Interestingly, we found some evidence that underweight males, on average, initiated the HPV vaccine course at a younger age than their male normal-weight peers and were more likely to complete the series. Further research in a larger sample of males is needed to confirm this finding and determine other possible factors that may explain this association. We also found an association between female underweight and a reduced likelihood of initiating the HPV vaccine series, as well as an association between female underweight and an earlier age of initiating the HPV vaccine series. These findings may be due to sparse data (less than 3% of females were underweight), but may warrant further investigation in a larger sample of female adolescents.
5.
ConclusionsOur analyses indicate that high BMI is not associated with endothelin receptor or timing of the three-dose HPV vaccine course in US males or females aged 9–18 years. High BMI also is not associated with completion of the HPV vaccine three-dose course in US females aged 9–18 years. Our findings highlight the overall low uptake of HPV vaccine compared to national targets. This study reinforces the need for efforts to increase HPV vaccine uptake in adolescents across all BMI categories.
Conflicts of interest
The authors report no conflicts of interest.
Fundin
gThis research was supported by the Office of the Director, National Institutes of Health, Early Independence Award (DP5OD009162 to NEB). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Contributions
NEB originally conceived of the research question. MES had primary responsibility of statistical analysis and manuscript writing. NEB and SMM provided writing and analytic support. All authors contributed significantly to the final manuscript.
AcknowledgmentThe authors gratefully acknowledge the scientific input and expertise of Dr. Shalini Kulasingam.
Vaccine safety; Post-licensure surveillance; Quadrivalent inactivated influenza vaccines
1. Introduction
In 2013, the World Health Organization (WHO) recommended inclusion of a second type B influenza virus in quadrivalent inactivated influenza vaccines (IIV4) for the 2013−2014 influenza season (WHO) [1]. However, one of the quadrivalent vaccine was approved during 2012 and distributed in the subsequent influenza season of 2013−14 [2]. On February 27, 2013, three IIV4 products were approved for use in the general population and were available for the 2013−14 influenza season[3]: Fluarix® Quadrivalent, (GlaxoSmithKline, Research Triangle Park, North Carolina) which on December 14, 2012 was approved for use in persons ≥3 years of age [2]; Fluzone® Quadrivalent (Sanofi Pasteur, Swiftwater, Pennsylvania) which on June 7, 2013 was approved for use in persons ≥6 months of age [4]; and FluLaval® Quadrivalent GlaxoSmithKline, which on August 16, 2013 was approved for use in persons ≥3 years of age [5]. In September 2013, The Advisory Committee on Immunization Practices stated that although IIV4 includes a second B virus, there is no preferential recommendation over IIV3 [6], and vaccination should not be delayed if only IIV3 is available.