Effect of Hurricane Maria on HPV, Tdap, and meningococcal conjugate vaccination rates in Puerto Rico, 2015–2019

ABSTRACT

In September 2017, Hurricane Maria devastated the Caribbean region, among them the US territory of Puerto Rico (PR). Vaccination distribution and uptake suffered from the impact. This study evaluated the trends in monthly vaccination initiation rates for human papilloma virus (HPV), Tdap and meningococcal conjugate (MenACWY) adolescent vaccines from 2015 to 2019, during which it was possible to observe and analyze the impact of Hurricane Maria on vaccine initiation. Monthly initiation rates were estimated. Age-standardized initiation rate ratio (SRR) and 95% CI were estimated. The analysis included 85,340 adolescents; 52.3% were male, and 47.7% were females. September 2017 showed HPV vaccine initiation had the lower rates of all the studied vaccines, with a rate of 75% after the disaster (from a rate of almost 90% in July 2017). Tdap and MenACWY vaccines rates remained above 90% in the same period. The SRR of HPV vaccine for September and October 2017 showed an estimated reduction of 5% and 8% in vaccine initiation rates, respectively for each month, when 2016 was the reference year (p > .05). The SRR of Tdap and MenACWY vaccines for November 2017 showed significant reductions when 2015 and 2016 were reference years (p < .05). HPV vaccine initiation rate was the most severely affected by the Hurricane Maria. Post-natural disaster protocols should strengthen existing programs for facilitate immunization access.

KEYWORDS:

• Hurricane Maria
• HPV vaccine
• immunization
• Tdap vaccine
• meningococcal vaccine
• natural disasters

Acknowledgments

The content is entirely the responsibility of the authors and does not necessarily represent the official views of the Comprehensive Cancer Center UPR. We thank Vilnery Rivera Figueroa and Glizette Arroyo Morales for your support and collaboration.

Disclosure statement

VCL has received compensation from Merck and Co., Inc. for consultancy in June 2020. APO received personal fees from serving as a consultant for Merck (October 2019) outside the submitted work. The other authors have declared that they have no competing interest.

Author contributions

VCL was conceptualization, funding acquisition, methodology, validation, and writing – original draft. OLDM’s contribution was conceptualization, formal analysis, visualization, writing – original draft. DTML’s contribution was writing – review and editing. RSA’s contribution was writing – review and editing. IVJ’s contribution was writing – review and editing. APOM’s contribution was writing – review and editing. ELSP’s contribution was methodology, validation, writing – review and editing.

Additional information

Funding

This work was supported by National Cancer Institute (NCI) [grant R01CA232743] (“Implementation of School-Entry Policies for Human Papillomavirus Vaccination”) within University of Puerto Rico Comprehensive Cancer Center. The National Cancer Institute had no role in the study design; collection, analysis, and interpretation of the data; writing of the manuscript; or decision to publish. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCI.