Human Papillomavirus Vaccine Uptake among Adolescent Survivors of Hematopoietic Stem Cell Transplant

doi:10.21203/rs.3.rs-4687503/v1

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Research Article

Human Papillomavirus Vaccine Uptake among Adolescent Survivors of Hematopoietic Stem Cell Transplant

https://doi.org/10.21203/rs.3.rs-4687503/v1

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Purpose

To characterize the rate of human papillomavirus (HPV) vaccine uptake in the adolescents after hematopoietic stem cell transplant (HSCT).

Methods

This retrospective study evaluated the vaccine history of adolescent HSCT patients ≥ 11 years of age transplanted between 2015 and 2022 at a tertiary care medical center. Logistic regression was used to examine bivariate associations between HPV vaccine uptake and covariates including demographic factors, indication for and type of HSCT, receipt of HPV vaccine prior to transplant, and receipt of other vaccines after transplant.

Results

Among 119 (n = 53 female; n = 66 male) eligible patients, 66 (55.5%) received ≥ one dose of the HPV vaccine after HSCT. Among those who initiated vaccination, 45/66 (68.2%) completed two or more doses. Of 69 patients who were eligible to receive the vaccine prior to HSCT, 19/36 (52%) were vaccinated both before and after HSCT, compared to 14/33 (42%) who did not receive the vaccine before HSCT but chose to be vaccinated after HSCT. No statistically significant difference was identified between those who did and did not initiate HPV vaccination after HSCT among covariates examined.

Conclusions

Rate of HPV vaccine uptake after HSCT was lower compared to the general U.S. adolescent population and lower than the rate of other recommended vaccines. Receiving HPV vaccine prior to HSCT was not associated with HPV re-uptake after HSCT.

Implications for Cancer Survivors: HPV vaccination continues to be suboptimal in HSCT survivorship and should be a targeted goal for improvement in preventing secondary malignancy in this high-risk population.

Human papillomavirus

vaccination

hematopoietic stem cell transplant

adolescent and young adults (AYA)

Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States, with an estimated 14 million new infections annually [1]. Over half of these new infections occur in adolescents and young adults ages 14 to 25 years [2]. Though the vast majority of HPV infections self-resolve over time, persistent infection with high-risk subtypes remains the primary known cause of cervical, oropharyngeal, and anogenital dysplasia and malignancy. Infection with high-risk HPV 16 or 18 alone is associated with over 70% of all cervical cancers [3], oropharyngeal squamous cell carcinomas [4], and penile cancers [5] and with 90% of anal squamous cell carcinomas [6]. Reducing HPV infection and transmission is critical to reducing disease burden. The Centers for Disease Control and Prevention (CDC) recommends vaccination of both males and females starting at age 11 or 12 years, with two doses of the HPV vaccine given 6 to 12 months apart; vaccination may begin as early as age 9 years. Among immunocompromised individuals or those older than age 15 years, the current recommended vaccine series includes 3 doses of the HPV vaccine at 0, 2 and 6 months [7]. As HPV is spread through sexual contact via skin-skin or skin-mucosa contact, vaccination in childhood or adolescence is a critical opportunity to acquire immunity prior to exposure with the onset of sexual activity. Therefore, the greatest risk reduction for cervical cancer occurs when vaccination occurs at a younger age and prior to HPV exposure [8].

The HPV vaccine is particularly important for hematopoietic stem cell transplant (HSCT) patients, who are at significantly increased risk of HPV-related disease compared to the general population because of their immunocompromised state [9]. Each year, more than 8000 allogeneic HSCTs are performed in the United States [10]. Previous studies have shown that 30 to 40% of long-term adult HSCT survivors will have HPV-related disease within 5 years of transplant; up to 20% of these patients will have severe, persistent, or multifocal disease in adulthood [11, 12]. In one retrospective case-control study including 700 adult HSCT patients, those with a history of HSCT had 3.5 times higher odds of developing HPV-related precancer or secondary malignancy compared to healthy controls [13]. HPV vaccination is critical to reducing the risk of HPV infection and related disease in the HSCT population. Importantly, HPV vaccination prior to transplant is not protective against HPV after transplant. Survivors of HSCT have lost or reduced immunity after transplant [14]; as such, patients who have undergone HSCT are advised to initiate or re-initiate both the HPV vaccine and other age-based vaccines regardless of pre-transplant vaccination status [14, 15].

HPV vaccination has been shown to be safe and effective in post-HSCT patients, even for those receiving systemic immunosuppression [16]. The current HPV vaccine guidelines at our institution for HSCT patients recommend administration of the HPV vaccine series starting at 16 months after HSCT, though patients may receive the vaccine as soon as 12 months after HSCT if fully immune reconstituted and sooner vaccination is desired. The guidelines thereafter follow the general CDC recommendations for timing of 2nd and 3rd doses, at 2 and 6 months respectively after the initial dose. The recommendation for HPV vaccination with the 3-dose series after HSCT is concordant with the Children’s Oncology Group (COG) recommendations for long-term follow up of HSCT patients [17]. Despite these guidelines, data remains limited regarding the rate of HPV vaccine uptake after HSCT in the pediatric and adolescent setting. Further investigation into the uptake of HPV vaccination is necessary to improve patient outcomes and provide evidence for future quality improvement to increase vaccine administration in this population.

Patient characteristics

This retrospective study evaluated the vaccine history in a cohort of pediatric and adolescent HSCT survivors transplanted between 2015 and 2022 at the Cincinnati Children’s Hospital and Medical Center (CCHMC). These study dates were chosen to reflect the updated 2016 guidelines of the American Cancer Society, which extended the recommendation to include routine vaccination of males as well as females. Subjects were included in the study if they had undergone a hematopoietic stem cell transplant for an oncologic or non-oncologic diagnosis, were ≥ 11 years of age, and were at least 12 months from hematopoietic stem cell transplant. Subjects were excluded if they were medically ineligible to receive the HPV vaccine as determined by their HSCT provider, if they had death or disease relapse within the period of vaccine eligibility, or if vaccine data was unable to be extracted from the electronic medical record (EMR). This study was submitted to the CCHMC Institutional Review Board (IRB) and was deemed exempt from IRB approval.

Data Collection

Demographic information extracted from the EMR included sex, date of birth, age, race/ethnicity, state of residence, primary language, and insurance status. As the study institution’s EMR routinely syncs with centralized immunization databases in Ohio (OH), Kentucky (KY), and Indiana (IN) that require healthcare providers to report complete immunization histories, residence was categorized as OH/KY/IN, other U.S. state, or foreign country [18, 19]. Additional clinical information was extracted from the EMR, including indication for HSCT; treatment information including age at transplant, date of transplant, type of HSCT (allogeneic or autologous); and vaccine history. In addition to HPV vaccine information, data on other annual and age-based vaccines were collected including Diphtheria toxoid, Tetanus toxoid, and Acellular Pertussis (DTaP), COVID, and influenza vaccines. Data were managed securely using the web-based application Research Electronic Data Capture (REDCap).

Data Analysis

The primary outcome was the proportion of patients who were eligible for and received HPV vaccination after HSCT. Logistic regression was also used to examine the bivariate associations between HPV vaccine uptake after HSCT and the following clinical factors: demographic variables, indication for and type of HSCT, receipt of HPV vaccine prior to HSCT, receipt of other age-based vaccines, and the receipt of COVID and flu vaccines. A p-value less than 0.05 was considered statistically significant. All analyses were performed using R Statistical Software (v 4.4.0; R Core Team 2024).

Patient characteristics

A total of 333 potentially eligible patients were identified; 119 (35.7%) patients met inclusion criteria and were included in our final sample (Fig. 1). These included 53 (44.5%) patients assigned female at birth and 66 (55.5%) patients assigned male at birth. The median age at HSCT was 13.3 years (IQR 9.4–18.8 years). Most patients were non-Hispanic/White (81.5%) from North America (89.9%) and resided within the local OH/KY/IN area (75.6%). Slightly more than half of patients (53.8%) underwent HSCT for treatment of malignancy, such as leukemia or lymphoma (38.7%) or a solid tumor (15.1%). The remaining 46.2% of patients underwent HSCT for a non-malignant condition, most commonly a bone marrow failure syndrome (34.5%), such as aplastic anemia or Fanconi anemia (Table 1).

HPV vaccine uptake

Among the 119 HSCT survivors, 66 (55.5%) received at least one dose of the HPV vaccine at a median of 2.1 years (interquartile range (IQR): 1.4–3.4 years) after HSCT. A higher proportion of females than males received the HPV vaccine after HSCT (58.5% vs 53.0%; p > 0.05). The median age at first post-HSCT HPV vaccine dose was 16.0 years (IQR 13.0, 20.7). The majority (46/66, 69.6%) of patients who initiated the HPV vaccine series completed two or more doses. Only 18/66 (27%) of those who initiated the vaccine completed the recommended three-dose series and were equally likely to be male or female. The median time from initiation to completion of the three-dose series was 0.6 years (IQR 0.5, 0.8 years) (Table 2).

Rate of HPV re-vaccination

Of those included in the study, 58.0% (69/119) were eligible to receive the HPV vaccine prior to HSCT based on age. Over half (36/69, or 52.1%) received at least one HPV vaccine dose prior to HSCT, and of those, approximately half (19/36, 52.8%) were again re-vaccinated against HPV after HSCT. Patients who were revaccinated were more often male (68.4%) than female (31.6%) and re-initiated HPV vaccine uptake at a median of 1.5 years (IQR 1.1, 2.0 years) after HSCT. Of the 47% (33/69) who were not vaccinated against HPV prior to HSCT, more than half (19/33, 57.6%) had not received the vaccine after HSCT. HPV vaccination prior to HSCT was not associated with a greater likelihood of HPV vaccination after HSCT (Table 3, p > 0.05).

No statistically significant difference was identified between those who did and did not initiate HPV vaccination after HSCT among covariates examined in this study, including age, sex, state of residence, race, primary language, insurance status, indication for and type of HSCT, receipt of other recommended vaccines, and receipt of COVID and flu vaccines (Table 1).

This study is the first to characterize the HPV vaccination rates in a large population of young HSCT survivors both before and after transplant. Among HSCT survivors ≥ 11 years of age, only 55.5% initiated HPV vaccination after HSCT. When compared to the general U.S. population of adolescents age 13 to 17 years in 2022, the rate of at least one HPV vaccine dose in the study population (55.5%) was lower than that of the general population (76.0%) [20] despite study vaccination rates equal to or greater than the general population for COVID, DTaP, and influenza vaccines [21] (Table 2). This HPV vaccination rate is greater, however, than the rate of 24 to 48% of HPV vaccination in childhood cancer survivors reported in the literature [22]. Interestingly, receiving the HPV vaccine prior to HSCT was not significantly associated with HPV re-uptake after HSCT, which highlights the need for targeted counseling even for patients who have received the HPV vaccine previously.

Because HPV is a sexually-transmitted virus, vaccination is most effective at preventing HPV-associated malignancy when administered prior to initiation of sexual activity [8]. Sexual activity, including genital-genital, oral-genital, or anal sex, carries risk of HPV transmission due to skin-skin or skin-mucosa contact. In the general population, approximately 20% of 15 year-olds and 65% of 18 year-olds have had sexual intercourse [23]. As such, many adolescent HSCT survivors may initiate sexual activity prior to or within the first few years after HSCT. HPV vaccination soon after HSCT would therefore likely provide the most benefit. However, even delayed vaccination after HPV exposure would likely provide some, albeit decreased, therapeutic benefit. A meta-analysis by Di Donato et al. showed an overall decreased risk of recurrence of cervical intraepithelial neoplasia grade 2 or higher (CIN2+) when patients were vaccinated after surgical treatment for the disease as compared to those who were not vaccinated against HPV [24]. While prophylactic HPV vaccination is most effective, catch-up vaccination is also beneficial. This benefit may be even more pronounced in the HSCT population as risk for primary or secondary malignancies. Interestingly, our data also demonstrated that patients with a primary diagnosis of malignancy were not more likely than those with a non-oncologic primary diagnosis to receive the HPV vaccine to prevent a secondary, HPV-related malignancy.

Our study confirms that HPV vaccination in the adolescent HSCT population remains markedly lower than that of other recommended vaccines such as DTaP and influenza vaccines. (55.5% compared to 89.9% and 95.8%, respectively). Not only are rates of HPV vaccine uptake relatively low, but time to first HPV dose after HSCT is often delayed, with a median time to vaccine uptake of 2.0 years after HSCT despite routine recommendation starting at 16 months after HSCT. We hypothesize that patients may decline or deprioritize the HPV vaccine for any of several reasons. Because HPV is a sexually transmitted infection, social stigma may increase vaccine hesitancy or reduce the perceived necessity of vaccination among patients and parents of young children. Cancer survivors and parents of childhood cancer survivors who have declined participation in HPV vaccine trials have previously expressed that their child is too young to need the vaccine or that the vaccine is not necessary in the absence of sexual activity [25]. Alternatively, influenza, COVID, or pertussis may present with cough, fever, or other readily apparent symptoms of illness; in contrast, HPV infections are largely asymptomatic, and even HPV-related disease may be asymptomatic. The absence of symptoms, however, does not reflect the true disease burden. The cumulative proportion of genital HPV infection increases over time to up to 40.9% at 20 years after HSCT [12]. Most female patients who are found to have HPV-related disease are diagnosed during routine annual screening with cervical Papanicolaou smears. For female patients with HSCT before the age of 21 years, screening begins within 1 year of sexual debut or at 21 years, whichever occurs first, and is repeated annually until three consecutive cytology results are normal before returning to routine screening guidelines [26]. Yet due to the natural progression and regression of the disease [27], patients may be unaware of HPV infection if they are not having routine screening performed, are asymptomatic, or have disease regression prior to detection. For male patients, no equivalent routine HPV screening method is currently available [28]. Without clinically apparent symptoms, HPV infection may be less pressing for patients and families who have survived severe disease, such as cancer, or who are experiencing late effects from their disease or treatment.

Despite the CDC’s Federal Advisory Committee on Immunization Practices (ACIP) decade-long recommendation for routine vaccination against HPV in male as well as female adolescents [29], HPV vaccination rates in the general population remains suboptimal. Several studies have shown that the strongest predictor of HPV vaccine non-initiation is lack of provider recommendation [30, 22, 31]. In cancer survivors, other reasons for HPV vaccine refusal include vaccine hesitancy, disinterest in the vaccine, or lack of knowledge of vaccine safety in the context of cancer history [25, 32]. A secondary analysis of vaccine-naïve cancer survivors who refused participation in a clinical trial on the HPV vaccine expressed worry about long-term safety and side-effects, potential cancer relapse, and the desire to avoid additional medical interventions or needles that are not deemed “necessary” [25].

Once HPV vaccination was initiated, the majority (46/66, 69.6%) of patients received at least two doses; however, less than a third (18/66, 27%) of those who initiated the vaccine completed the recommended full three-dose series. Recent data suggests that two doses alone may be sufficient to provide protection against high-risk HPV. The World Health Organization (WHO) in December 2022 updated vaccination guidelines to recommend a one or two-dose schedule, with at least two doses for immunocompromised individuals [33]. A prospective cohort study of almost 18,000 adolescent females found that the immune response to HPV after two doses of the vaccine was non-inferior to that after three doses at 18 months after vaccination [34]. However, this evidence for the safety and comparability of a two-dose vaccine schedule is for an otherwise healthy population and may not apply to an immunocompromised population. Dobson et al. conducted a randomized controlled trial in 674 girls examining immunogenicity after 2 versus 3 doses of the HPV vaccine and found decreased immunogenicity to high-risk HPV-19 by 24 months after vaccination [35]. Immunocompromised individuals who received all three doses demonstrate persistent immunogenicity at 5 years post-vaccination [36]. Though incomplete HPV vaccine dosing is better than none, a full three-dose series continues to be recommended in populations at high risk for persistent or severe HPV-related disease.

Our study compromises a large, high-quality dataset of post-HSCT immunization practices from one of the largest pediatric HSCT centers in the United States. The majority (75%) of included patients lived within the tri-state area, which keeps an up-to-date statewide vaccine registry reported to a centralized database synced with the EMR. The data collected was therefore accurate, reliable, and up to date at the time of data collection. However, our data was collected from a single institution with limited generalizability. National surveys of providers from the Pediatric Blood and Marrow Transplant Consortium have demonstrated a wide variety of clinical immunization practices after HSCT [37]. Our study is also limited by its retrospective nature. We were unable to directly explore the reasons for lack of HPV vaccination after HSCT.

Our study demonstrates that the initiation of HPV vaccine is lower than the initiation of other recommended vaccines in adolescent HSCT survivors and lower than in the general population of individuals of similar age, despite being immunocompromised and therefore at high risk for secondary malignancy, and even fewer complete all three recommended doses. Early and complete vaccination should therefore be a targeted goal for improvement in this at-risk population. Future qualitative studies exploring reasons for vaccine refusal after HSCT could help inform these targeted practices and for improving HPV vaccination in this at-risk population.

Table 1. Patient Demographics and Clinical Characteristics of HSCT survivors

	Received HPV Vaccination After HSCT
	No (N = 53)	Yes (N = 66)	Overall (N = 119)*
Age at Analysis (years)
Mean (SD)	18.1 (5.97)	19.5 (6.31)	18.9 (6.17)
Median [Min, Max]	18.0 [11.0, 36.0]	18.0 [11.0, 43.0]	18.0 [11.0, 43.0]
Sex
Female	22 (41.5%)	31 (47.0%)	53 (44.5%)
Male	31 (58.5%)	35 (53.0%)	66 (55.5%)
State of Residence
OH/KY/IN	40 (75.5%)	50 (75.8%)	90 (75.6%)
Outside OH/KY/IN	13 (24.5%)	16 (24.2%)	29 (24.4%)
Race
Asian	4 (7.5%)	3 (4.5%)	7 (5.9%)
Black	3 (5.7%)	6 (9.1%)	9 (7.6%)
Middle Eastern	0 (0%)	3 (4.5%)	3 (2.5%)
White	45 (84.9%)	52 (78.8%)	97 (81.5%)
Missing	1 (1.9%)	2 (3.0%)	3 (2.5%)
Primary Language
Arabic	0 (0%)	3 (4.5%)	3 (2.5%)
English	51 (96.2%)	63 (95.5%)	114 (95.8%)
Other	2 (3.8%)	0 (0%)	2 (1.7%)
Indication
Bone Marrow Failure^a	18 (34.0%)	23 (34.8%)	41 (34.5%)
Hemoglobinopathy^b	2 (3.8%)	3 (4.5%)	5 (4.2%)
Immune deficiencies	2 (3.8%)	4 (6.1%)	6 (5.0%)
Liquid	22 (41.5%)	24 (36.4%)	46 (38.7%)
Other	2 (3.8%)	1 (1.5%)	3 (2.5%)
Solid tumor	7 (13.2%)	11 (16.7%)	18 (15.1%)
Type of HSCT
Allogeneic	42 (79.2%)	51 (77.3%)	93 (78.2%)
Autologous	11 (20.8%)	15 (22.7%)	26 (21.8%)
Other age-based vaccines received AFTER HSCT
No	5 (9.4%)	0 (0%)	5 (4.2%)
Unsure/Not specified in chart	5 (9.4%)	1 (1.5%)	6 (5.0%)
Yes	43 (81.1%)	64 (97.0%)	107 (89.9%)
Missing	0 (0%)	1 (1.5%)	1 (0.8%)
COVID vaccine
No	21 (39.6%)	19 (28.8%)	40 (33.6%)
Yes	32 (60.4%)	47 (71.2%)	79 (66.4%)
Flu vaccine
No	3 (5.7%)	2 (3.0%)	5 (4.2%)
Yes	50 (94.3%)	64 (97.0%)	114 (95.8%)
^a Myelodysplastic syndrome, Diamond Blackfan anemia, Dyskeratosis congenita, Fanconi anemia, Severe congenital neutropenia, Schwachman Diamond syndrome
^b Thalassemia, sickle cell disease
* All P > 0.05

Table 2. Select vaccination rates in study population as compared to general population^*

*General population data for ages 13 to 17 in 2022 available from Centers for Disease Control VaxView [38, 39, 21]

Table 3

Rates of HPV vaccination pre- and post-HSCT
	Total Eligible (n = 69)	Received HPV before HSCT
	Total Eligible (n = 69)	Yes (n = 36)	No (n = 33)
Received HPV after HSCT	33 (48%)	19 (53%)	14 (42%)
Did not receive HPV after HSCT	36 (52%)	17 (47%)	19 (58%)

P > 0.05

Acknowledgements: We are grateful to the patients who have attended the Cincinnati Children’s Bone Marrow Transplantation Program and the staff who have provided care to them.

Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Financial Interests: The authors have no relevant financial or non-financial interests to disclose.

Author Contributions: All authors contributed to the study concept and design. Material preparation, data collection, and analysis were performed by AM, KM, and TST. The first draft of the manuscript was written by AM, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Presentation: The results of this study were presented as an oral abstract at the North American Society for Pediatric and Adolescent Gynecology 38^th Annual and Clinical Research Meeting, April 5, 2024, Orlando, FL.

Gargano J, Meites E, Watson M, Unger E, Markowitze L. Chapter 5: Human papillomavirus. Manual for the surveillance of vaccine-preventable diseases. 2017.
Satterwhite CL, Torrone E, Meites E, Dunne EF, Mahajan R, Ocfemia MC, et al. Sexually transmitted infections among us women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013 Mar;40(3):187-93. https://doi.org/10.1097/OLQ.0b013e318286bb53
Castellsague X. Natural history and epidemiology of HPV infection and cervical cancer. Gynecol Oncol. 2008 Sep;110:S4-7. https://doi.org/10.1016/j.ygyno.2008.07.045
Pytynia KB, Dahlstrom KR, Sturgis EM. Epidemiology of HPV-associated oropharyngeal cancer. Oral Oncol. 2014 May;50(5):380-6. https://doi.org/10.1016/j.oraloncology.2013.12.019
Miralles-Guri C, Bruni L, Cubilla AL, Castellsague X, Bosch FX, de Sanjose S. Human papillomavirus prevalence and type distribution in penile carcinoma. J Clin Pathol. 2009 Oct;62(10):870-8. https://doi.org/10.1136/jcp.2008.063149
Grulich AE, Poynten IM, Machalek DA, Jin F, Templeton DJ, Hillman RJ. The epidemiology of anal cancer. Sex Health. 2012 Dec;9(6):504-8. https://doi.org/10.1071/SH12070
Human papillomavirus vaccination: ACOG committee opinion summary, number 809. Obstet Gynecol. 2020 Aug;136(2):435-36. https://doi.org/10.1097/AOG.0000000000004001
Lei J, Ploner A, Elfstrom KM, Wang J, Roth A, Fang F, et al. HPV vaccination and the risk of invasive cervical cancer. N Engl J Med. 2020 Oct 1;383(14):1340-48. https://doi.org/10.1056/NEJMoa1917338
Tanweer MS, Aljurf M, Savani BN, Iqbal PK, Hashmi S. Lower genital tract precancer and cancer in hematopoietic cell transplant survivors and the role of HPV: a systematic review and future perspectives. Clin Hematol Int. 2019 Sep;1(3):142-53. https://doi.org/10.2991/chi.d.190519.001
Health Resources & Services Administration. Donation and transplantation statistics 2022. https://bloodstemcell.hrsa.gov/data/donation-and-transplantation-statistics. Accessed 10 Jan 2023.
Savani BN, Stratton P, Shenoy A, Kozanas E, Goodman S, Barrett AJ. Increased risk of cervical dysplasia in long-term survivors of allogeneic stem cell transplantation--implications for screening and HPV vaccination. Biol Blood Marrow Transplant. 2008 Sep;14(9):1072-75. https://doi.org/10.1016/j.bbmt.2008.07.005
Shanis D, Anandi P, Grant C, Bachi A, Vyas N, Merideth MA, et al. Risks factors and timing of genital human papillomavirus (HPV) infection in female stem cell transplant survivors: a longitudinal study. Bone Marrow Transplant. 2018 Jan;53(1):78-83. https://doi.org/10.1038/bmt.2017.210
Zhao H, Duan Z, Li M, Chiao E, Ahmed S, Shih YT, et al. Increased incidence of human papillomavirus-related precancer or second malignancy among allogeneic stem cell transplantation patients: a SEER-medicare population study. Transplant Cell Ther. 2021 Dec;27(12):1016 e1-16 e9. https://doi.org/10.1016/j.jtct.2021.08.020
Ljungman P, Engelhard D, de la Camara R, Einsele H, Locasciulli A, Martino R, et al. Vaccination of stem cell transplant recipients: recommendations of the infectious diseases working party of the EBMT. Bone Marrow Transplant. 2005 Apr;35(8):737-46. https://doi.org/10.1038/sj.bmt.1704870
Carpenter PA, Englund JA. How I vaccinate blood and marrow transplant recipients. Blood. 2016 Jun 9;127(23):2824-32. https://doi.org/10.1182/blood-2015-12-550475
Stratton P, Battiwalla M, Tian X, Abdelazim S, Baird K, Barrett AJ, et al. Immune response following quadrivalent human papillomavirus vaccination in women after hematopoietic allogeneic stem cell transplant: a nonrandomized clinical trial. JAMA Oncol. 2020 May 1;6(5):696-705. https://doi.org/10.1001/jamaoncol.2019.6722
Children’s Oncology Group. Long-term follow-up guidelines for survivors of childhood, adolescent, and young adult cancers. 2023. http://www.survivorshipguidelines.org/ Accessed 10 Jan 2023.
Indiana Department of Health. Children & hoosiers immunization registry program (CHIRP). https://www.in.gov/health/immunization/children-and-hoosiers-immunization-registry-program-chirp/#Medical_Providers. Accessed 10 Jan 2023.
Kentucky Cabinet for Health and Family Services. Kentucky immune registry (kyir). 2024. https://www.chfs.ky.gov/agencies/dph/dehp/idb/Pages/kyir.aspx.
Pingali C, Yankey D, Elam-Evans LD, Markowitz LE, Valier MR, Fredua B, et al. Vaccination coverage among adolescents aged 13-17 years - national immunization survey-teen, United States, 2022. MMWR Morb Mortal Wkly Rep. 2023 Aug 25;72(34):912-19. https://doi.org/10.15585/mmwr.mm7234a3
Centers for Disease Control. HPV and TDaP vaccination coverage among adolescents age 13-17 years, national immunization survey-teen. 2023.
Klosky JL, Hudson MM, Chen Y, Connelly JA, Wasilewski-Masker K, Sun CL, et al. Human papillomavirus vaccination rates in young cancer survivors. J Clin Oncol. 2017 Nov 1;35(31):3582-90. https://doi.org/10.1200/JCO.2017.74.1843
Guttmacher Institute. Fact sheet: adolescent sexual and reproductive health in the united states. New York, NY 2019. https://www.guttmacher.org/sites/default/files/factsheet/adolescent-sexual-and-reproductive-health-in-united-states.pdf. Accessed 24 Oct 2023.
Di Donato V, Caruso G, Petrillo M, Kontopantelis E, Palaia I, Perniola G, et al. Adjuvant HPV vaccination to prevent recurrent cervical dysplasia after surgical treatment: a meta-analysis. Vaccines. 2021 Apr 21;9(5). https://doi.org/10.3390/vaccines9050410
Cherven B, Klosky JL, Keith KE, Hudson MM, Bhatia S, Landier W. Reasons for refusal of the human papillomavirus vaccine among young cancer survivors. Cancer. 2023 Feb 15;129(4):614-23. https://doi.org/10.1002/cncr.34521
Moscicki AB, Flowers L, Huchko MJ, Long ME, MacLaughlin KL, Murphy J, et al. Guidelines for cervical cancer screening in immunosuppressed women without hiv infection. J Low Genit Tract Dis. 2019 Apr;23(2):87-101. https://doi.org/10.1097/LGT.0000000000000468
Insinga RP, Dasbach EJ, Elbasha EH. Epidemiologic natural history and clinical management of human papillomavirus (HPV) disease: a critical and systematic review of the literature in the development of an HPV dynamic transmission model. BMC Infect Dis. 2009 Jul 29;9:119. https://doi.org/10.1186/1471-2334-9-119
Garland SM, Molesworth EG, Machalek DA, Cornall AM, Tabrizi SN. How to best measure the effectiveness of male human papillomavirus vaccine programmes? Clin Microbiol Infect. 2015 Sep;21(9):834-41. https://doi.org/10.1016/j.cmi.2015.05.038
Stokley S, Jeyarajah J, Yankey D, Cano M, Gee J, Roark J, et al. Human papillomavirus vaccination coverage among adolescents, 2007-2013, and postlicensure vaccine safety monitoring, 2006-2014--united states. MMWR Morb Mortal Wkly Rep. 2014 Jul 25;63(29):620-4. Available from https://www.ncbi.nlm.nih.gov/pubmed/25055185
National Vaccine Advisory Committee. Overcoming barriers to low HPV vaccine uptake in the United States: recommendations from the national vaccine advisory committee. Public Health Rep. 2016 Jan-Feb;131(1):17-25. https://doi.org/10.1177/003335491613100106
Rahim MQ, Jacob SA, Coven SL, Miller M, Meagher CG, Lozano G, et al. Identifying barriers to HPV vaccination for patients with sickle cell disease and childhood cancer survivors. J Pediatr Hematol Oncol. 2023 Nov 1;45(8):e940-e47. https://doi.org/10.1097/MPH.0000000000002752
Waters AR, Weir C, Kramer HS, van Thiel Berghuijs KM, Wu Y, Kepka D, et al. Implementation barriers and considerations for recommending and administering the human papillomavirus (HPV) vaccination in oncology settings. J Cancer Surviv. 2023 May 6. https://doi.org/10.1007/s11764-023-01391-4
World Health Organization. Human papillomavirus vaccines: Who position paper (2022 update). Weekly epidemiological record. 2022;97(50):645-72.
Sankaranarayanan R, Prabhu PR, Pawlita M, Gheit T, Bhatla N, Muwonge R, et al. Immunogenicity and HPV infection after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre prospective cohort study. Lancet Oncol. 2016 Jan;17(1):67-77. https://doi.org/10.1016/S1470-2045(15)00414-3
Dobson SR, McNeil S, Dionne M, Dawar M, Ogilvie G, Krajden M, et al. Immunogenicity of 2 doses of HPV vaccine in younger adolescents vs 3 doses in young women: a randomized clinical trial. JAMA. 2013 May 1;309(17):1793-802. https://doi.org/10.1001/jama.2013.1625
MacIntyre CR, Shaw PJ, Mackie FE, Boros C, Marshall H, Seale H, et al. Long term follow up of persistence of immunity following quadrivalent human papillomavirus (HPV) vaccine in immunocompromised children. Vaccine. 2019 Sep 3;37(37):5630-36. https://doi.org/10.1016/j.vaccine.2019.07.072
Hudspeth MP, Hill TN, Lewis JA, Van Meter E, Ragucci D. Post-hematopoietic stem cell transplant immunization practices in the pediatric blood and marrow transplant consortium. Pediatr Blood Cancer. 2010 Jul 1;54(7):970-5. https://doi.org/10.1002/pbc.22444
Centers for Disease Control. Covid-19 vaccination coverage and vaccine confidence among children: United States, Children 12-17 years, 2022. 2023. https://www.cdc.gov/vaccines/imz-managers/coverage/covidvaxview/index.html. Accessed 18 Jan 2024.
Centers for Disease C. Influenza (flu): Flu vaccination coverage, 2022-23 season, United States, 13-17 years. 2023. https://www.cdc.gov/flu/fluvaxview/index.htm. Accessed 18 Jan 2024.

No competing interests reported.

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Human Papillomavirus Vaccine Uptake among Adolescent Survivors of Hematopoietic Stem Cell Transplant

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Abstract

Figures

Background

Methods

Patient characteristics

Data Collection

Data Analysis

Results

Patient characteristics

HPV vaccine uptake

Rate of HPV re-vaccination

Discussion

P > 0.05

Declarations

References

Additional Declarations

Status:

Version 1