Physician recommendation key to HPV vaccine coverage



Better vaccine coverage of adolescents against HPV infection hinges on physicians and other health care professionals both recommending the vaccine and educating patients and parents about its importance, according to a report published online Nov. 25 in JAMA Pediatrics.

In a review of the extensive literature concerning barriers to HPV vaccination among patients aged 11-17 years, health care professionals’ failure to recommend the vaccine was found to be a leading obstacle to more widespread coverage, said Dawn M. Holman of the division of cancer prevention and control, Centers for Disease Control and Prevention, Atlanta, and her associates.


Health care professionals’ failure to recommend the HPV vaccine to adolescents was found to be a leading obstacle to more widespread coverage, said Dawn M. Holman.

The most recent data from the National Immunization Survey indicates that only 53% of adolescent girls in the United States have received at least one dose of the HPV vaccine series, only 35% have completed all three doses in the series, and only 8% of adolescent boys in the United States have initiated the HPV vaccine series. By comparison, coverage for the meningococcal conjugate vaccine is approximately 70% and coverage for the tetanus, diphtheria, and acellular pertussis vaccine is 78% in the same age group.

Ms. Holman and her associates performed a systematic review of the literature and found 55 studies published in 2009-2012 that addressed obstacles to HPV vaccination in this age group.

In ten articles that addressed barriers to HPV vaccination among health care professionals, researchers found that while most physicians support HPV vaccination and offer it to their patients, many tend not to offer it to the youngest adolescents or to boys. Many also offer HPV vaccination only according to their own perception of the patient’s risk of contracting the virus. And many do not appear to understand the importance of giving the HPV vaccine well before adolescents become sexually active.

Health care professionals also tend not to provide detailed information to either patients or their parents regarding the risks and benefits of HPV vaccination, or they emphasize the fact that it is optional – both of which come across to patients and parents as a less-than-ringing endorsement. Some health care professionals reported that HPV vaccination is under the parents’ control rather than theirs, and many cited the cost of the HPV vaccine, and the lack or lateness of insurance reimbursement, as a significant obstacle.

In contrast, concerns about the safety and efficacy of the HPV vaccine were rarely cited as contributing to poor coverage (JAMA Pediatrics 2013 Nov. 25 [doi:10.1001/jamapediatrics.2013.2752]).

A total of 64% of the reviewed articles involved barriers to vaccination among parents. Not having a physician recommendation and not getting enough information about the HPV vaccine from health care providers were the chief obstacles to greater coverage in this group. Certain religious affiliations also were associated with opposition to the HPV vaccine.

In contrast, costs and lack of access were cited infrequently. Few parents reported concerns about vaccine safety or efficacy, and few reported concern that the vaccination might affect their child’s sexual behavior.

"Providing adequate, clear, and accessible information to parents about HPV infection, vaccine safety, adverse effects, and the appropriate age for vaccination may be one way health care professionals can reduce concerns and misconceptions about the vaccine," Ms. Holman and her colleagues noted.

Other strategies to improve HPV vaccination coverage include educating health care professionals and the public in general about the importance of vaccinating adolescent males, and ensuring that underserved populations are informed about and given access to the vaccine, they added.

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