Parental Hesitancy with the HPV Vaccine

Oncogenic HPV infections contribute to virtually all cases of cervical, 90% of anal, 69% of vaginal, 60% of oropharyngeal, 51% of vulvar, and 40% of penile cancers, altogether over 44,000 cancers per year.

It is estimated that the HPV vaccine could prevent >90% of HPV-attributable cancers yet HPV vaccination coverage remains low among adolescents. As of 2020, only 75.1% of adolescents aged 13 to 17 years had received at least 1 dose of the HPV vaccine and only 58.6% had completed the series, either 2 or 3 doses based on the age of initiation.

One of the main reasons for suboptimal HPV vaccination coverage is parental vaccine hesitancy. In the years after the release of the HPV vaccine, primary barriers to HPV vaccination voiced by parents included lack of provider recommendation and lack of knowledge as well as concerns about cost, the newness of the vaccine, and potential effects on child sexual behavior.

A recent study published in Pediatrics analyzed 10 years of data from the National Immunization Survey-Teen (NIS-Teen), which included 119,695 adolescents aged 13 to 17 years. The following table (abridged) shows the most common reasons cited.

Source: Adjei Boakye et al. Pediatrics. 2023

Interestingly, the proportion of parents citing “safety or side effects” as a reason for vaccine hesitancy increased significantly by 15.6% annually from 2010 to 2018. The proportion of parents citing “not recommended,” “lack of knowledge,” or “child not sexually active” as reasons for vaccine hesitancy decreased significantly by 6.8%, 9.9%, and 5.9%, respectively per year between 2013 and 2020. No significant changes were observed for parents citing “not necessary.”

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