title: Summer Peaks in Uptake of Human Papillomavirus and Other Adolescent Vaccines in the United States.
abstract: BACKGROUND
  Seasonality in human papillomavirus (HPV) vaccination could have a large impact on national cancer prevention efforts. We hypothesized that uptake of HPV vaccine and other adolescent vaccines in the United States would be highest in the summer.
  
  
  METHODS
  Data came from health care provider-verified vaccination records for 70,144 adolescents (ages 13-17 years) from the 2008 to 2012 versions of the National Immunization Survey-Teen. Using the Edwards method for testing annual trends, we examined seasonal patterns in the uptake of HPV and other recommended adolescent vaccines [tetanus, diphtheria, and pertussis (Tdap) booster and meningococcal vaccine]. HPV vaccine initiation (receipt of the first of the three-dose series) data were for female adolescents.
  
  
  RESULTS
  Uptake for HPV and other adolescent vaccines peaked in the summer across years and states (all P < 0.001). Uptake was five times as frequent at the peak as at the trough for HPV vaccine, and HPV vaccine initiation was highest in June, July, and August (percent of doses delivered in these months: 38.7%). The same pattern existed for Tdap booster and meningococcal vaccine. Concomitant (same-day) vaccination of HPV vaccine with other adolescent vaccines also demonstrated summer peaks each year nationally (all P < 0.001).
  
  
  CONCLUSIONS
  Uptake of adolescent vaccines increased dramatically in summer months. These summer peaks are an important opportunity for interventions focused on concomitant vaccination.
  
  
  CONCLUSIONS
  The potential cancer prevention impact of HPV vaccination programs could be increased, for example, by delivering messages about concomitant vaccination during the summer, when adolescents and their parents might be most open to them.
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Moss
authors.affiliation: College of Medicine, The Ohio State University, Columbus, Ohio.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Reiter
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Rimer
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Kurt M
authors.initials: KM
authors.lastname: Ribisl
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina. Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina. ntb@unc.edu.
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D008297:Male; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012621:Seasons; D014481:United States
chemical_list: D053918:Papillomavirus Vaccines