More parents saying no to HPV vaccine for their daughters

While overall vaccination rates are up slightly, more parents are citing fears about the vaccine. Doctors are encouraged to stress the immunization's efficacy and safety.

By — Posted April 1, 2013

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Although human papillomavirus vaccine often is considered a pediatric issue, all physicians should talk about the immunization with their adolescent and young adult female patients, says the lead author of a recent study.

The recommendation comes as a growing number of parents are choosing to forgo the HPV vaccine due largely to doubts about its necessity and concerns about its safety, said a study published online March 18 in Pediatrics.

“I wasn't surprised that [parents have] safety concerns about the vaccine, but I'm surprised that [the number of parents is] increasing,” said lead study author Paul M. Darden, MD, a pediatrician in Oklahoma City.

Between 2008 and 2010, there was an almost fourfold increase in the percentage of parents who said fears about the HPV vaccine are keeping them from giving the immunization to their daughters, the study said.

As a result, females, who are encouraged to receive three doses of the immunization between ages 11 and 12, are entering their 20s still unvaccinated against the virus, medical experts say.

This is “very concerning to me, because there's only a small window to get this vaccine and maintain its maximum benefits. That's before [people] become sexually active,” said Abbey B. Berenson, MD, PhD. She is director of the Division of Pediatric and Adolescent Gynecology at the University of Texas Medical Branch at Galveston.

Dr. Darden encourages physicians to strongly recommend the immunization to all unvaccinated female patients between 11 and 26. He said doctors should listen to parents' concerns, but they also should stress that they are experts in this field and that data show the immunization is safe and effective.

For instance, an Oct. 1, 2012, study of 189,629 girls and women ages 9 to 26 found no significant adverse events associated with the immunization. The findings were published in the December 2012 issue of JAMA Pediatrics, formerly Archives of Pediatrics & Adolescent Medicine.

The study did show an increased risk of patients fainting at the time of injection or developing a skin infection later. But those side effects are common with any vaccine, particularly among adolescents, doctors say.

“Much of the patient education regarding this vaccine still is probably occurring in pediatric clinics,” Dr. Berenson said. “If girls aren't getting the vaccine while they're seeing a pediatrician, providers of adults should address it.”

4,000 deaths yearly due to cervical cancer

HPV is the most commonly transmitted sexual infection in the U.S. and the leading cause of cervical cancer among women, according to the CDC. About 20 million Americans are infected with one of the more than 40 types of the virus. About 12,000 U.S. women are diagnosed with cervical cancer each year, and 4,000 die of the disease, the CDC said.

HPV is the most commonly transmitted sexual infection in the U.S. and the leading cause of cervical cancer.

For the Pediatrics study, researchers examined data on more than 98,000 adolescents age 13 to 17 whose parents participated in the 2008-2010 National Immunization Survey — Teen. The studied vaccines were HPV; tetanus, diphtheria and acellular pertussis (Tdap) or tetanus and diphtheria (Td); and quadrivalent meningococcal conjugate (MCV4).

Researchers found that adolescent vaccine rates are improving, but they still fall below the Healthy People 2020 goals.

The percentage of females fully immunized with three doses of HPV vaccine was substantially lower than for the other vaccines, but increased from 17.9% in 2008 to 32% in 2010. Possibly contributing to that improvement was an uptick in physicians recommending the HPV immunization during the study period.

Despite doctors' efforts, the percentage of parents who don't intend to vaccinate their daughters against HPV increased. In 2010, 43.9% said they did not plan to seek HPV immunization, up from 39.8% of parents in 2008.

Largely driving that decision is a belief that the vaccine is not needed (17.4%) and concerns about the immunization's safety or side effects (16.4%). In 2008, only 4.5% of parents cited vaccine safety concerns as the reason they chose not to immunize their daughters against HPV.

Dr. Berenson is not sure why HPV vaccine safety concerns are increasing. Possibly contributing to the worries is misinformation about the immunization that is publicized by the media or posted online, Dr. Darden said.

For instance, in September 2011, then-Republican presidential hopeful Rep. Michele Bachmann of Minnesota told reporters that a supporter's daughter developed mental retardation after receiving the HPV vaccine. After Bachmann's comment, O. Marion Burton, MD, then president of the American Academy of Pediatrics, discredited the claim.

“We have good evidence that the vaccine will prevent about 70% of the cervical cancer that we see now,” Dr. Darden said. “I find that convincing and compelling.”

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Why parents refuse HPV vaccine

Parents give various reasons for not vaccinating their adolescent daughters against the human papillomavirus.

Reason 2008 2009 2010
Not recommended by clinician 10.8% 8.5% 9.0%
Not needed/not necessary 14.4% 15.5% 17.4%
Lack of knowledge 15.8% 15.7% 10.2%
Not appropriate age 5.8% 4.4% 4.4%
Safety concern/side effects 4.5% 7.7% 16.4%
Don't know 7.4% 4.8% 5.0%
Not sexually active 14.1% 12.3% 11.1%
Multiple reasons 7.2% 7.2% 9.2%
All other reasons 20.0% 24.0% 17.2%

“Reasons for Not Vaccinating Adolescents: National Immunization Survey of Teens, 2008-2010,” Pediatrics, published online March 18 (link)

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External links

“Safety of Quadrivalent Human Papillomavirus Vaccine Administered Routinely to Females,” JAMA Pediatrics, formerly Archives of Pediatrics & Adolescent Medicine, December 2012 (link)

Centers for Disease Control and Prevention on HPV and the HPV vaccine, (link)

“Reasons for Not Vaccinating Adolescents: National Immunization Survey of Teens, 2008-2010,” Pediatrics, published online March 18 (link)

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