At-risk girls least likely to be offered HPV vaccine
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Adolescent girls in the United Kingdom who are at the greatest risk for acquiring HPV are the least likely to be offered the vaccine and to complete the three-dose vaccination schedule, according to new study results.
The United Kingdom’s HPV vaccination program, introduced in 2008, saw an uptake in vaccination of 66% in the first 3 years, well below the 80% coverage rate required to make a significant impact on cervical cancer deaths, according to the researchers.
Rachel J. Sacks, MBBS, of Imperial College Healthcare NHS Trust in London, and colleagues reported on data from anonymous questionnaires completed by 2,247 adolescent females aged 13 to 19 years attending sexual health clinics located throughout the United Kingdom. The questionnaires assessed demographics, HPV-related risk factors, offers of HPV vaccination by health care providers and whether vaccination had been completed. Respondents’ answers were compared with national data.
Adolescents surveyed were at much greater risk for HPV than the general population, including having higher rates of smoking (48% vs. 14% among 15-year-olds); having sexual intercourse before aged 16 years (52% vs. 38%); having a previous STI (25% vs. 4%); and more likely not to be in school, employed or in training (8% vs. 2% among 16-year-olds).
Seventy-four percent of participants were offered HPV vaccination; 60% were offered at school and 24% by a general practitioner. However, girls living in London (66%; adjusted OR=0.29; 95% CI, 0.19-0.44); girls who were not in school, employed or in training (49%; adjusted OR=0.26; 95% CI, 0.16-0.42); girls whose ethnicity was not white (64% to 69%); girls aged 17 to 19 years (67%; adjusted OR=0.37; 95% CI, 0.25-0.53); smokers (69%; adjusted OR=0.74; 95% CI, 0.63-0.87); and girls with a previous STI (63%; adjusted OR=0.69; 95% CI, 0.5-0.95) were all significantly less likely to be offered vaccination.
According to the researchers, 65% of participants who were offered vaccination completed the recommended schedule, but there were significantly lower completion rates among some of the same subgroups, including girls living in London (58%; adjusted OR=0.58; 95% CI, 0.41-0.81); girls who were not in school, employed or in training (48%; adjusted OR=0.53; 95% CI, 0.38-0.76); girls aged 17 to 19 years (62%; adjusted OR=0.67; 95% CI, 0.50-0.89); girls whose ethnicity was not white (42% to 56%); smokers (59%; adjusted OR=0.63; 95% CI, 0.50-0.80); and girls with a previous STI (53%; adjusted OR=0.68; 95% CI, 0.53-0.87).
The overall completion rate was 47%, the researchers said.
Among girls who refused HPV vaccination, 57% said they might have accepted had they been better informed by their parents and friends of the vaccine’s indication, efficacy and safety. Seventy-five percent of respondents who started the vaccination course but didn’t complete it reported that they were not adequately followed up.
Although self-reports can be unreliable, the researchers said the survey “demonstrates the vulnerability of this sample of young women … in terms of higher prevalence of risk factors for HPV acquisition and development of cervical cancer, and lower reported offer and uptake of the HPV vaccination, that might have reduced their risk of acquiring an oncogenic HPV, compared with national data.”
Rachel J. Sacks, MBBS, can be reached at Jefferiss Wing, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London W2 1NY, UK; email: rachel.sacks@imperial.nhs.uk.
Disclosure: The researchers report no relevant financial disclosures.