Impact of Interventions to Improve Human Papillomavirus Vaccine Uptake on Other Vaccines Due: A Secondary Analysis of a Randomized Trial

Objective

We sought to determine if our recent trial of human papillomavirus (HPV) vaccine uptake improved influenza, meningococcal ACWY, and tetanus-diphtheria-acellular pertussis (Tdap) vaccine uptake.

Methods

We conducted a secondary analysis of our 4-year factorial stepped–wedge cluster-randomized trial of 6 primary care practices affiliated with the Mayo Clinic. We restricted our analysis to those adolescents 11- to 12-years-old due for at least 1 of 3 vaccines in addition to HPV. Trial arms included 1) usual care, 2) mailed reminder-recall letters to parents of empaneled adolescents following their birthdays alerting parents to the need for HPV vaccination and other vaccines due, 3) monthly confidential audit-feedback reports to providers sent via intracampus mail comparing rates of HPV vaccination for that provider with others, and 4) both interventions. Outcomes included receipt of influenza, meningococcal ACWY, and Tdap vaccines during the study step.

Results

Among trial participants, 8698 adolescents were due for ≥1 dose HPV and at least 1 of the other vaccines. The parent reminder-recall resulted in a clinically and statistically significant increase in uptake of the other vaccines (odds ratios ranging from 1.44–1.86, all 95% confidence intervals above 1.13) as it did in combination with the provider audit-feedback. Provider audit-feedback alone had no statistically significant impact.

Conclusions

The parent reminder-recall substantially improved uptake of all 3 vaccines, whereas the provider audit-feedback did not. This made sense as the reminder-recall treated all vaccines as equally recommended without a focus on the HPV vaccine due, while the audit-feedback only reported the provider’s success with HPV vaccine uptake.