title: Risk of Delayed Human Papillomavirus Vaccination in Inner-City Adolescent Women.
abstract: BACKGROUND
  Uptake of human papillomavirus (HPV) vaccine in the United States is slow, and the effectiveness of the vaccine has not been assessed in high-risk adolescent populations.
  
  
  METHODS
  We conducted a longitudinal study of 1139 sexually active, inner-city adolescent women receiving the 3-dose quadrivalent (4vHPV) vaccine. Cervical and anal specimens collected semiannually were tested using an L1-specific polymerase chain reaction assay. Postvaccination incidence of 4vHPV vaccine and nonvaccine HPV types, and risk of cervical cytological abnormalities, were assessed in relation to time to completion of all 3 vaccine doses.
  
  
  RESULTS
  Compared to vaccine naive women at enrollment, vaccinated women had significantly lower incidence rate ratios of cervical infection with HPV6/11/16/18 (0.2; 95% confidence interval [CI], .1-.4) and the related types HPV31 and HPV45 (0.4 [95% CI, .2-1.0] and 0.3 [95% CI, .1-.6], respectively), as well as significantly lower incidence rate ratios of anal infection with HPV6/11/16/18 (0.4; 95% CI, .2-.7). Notably, we observed higher risks of cervical HPV6/11/16/18 infection (hazards ratio [HR], 2.9; 95% CI, 1.0-8.0) and associated cytological abnormalities (HR, 4.5; 95% CI, .7-26.0) among women immunized at ≥15 years of age who took ≥12 months (vs <12 months) to complete the 3-dose regimen.
  
  
  CONCLUSIONS
  Among adolescents immunized at ≥15 years of age, a longer time to complete the 3-dose schedule was associated with an increased risk of anogenital HPV6/11/16/18 infection and an increased incidence of associated cervical cytological abnormalities.
authors.affiliation: Albert Einstein College of Medicine, Bronx.
authors.forename: Nicolas F
authors.initials: NF
authors.lastname: Schlecht
authors.affiliation: Mount Sinai Adolescent Health Center.|Icahn School of Medicine at Mount Sinai, Manhattan, New York.
authors.forename: Angela
authors.initials: A
authors.lastname: Diaz
authors.affiliation: Albert Einstein College of Medicine, Bronx.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Shankar
authors.affiliation: Icahn School of Medicine at Mount Sinai, Manhattan, New York.
authors.forename: Arnold H
authors.initials: AH
authors.lastname: Szporn
authors.affiliation: Icahn School of Medicine at Mount Sinai, Manhattan, New York.
authors.forename: Maoxin
authors.initials: M
authors.lastname: Wu
authors.affiliation: Mount Sinai Adolescent Health Center.|Icahn School of Medicine at Mount Sinai, Manhattan, New York.
authors.forename: Anne
authors.initials: A
authors.lastname: Nucci-Sack
authors.affiliation: Mount Sinai Adolescent Health Center.|Icahn School of Medicine at Mount Sinai, Manhattan, New York.
authors.forename: Ken
authors.initials: K
authors.lastname: Peake
authors.affiliation: Albert Einstein College of Medicine, Bronx.
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.affiliation: Albert Einstein College of Medicine, Bronx.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Burk
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000821:virology; D002584:Cervix Uteri / Q000821:virology; D002648:Child; D004279:DNA, Viral / Q000235:genetics; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D008137:Longitudinal Studies; D055118:Medication Adherence; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D030361:Papillomavirus Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000821:virology; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D016133:Polymerase Chain Reaction; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D004279:DNA, Viral; D053918:Papillomavirus Vaccines
keywords: adolescent medicine; cervical neoplasia; human papillomavirus; vaccination; women's health