Carolinas Research Day 2021

A Review Of HPV Vaccination Uptake in New Beginnings Pediatrics Clinic, Blacksburg, VA Julie Mehta, MA, OMS II; Maha Nayyar, MPH, MS, OMS I; Mahnoor Khurshid, OMS I; Dr. Sofia Abraham-Hardee, DO/PhD, FACOP, FAAP, CS; Dr. Theresa J McCann, MPH, PhD Edward Via College of Osteopathic Medicine, Virginia Campus + New Beginnings Pediatrics Clinic, Blacksburg, VA Abstract Introduction

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Methods HPV vaccine is administered either as a two or three dose series beginning at age 9 years, as recommended by the CDC. According to this 2016 graph by the CDC, Virginia, along with a lot of southern Appalachian states, remains one of the lowest to administer the HPV Vaccine to adolescent teens. This study aims to get baseline data for HPV vaccination uptake in a pediatrics clinic in Blacksburg, Virginia to further our understanding about trends of vaccination uptake. • Subjects: A retrospective chart review will be conducted for patients aged 9-21 who have either initiated and/or completed any dose of the HPV Vaccination from January 1, 2012 – December 30, 2020 at the New Beginnings Pediatrics Clinic. • De-identified electronic medical records will be reviewed for age, race, gender, date/age of each vaccination dose, series completion, and county of residence and these variables will be collected in a Microsoft Excel Spreadsheet. • Preliminary data will be collected for about 500 patients. Amongst the cohort of patients from New Beginnings Pediatrics Clinic, we anticipate that our data will show the following findings: 1. Significant differences in HPV vaccine uptake between patients whose county of residence is located within the Appalachian region and patients whose county of residence is located outside the Appalachian region. 2. No significant differences in HPV vaccine uptake between male and female adolescent patients 3. Higher rates of first dose received than of completion of vaccination series. 4. An increased rate of HPV vaccine uptake in 2020 compared to 2012. 5. Significant differences in HPV vaccine uptake between Caucasian patients and non-Caucasian patients. Results

Research demonstrates that cervical cancer rates are disproportionately higher in the rural Appalachian region, which includes Southwest Virginia. The Human Papillomavirus (HPV) vaccine is used to prevent the onset of HPV as well as prevent cervical cancer. Thus, the measured rates of cervical cancer in Southwest Virginia could be associated with low vaccination rates. Despite being one of the few states that has a required mandate for girls to receive the HPV Vaccine, Virginia still remains one of the lowest states to administer the vaccine, both to adolescent girls and boys alike. A 2014 study found that there was no change in HPV vaccination uptake among adolescent girls even five years after the introduction of a statewide mandate (1). In fact, according to Healthy People 2020, in 2018 only 51.5% of girls aged 13-15 and 37.6% of boys aged 13-15 received the HPV Vaccination in Virginia, despite the statewide mandate (2). It has also been found that counties within rural Appalachia have one of the lowest traditional screening rates, and also one of highest rates of incidence and mortality from HPV-related cervical cancers as compared to the rest of the United States, especially among Appalachian women aged 18-26 (3). These findings could be attributed to higher rates of smoking and alcohol consumption in this region which is shown to be associated with higher rates of HPV-related cervical cancers that could be reduced with preventive measures, such as vaccinations and routine pap smears. The measured rates of cervical cancers in these areas could also be associated with low vaccination rates. There is currently limited data on administration of the HPV Vaccine in the Southwest Virginia area. This study is an anonymous retrospective chart review that aims to assess de-identified medical records to count the number of boys and girls that have initiated and/or completed the recommended doses of the HPV vaccine at New Beginnings Pediatrics Clinic located in Blacksburg, VA. Data will be collected by reviewing an estimated 500 electronic medical records of subjects aged 9- 21 at the time of the study. Findings will be used to measure uptake of HPV vaccine in this clinic population.

Estimated CDC Vaccine Coverage of >1 dose of HPV vaccine among adolescents aged 13-17 in Males ( L ) and Female ( R )

Conclusions

This study aims to gather baseline data about the HPV vaccine uptake at the New Beginnings Pediatric Clinic. After gathering this baseline data, it may be used to investigate further research studies, where we may examine parental attitudes about the HPV vaccination hesitation, or the factors like cost and access to healthcare that may play a role into decreased uptake of the vaccine in certain areas. This study may also be used to propose programs in local middle schools that may increase educational awareness for both adolescents and their parents, as such programs may help to eradicate misconceptions about the HPV vaccine and increase vaccine uptake and adherence, It would also be beneficial to compare baseline data of HPV vaccines given at New Beginnings Pediatric clinic, which is located in a rural Southwest Virginia, to a clinic located in more urban area.

References

1. https://www.sciencedirect.com/science/article/abs/pii/S00029378160049 19 2. https://www.healthypeople.gov/2020/data/map/4657?year=2018 3. https://cebp.aacrjournals.org/content/cebp/20/4/591.full.pdf 4. https://www.cdc.gov/mmwr/volumes/66/wr/mm6633a2.htm

Acknowledgements

We would like to thank Edward Via College of Osteopathic Medicine, Virginia Campus along with New Beginnings Pediatrics Clinic in Blacksburg, Virginia as well as the office manager, Ms. Dee Dee Linkous for providing us with the de-identified data to conduct our retrospective clinical chart review.

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