Infectious Disease

HPV vaccination rate improves but many parents remain hesitant

March 07, 2023

3 min read

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The authors report no relevant financial disclosures.

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The rate of teenagers vaccinated against HPV is improving but a significant number of parents remain hesitant about their children receiving the vaccine, a study found.

From 2011 to 2020, the rate of female teens receiving the HPV vaccine increased by around 22 percentage points and coverage among male teens increased by 57 percentage points, according to a study published in The Journal of Infectious Diseases.

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At the same time, however, most parents of unvaccinated teens said they did not intend to have their child vaccinated against HPV, which can cause cervical, head and neck cancers.

“Adolescent HPV vaccination steadily increased from 2011 to 2020 among female and male teens, as well as among all racial and ethnic groups in the United States,” Jodie L. White, MHSc, research data analyst at Johns Hopkins University School of Medicine, and colleagues wrote in the study.

“However, there were minimal changes in parental intent to vaccinate over the study period, with approximately two-thirds of parents of unvaccinated male and female teens in 2019 to 2020 remaining hesitant to initiate HPV vaccination,” they wrote.

The quadrivalent HPV vaccine, introduced in 2006 as a three-dose vaccine, has been shown to reduce risk for HPV infection and has been linked to decreases in a range of cancers in both men and women who have been vaccinated. Since 2016, a two-dose schedule was introduced for teens who started the vaccine series before age 15 years, White and colleagues noted.

Early on, the researchers said, the most preferable reason some parents were hesitant about the vaccine is because it was seen as “not necessary.” In recent years, they wrote that has been replaced by safety concerns that were exacerbated by the COVID-19 pandemic and “increasing misinformation about vaccine safety” overall.

The researchers analyzed data on 403,968 parents who participated in the National Immunization Survey Teen, an annual random digit dialing landline telephone and cell phone survey of parents and guardians about their US teens aged 13 to 17 between 2011 and 2020.

Of the participating parents, 346,850 reported the number of HPV vaccinations their teen received. From 2011 to 2020, the parent-reported prevalence of teens having received at least one HPV vaccination dose increased among females from 47.3% to 65.5% and among males from 14.6% to 59.2%. Provider-verified data also showed this increase, with vaccinations among females rising from 53.4% ​​to 75.2% and among males from 14.5% to 71.5%.

Although non-Hispanic white female and male teens were found in 2020 to be more likely to receive a recommendation for the HPV vaccine from their doctor, racial and ethnic minority teens were “slightly” more likely than non-Hispanic white teens to have received at at least one HPV vaccine dose.

There were 175,761 parents who reported their teens had not been vaccinated against HPV, with 169,979 providing data on whether they would initiate HPV vaccination in their teens during the next year.

From 2011 to 2020, the proportion of parents who were “very/somewhat likely” to initiate vaccination decreased from 38.5% to 38.4%. There was also a small decrease in intent to initiate vaccination among parents of unvaccinated non-Hispanic white female teens but an increase in intent to vaccinate among parents of non-Hispanic white male teens.

Parents of unvaccinated racial and ethnic minority teens — both males and females — were more likely to intend for their children to receive the vaccine than parents of non-Hispanic white teens.

The five most common reasons for vaccine hesitancy from 2013 to 2020 were that the vaccine is “not needed or not necessary” or “not recommended,” a “lack of knowledge” or that the teen was “not sexually active.” Over time, however, the number of parents of unvaccinated teens who cited “safety concerns/side effects” as their main reason increased for females from 17.5% in 2013 to 29.1% in 2020 and for males from 8% in 2013 to 22.8% in 2020, and the previous top five have all decreased in that time.

Additionally, in 2020, roughly one-fifth of parents of unvaccinated non-Hispanic Black female and male teens said the vaccine was “not necessary,” whereas one-fifth of parents of unvaccinated non-Hispanic other or multiracial male teens said the vaccine was “Not recommended” for their sons.

The CDC currently recommends adolescents aged 11 or 12 years start the HPV vaccine series, although children are eligible for the vaccine as early as age 9 years.

A recently published study showed that moving the recommendation to age 9 or 10 years could improve HPV vaccine uptake by ages 13 or 15 years, although children were less likely to complete the vaccine series within 3 years if they started it at an earlier age.

White and colleagues, having found that parents who are strongly hesitant to start HPV vaccination had not received a recommendation from their care provider, suggest better communication could ultimately improve the situation.

“Both presumptive recommendation and motivational interviewing used in tandem have been shown to significantly increase HPV vaccine uptake, even among hesitant parents,” White and colleagues wrote. “Utilization of these methods as standard clinical practice may help decrease parental hesitancy and boost adolescent vaccination.”

References:

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