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Clinician recommendation positively linked to male vaccination against HPV
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Many parents interviewed about their knowledge of HPV had a limited understanding of the disease, but most said they would have their son vaccinated if their clinician recommended it, according to study results.
Last year, the CDC’s Advisory Committee on Immunization Practices issued a revised statement recommending universal vaccination of 11- to 12-year-old boys, with catch-up vaccinations for those aged 13 to 21 years. The revised, stronger recommendation came in response to data showing that vaccination could effectively prevent both genital warts and anal cancer precursors and epidemiologic data showing the increasing importance of HPV as a causal factor for head and neck cancers.
According to Rebecca B. Perkins, MD, and colleagues of the Boston University School of Medicine, in light of the recommendations promoting universal HPV vaccination for males, understanding attitudes and actions regarding this vaccine gains increasing importance.
“Most parents are open to vaccinating their sons against HPV – providers should not hesitate to follow the CDC guidelines and recommend this vaccine to males,” Perkins told Infectious Diseases in Children.
As such, Perkins and colleagues interviewed 121 parents of adolescent boys, who identified as black, Latino or white.
The researchers reported that three-quarters of the parents, regardless whether they were mothers or fathers, would accept HPV vaccination if their clinician recommended it. However, only 30% of sons were actually vaccinated. The investigators also said parents who intended to vaccinate and having an older son were more linked to vaccinations.
Disclosure: The study was funded by the American Cancer Society and the American College of Obstetricians and Gynecologists/Merck Adolescent Health Research Award. The researchers report no relevant financial disclosures.
Perspective
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Joseph A. Bocchini Jr., MD
More than anything, this article reminds us of the critical role physicians have in educating parents about vaccine-preventable diseases and in vaccine uptake.
In this study, completed when the recommendation for use of HPV vaccine in males was permissive, 120 low-income, minority parents accompanying their 11- to-17-year-old sons on visits to pediatric and adolescent practices in a Boston academic medical center and a community health center were found to have limited knowledge of HPV. However, after reading a brief educational paragraph about HPV disease in males, 75% of parents indicated that if the vaccine was recommended by the physician at that day’s visit, they would agree to have their sons immunized. Also, as found in a number of other studies on vaccine acceptance, physicians were identified as the most trusted source for information about vaccines, and physician recommendations were the most important factor in making the decision to vaccinate.
Another important finding was the significant gap between the percentage of parents who indicated that they would accept HPV vaccination of their sons (75%) and the sons who actually received HPV vaccine (30%) at the visit. These appear to have been missed opportunities at one of the clinic sites where the topic of immunization was not likely to have been discussed. Less than one-third of parents indicated that they would ask for the vaccine if it was not offered by the physician during a visit, even if they were in favor of their son receiving it.
In summary, in the population studied, the most significant barrier to immunization appeared to be the physician making a recommendation for giving HPV vaccine. Uptake of HPV vaccine has lagged behind the other vaccines recommended for adolescents at ages 11 through 12 years. In surveys, some physicians indicate a reluctance to address issues related to HPV infection in younger patients. The American Academy of Pediatrics and the CDC have information available to help structure a discussion with parents and relieve the discomfort some physicians have addressing this subject with parents of younger adolescents.
Physicians are responsible for educating parents on the need for HPV vaccine in both boys and girls at 11 through 12 years of age. And, we must make as strong a recommendation for HPV vaccine as we make for meningococcal vaccine and for Tdap. Modeling shows that the maximum benefit of HPV vaccine is achieved when the vaccine is given before a person becomes sexually active. Parents underestimate the likelihood that their adolescent will become sexually active. HPV infections are acquired soon after the onset of adolescent sexual activity. Waiting to give vaccine until an older age leaves adolescents at risk for acquiring a vaccine-preventable disease that causes almost all cervical, and many anogenital and oral cancers.
Pediatricians have the opportunity to reduce the incidence of HPV-related cancers and genital warts in their female and male patients. The additional effort to initiate the discussion on HPV and educate parents on the need to vaccinate at ages 11 through 12 years is well worth it.
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Harry S. Jacob, MD, FRCPath(Hon)
One should not forget that the cost of vaccination (more than $300) is a major disincentive for folk of meager means with no — or ineffective — insurance that might facilitate vaccination of their sons. I suspect that economic, not to mention moral, benefits of governmental subsidization for this procedure would be enormous, considering the reductions in cervical and head and neck cancers that would result, thereby.
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