HPV Vaccination in Youngest Eligible Age Group Down During COVID-19 Pandemic

Clinicians should consider patient age and seasonality in efforts to surpass prepandemic levels of human papillomavirus vaccine uptake across all age groups.

Despite an overall decrease in the number of patient encounters during the COVID-19 pandemic, there was a consistent increase in the rate of human papillomavirus (HPV) vaccinations per encounter in children aged 9 to 22 years. These study findings were published in a research letter in JAMA Network Open.

Researchers at Children’s Health Medical Group in Dallas, Texas, conducted a cross-sectional study to analyze the rate of HPV vaccination per patient encounter between January 2019 and December 2021 rates among patients aged 9 to 22 years. Data captured from electronic health records were used to identify patients eligible for HPV vaccination and determine whether a vaccine dose was received at an encounter, including well-child and follow-up visits. Mann-Whitney testing was used to assess patient demographics and encounter features, with adjustments made for the nonindependence of observations. Difference-in-difference testing that assessed the total number of vaccines administered across each season and each year was used to characterize the effects of the pandemic and seasonal variation on HPV vaccination rates.

The analysis included a total of 10,469 patient encounters, comprising 4548 unique patients. Although the number of patient encounters decreased by 19.3% between 2019 (n=3957) and 2021 (n=3192), HPV vaccination rates per encounter were increased in 2020 (35.6%) and 2021 (35.0%) compared with 2019 (30.9%; P <.001).

The researchers further analyzed the rate of vaccination according to patient age group. They found that patients in the youngest age group (age, 9-10 years) accounted for 3629 (34.7%) of the 10,469 patient encounters, yet the lowest percentage of HPV vaccinations were observed in this age group when compared with those aged 11 to 22 years.

After stratification by encounter year and season of vaccine receipt, the researchers observed that vaccination rates during the winter increased by 17.99% in 2020 compared with 2019. Compared with the spring and summer of 2019, HPV vaccination rates decreased by 37.31% and 22.30% in the spring and summer of 2020, respectively.

The pandemic may have been associated with providers feeling pressured to not miss vaccination at in-person encounters.

Compared with prepandemic vaccination rates in 2019, rates in 2021 increased by 6.97% and 4.23% in the fall and winter, respectively, and decreased by 9.33% and 25.29% in the spring and summer, respectively.

This study was limited by the use of encounter-level data rather than state or national patient-level data.

In regard to these findings, the researchers noted that “The pandemic may have been associated with providers feeling pressured to not miss vaccination at in-person encounters.”

Disclosures: Some authors disclosed reception of grants from national agencies during the study. Please see the original reference for a full list of disclosures.


Francis JKR, Weerakoon SM, Lucas SL, et al. Human papillomavirus vaccination before and during the COVID-19 pandemic. JAMA Netw Open. Published online September 19, 2022. doi:10.1001/jamanetworkopen.2022.34000