2015. Vaccination administration was determined by using Current Procedural Terminology codes. A missed opportunity was defined as the absence of an HPV vaccine at the following encounter types: visits with a 4-valent meningococcal conjugate vaccine (MenACWY) or tetanus, diphtheria, and acellular pertussis (Tdap) vaccine claim; well adolescent visits; or any encounter with a primary care provider (PCP). Missed opportunities were stratified by type of provider (pediatrician or nonpediatrician).

Results: Among 14588 adolescent girls, only 6098 (41.8%) initiated the HPV vaccine series. HPV vaccine was given at 37.1% of visits when a Tdap or MenACWY vaccine was administered, 26.0% of well adolescent visits and 41.8% of PCP visits. Pediatricians had fewer missed opportunities than nonpediatricians to administer HPV (50.7% vs 60.8%), as well as Tdap, although the difference was larger for Tdap (7.0% vs 29.6%).

Conclusions: These data indicate that pediatricians and nonpediatricians alike are missing opportunities to administer the HPV vaccine when other adolescent vaccines are given. Efforts should be focused on converting these missed vaccination opportunities into cancer-prevention visits.

Keywords: human papillomavirus; insured population; missed opportunities; vaccination rates; vaccine.

MeSH terms

  • Adolescent
  • Child
  • Female
  • Humans
  • Meningococcal Vaccines / therapeutic use
  • Papillomavirus Infections / prevention & control
  • Papillomavirus Vaccines / therapeutic use*
  • Pediatricians / statistics & numerical data
  • United States
  • Vaccines, Conjugate / therapeutic use


  • MenACWY
  • Meningococcal Vaccines
  • Papillomavirus Vaccines
  • Vaccines, Conjugate