73 - Raising Rates, Reducing Risk: HPV Vaccination for 9–10-Year-Olds in Primary Care

Publication Number: 4071.73

Hanna Lemerman, Akron Children's Hospital, Copley, OH, United States; Laurie Engler, Akron Children's Hospital, Barberon, OH, United States; McKenzie Kraly, Akron Children's Hospital, New Franklin, OH, United States

Background: HPV is the most prevalent STI in the United States and a leading cause of preventable cancers, yet completing the full vaccine series continues to be a challenge. Initiating HPV vaccination at 9 and 10 years old provides more opportunities for timely series completion and is associated with higher vaccination rates. Administration at age 9-and 10-years old remains infrequent in clinical practice due considerable vaccine hesitancy compared to other childhood vaccines and is a newer recommendation in the vaccine schedule. The reliance on opt-in EHR order sets makes it more difficult for providers to remember to offer HPV vaccine and can imply that it is not as highly recommended as other vaccines.

Objective: We aimed to increase HPV vaccination rates among 9- to 10-year-old patients from 5% to 50% by the end of 2025 for primary care patients at annual well visits.

Design/Methods: An opt-out protocol was implemented, whereby the HPV vaccine was preselected in Epic® SmartSets for patients who were due for vaccination. This approach was piloted by introducing prechecked HPV vaccine orders for 9- and 10-year-olds across four primary care locations. Standardized provider and clinical staff scripting was developed and disseminated to ensure strong recommendations for HPV vaccination. Additional educational resources were provided to patients and their families to support informed decision-making. The team systematically tracked canceled HPV vaccinations and identified associated errors to inform process improvements. In May 2025, the Epic SmartSet configuration was scaled to all 45 primary care sites, facilitating broader adoption of the intervention.

Results: Switching from an opt-in to an opt-out vaccine protocol within Epic SmartSets resulted in increased HPV vaccination rates with sustained results from 5% to 26% by August 2025. HPV vaccination rate increased from a baseline value of 9% to a peak of 60% during the pilot site period. When we scaled it to all 45 primary care sites in the network, the overall rate dropped to 20% initially but it increased to 26% by mid-August 2025. HPV vaccine cancellation rates declined below 10% by August 2025.

Conclusion(s): Preselecting the HPV vaccine in the EHR improved consistency in offering it at annual well visits, reduced missed opportunities, and emphasized its importance alongside other vaccines. This led to higher and more sustained vaccination rates, though vaccine hesitancy remains a major challenge to achieving optimal coverage. Small-scale pilot trials facilitated smoother rollout and scaling of the process throughout the broader primary care network.

HPV Vaccine Administration at 9 & 10 Years Old Key Driver Diagram (KDD)
KDD of HPV vaccine administration at 9- and 10-year-old patients at well visits.

HPV Vaccination Rates at 9 & 10 Years Old at Well Visits
Control chart of HPV vaccination rates at 9- and 10-Year-old patients at well visits.

HPV Vaccine Cancellation Rates for 9 and 10 Year Olds at Well Visits
Control chart of HPV vaccination cancellation rates for 9- and 10-Year-old patients at well visits.