IMPROVING HPV VACCINATION RATES AMONG JUVENILE JUSTICE INVOLVED YOUTH

Purpose: Youth involved in the juvenile justice system often have lower vaccination rates compared to their counterparts in the general population. The immunization protocol at a large urban juvenile detention center was revised to provide catch-up immunizations after adjudication and prior to placement. This study evaluated the effects of this change on the rate of adolescent immunizations, including HPV. Methods: After IRB approval, we conducted a retrospective chart review of youth at our pre-adjudication facility. Immunization records were accessed from the state database to obtain HPV, MCV, and Tdap vaccination data. In 2015, the medical intake protocol at our facility was revised to provide catch-up immunizations for all youth. Immunization rates were compared to rates from a prior study in 2014 before the immunization protocol began. Sexual history was also abstracted from the intake history and physicals. Results: 368 records from January through April of 2017 were reviewed. 128 (40%) youth identified as White, 187 (58.4%) as Black, one (0.3%) identified as Asian, and 4 (1.2%) identified as Other. About 80% of participants were male. Youth ranged in age from 11 to 18 years, with an average age of 15 years. Among the 168 (45.7%) youth whose state immunization records could be accessed, 95.6% had initiated the MCV series, 96.3% had received the Tdap, and 76.2% had started the HPV series. In 2014, these numbers were 79%, 74%, and 18%, respectively at the same facility. In 2017, 67.9% of subjects who had initiated the HPV series completed it; in 2014 only 22% of youth had received more than one HPV vaccine and only 7% had completed all three doses. Approximately 82% of youth with immunization history available reported being sexually active, with 66% of these having completed the HPV series. Conclusions: Vaccination rates for MCV, Tdap, and HPV dramatically improved in this facility under the revised protocol. This improvement in coverage against HPV could be a result of promoting the initiation and completion of the series once adjudicated but may also be influenced by nationwide trends. Revised CDC and ACIP guidelines from 2016 regarding HPV vaccination dosing may have also improved vaccine series completion.