Immunization Program and 1 more...less...

Immunization Registry

% of females age 13-17 who received at least one dose of HPV

72%Q1 2020

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Story Behind the Curve

Last Updated: June 2016

Author: Immunization Program, Vermont Department of Health

The HPV vaccine prevents cancer in women and men. Extensive research has shown that the HPV vaccine is very effective and safe. Since the CDC recommendation in 2006 for girls and 2011 for boys, HPV immunization rates in Vermont and across the country have been much lower than the rates for other teen vaccines. The Healthy People 2020 goal is that 80% of girls and boys receive three doses of HPV vaccine. There are a number of funded initiatives in the U.S. at this time to increase HPV vaccination rates.

In 2015, the HPV Initiative Workgroup was convened by the Vermont Child Health Improvement Program (VCHIP) to bring together organizations working to increase HPV immunization rates in Vermont. This allowed for coordination and collaboration among different organizations (see Partners).

It was recognized that practices weren’t aware of HPV immunization rates and may not have perceived it as a problem. In 2015, the Vermont Immunization Registry began mailing practice specific HPV quarterly reports to all providers enrolled in the Vaccines for Children program. Providers now have ready information on HPV rates for doses 1, 2 and 3 for girls and boys, with a comparison to statewide rates. This data helped motivate providers to consider how they might make changes to increase HPV rates. The Immunization Program offered practices an immunization specific quality improvement visit (known as AFIX) with a District Office public health nurse. AFIX provides practices with an opportunity to review immunization rates and evidence-based strategies to determine strategies they can implement to increase all immunization rates. During 2015 and 2016, AFIX visits have had specific emphasis on discussion of strategies for increasing HPV vaccine coverage, including the importance of an effective provider recommendation. Follow-up visits assess the impact of strategies the practice selected during the AFIX visit.

The National Improvement Partnership Network (housed at VCHIP) received funding to provide selected states with a comprehensive quality improvement program for pediatricians and family medicine providers to specifically increase HPV immunization rates. Over 20 Vermont practices have participated in this well-researched initiative.

Access to HPV vaccines is excellent in Vermont. Through the Vaccines for Children and Adults programs, enrolled providers receive HPV at no cost. Vermont made HPV9, the newest HPV vaccine, available as soon as it could be purchased from the CDC contract. For those teens without a health care provider or insurance, the District Offices administer vaccine at no cost.

The newly developed CDC HPV materials have been widely used to educate providers and parents.


Vermont Chapters of the AAP and AAFP, the Vermonters Taking Action Against Cancer coalition, VCHIP, Vermont Area Health Education Center, the Agency of Education and the Hicks Foundation.

What Works
  • Use of evidence-based strategies outlined in the Community Guide. Providing support to individual practices so they can make changes and implement selected strategies.
  • Provide practices with immunization coverage rates at baseline and after a short period of time to assess effectiveness of strategies chosen as part of AFIX or NIPN quality improvement efforts.
  • Have providers recommend a “package of protection” which includes all teen recommended vaccines.
Action Plan

Continue efforts to increase parent acceptance by making them aware of the safety and effectiveness of the HPV vaccine in preventing cancer.

Continue efforts to strengthen the provider recommendation and implement evidence-based strategies in provider practices to improve HPV vaccination rates.

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