Utilization of Administrative Data to Assess the Association of an Adolescent Health Check-up with Human Papillomavirus Vaccine Uptake in Germany

Background: In Germany, 3-dose human papillomavirus (HPV) vaccination is recommended for 12-17 year-old females. Countrywide monitoring of HPV vaccination coverage (VC) does not exist, but small-scale surveys suggested suboptimal uptake. There is currently no concerted implementation strategy in place, and approaches for improved vaccine delivery are needed. Our objectives were to analyze health insurance claims data to estimate HPV VC in the target population and to assess the association of the routine adolescent health check-up 'J1' (offered to 12-14 year-olds) with HPV vaccine uptake.

Methods: We sampled a subset of 12-16 year-old females from claims data in 15 of the 16 German federal states. Sampling was based on documented physician contacts flanking the follow-up period 2008-2012. We reconstructed age- and region-stratified histories of individual-level HPV vaccination series and J1 utilization and calculated country-level estimates.

Results: The study sample represented 54% (n=1.04 million) of the total target population. VC estimates for starting (and completing) HPV vaccination series ranged from 6.1% (1.2%) among 12-year-olds to 47.6% (36.2%) among 16-year-olds. J1 utilization was 50% at maximum. In J1-attendees, 42.0% had received ≥1 vaccine doses, translating into a significant association of J1 utilization and vaccine uptake with a 6.9-fold higher likelihood in 12-year-olds and 1.4-fold higher likelihood in 16-year-olds of receiving HPV vaccination.

Conclusion: HPV VC in Germany is low. Adolescent check-up J1 is associated with increased and accelerated HPV vaccine uptake securing immunization before sexual debut and should be used as a tool to improve VC in the target population. However, J1 utilization is only moderate and more than half of attendees had not received HPV vaccination, which represents a substantial proportion of missed opportunities. This indicates that J1 needs both further promotion through legislative structures already in place for other health check-ups and more awareness as an opportunity to offer HPV vaccinations.