60% American parents won't vaccinate children against HPV virus that causes 34,800 new cancers annually: Study
National Immunization Study shows that in Idaho, Kansas, Michigan, Montana, Nebraska, North Dakota, Oklahoma and Utah, vaccine hesitancy is higher than 65%
Parents of 1 in 2 unvaccinated US adolescents have no intention to initiate the vaccine against the human papillomavirus (HPV), a common virus that can lead to certain types of cancer later in life.
According to the US Centers for Disease Control and Prevention (CDC), HPV is responsible for 34,800 new cancer diagnoses yearly. The agency recommends a two-dose vaccination regimen for children if the first dose is received before age 15, or a three-dose regimen if the series is started between ages 16 and 26. Researchers from the University of Texas Health Science Center at Houston (UTHealth) found that of the estimated 4.3 million children in the US who were not vaccinated against HPV, nearly 60% of their parents had no intention to initiate the vaccine series. Survey data from the 2017-2018 National Immunization Study shows that in certain states – Idaho, Kansas, Michigan, Montana, Nebraska, North Dakota, Oklahoma, and Utah – vaccine hesitancy was even higher at more than 65%.
The team found that safety concerns are a substantial contributing factor to parental lack of intent to initiate the HPV vaccine series, and a lack of recommendations from healthcare providers contributes substantially to parental lack of intent to complete the series. “The hesitancy of parents to protect their child against HPV is troubling because improving HPV vaccination coverage is our only option to curb the rising burden of cancers caused by this virus. The silver lining is that these reasons are addressable. Healthcare providers can play a vital role in combating misinformation by educating parents about HPV vaccine safety and benefits. They can also emphasize the importance of series completion,” writes Dr Kalyani Sonawane, the study's first author and an assistant professor at UTHealth School of Public Health, in the analysis published in The Lancet Public Health.
More than 90% of all cervical and anal cancers, over 60% of all penile cancers, and about 70% of all oral cancers are caused by HPV, a highly contagious sexually transmitted infection. The current vaccine protects against nearly 90% of cancer-causing HPV infections. However, current vaccination rates reveal that just over half of US teenagers (51.1%) are fully vaccinated.
The research team conducted a cross-sectional study using responses from parents and caregivers of 82,297 US children ages 13 to 17. They found that parents of 1 in 4 adolescents who received their first HPV vaccine dose did not intend to complete the series.
In Arkansas, Florida, Georgia, Hawaii, Idaho, Utah, and West Virginia, over 30% of parents reported that their teenager would not receive subsequent vaccine doses to complete the series. In the District of Columbia (11.2%) and Rhode Island (20·4%), parental lack of intent was relatively low. Both regions have an HPV vaccine mandate.
“In 2017-18, the parent or caregiver of 82,297 US adolescents aged 13-17 years completed a survey. 30,558 (37.1%) were unvaccinated and 9,073 (10.8%) received only one HPV vaccine dose. Parents of 58% (17,171 out of 29,086) of unvaccinated adolescents with data available on parental intent had no intention to initiate the HPV vaccine series. Parents of 23.5% (2,166 out of 9,072) of initiators with data available on parental intent had no intention to complete the HPV vaccine series,” write authors.
The five most common reasons for parental lack of intent to initiate the HPV vaccine series in unvaccinated adolescents were safety concerns (22.8%), not needed or not necessary (16.1%), not recommended (12.2%), lack of knowledge (9.5%), and already up-to-date (9%). For parents of children who received one dose but failed to complete the full series, the most common cause cited was lack of a recommendation from a healthcare provider. “The most common reason for lack of intent among parents to initiate the vaccine for unvaccinated adolescents was safety concerns (22.8% or 4,182 out of 16,455). Lack of a recommendation from a healthcare provider (22.2% or 440 out of 1,944) was the most frequently cited reason for the absence of intent to complete the series among parents of adolescents who received only one HPV vaccine dose. Receipt of a recommendation from a healthcare provider was associated with greater odds of parental intent to initiate the HPV vaccine series,” say researchers.
An important finding of the analysis is that despite having received a recommendation from a healthcare provider to initiate the HPV vaccine series, a substantial proportion (over 60%) of parents had no intention to do so, with the majority reporting safety as their primary concern. “45.5% (13,156 out of 29,086) of parents of unvaccinated adolescents had reportedly received an HPV vaccine recommendation. Parents of 60.6% (7,938 out of 13,156) of unvaccinated adolescents with a recommendation from a healthcare provider and data available on parental intent had no intention to initiate the series,” the findings state.
Based on their findings, the researchers caution that lack of parental intent to initiate and complete the HPV vaccine series for adolescents is a major public health concern in the US. Combating vaccine safety concerns and strong recommendations from healthcare providers could improve the currently suboptimal HPV vaccination coverage, they suggest. “If these trajectories continue, the Healthy People 2020 goal of achieving 80% HPV vaccination coverage among US adolescents will be far beyond reachable, particularly in states with low vaccination coverage and high parental hesitancy. Aggressive and coordinated efforts among healthcare providers, parents, media, policymakers, and state health agencies are urgently needed to combat HPV vaccine hesitancy,” write authors.