New Survey Sheds Light on Low HPV Vaccination Rate

Laird Harrison

October 17, 2013

SAN FRANCISCO — Only 54% of adolescent girls in the United States were vaccinated last year for human papillomavirus (HPV), and of those who were, just 33% completed the series of injections, researchers told reporters attending a news conference here at IDWeek 2013.

The Advisory Committee on Immunization Practices (ACIP) recommends routine HPV vaccination for girls 11 to 12 years of age. However, vaccination rates in populations most at risk for cervical cancer — black, Hispanic, and those living below the federal poverty line — are even lower.

"Healthcare providers could potentially use the findings from this study to guide how they counsel families about the vaccine," said lead investigator Sean O'Leary, MD, from the University of Colorado School of Medicine in Aurora.

In an effort to better understand the reasons for the low rates of HPV vaccination, the investigators interviewed 30 parents by telephone for 25 to 40 minutes.

Three groups were interviewed: English-speaking parents of girls who did not complete the series of vaccinations, Spanish-speaking parents of girls who did not complete the series, and Spanish-speaking parents of girls who did not initiate the series.

The English-speaking parents of girls who did not initiate the series participated in a 2-hour focus group discussion.

Both Spanish- and English-speaking parents reported that their healthcare providers had not fully encouraged the vaccinations. However, English speakers said they mistrusted the healthcare system and the vaccine's safety, whereas Spanish speakers said they worried that the vaccine would encourage the girls to have sex.

Safety Concerns and Doubt

All the families received care from Denver Health and Hospital Authority and the Rocky Mountain Youth Clinics. Many were on Medicaid or uninsured, but all had medical homes, Dr. O'Leary reported.

Previous research has shown that the vaccine can prevent precancerous lesions associated with cervical cancer, providing strong indirect evidence that it can stop the cancer itself, said Dr. O'Leary. Researchers believe it might prevent other cancers as well, he noted.

Both English-speaking groups cited concerns about the vaccine's safety, expressed doubts about the risk for HPV infection, and communicated a distrust of the government or medicine. They wanted more information from healthcare providers, including information on the importance of getting all 3 shots.

 
I think physicians need to be more firm in recommending this vaccine than some are.
 

Both Spanish-speaking groups said that healthcare providers had either not encouraged the initiation of the vaccine series or had not explained the necessity of completing the series. The Spanish-speaking parents of girls who did not initiate the vaccine expressed concern that their daughters would have premarital sex.

Previous research has shown that the vaccine is safe and does not encourage sexual activity, Dr. O'Leary pointed out.

This study highlights the need for more education about the benefits of the vaccine, said news conference moderator Larry Pickering, MD, senior advisor to the director of the National Center for Immunization and Respiratory Diseases of the Centers for Disease Control and Prevention in Atlanta.

"Talking to parents about the HPV vaccine is an easy discussion," he said. "Talking to a woman who has cervical cancer and telling her she can longer have a baby and may die — that's a difficult discussion. I think physicians need to be more firm in recommending this vaccine than some are. "

Dr. O'Leary and Dr. Pickering have disclosed no relevant financial relationships.

IDWeek 2013: Abstract 140. Presented October 3, 2013.

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