Primary care physicians are more likely to strongly recommend HPV vaccination for teenagers than younger children, despite expert recommendations, according to a new study.
The Centers for Disease Control and Prevention (CDC) recommends vaccinating 11- and 12-year-olds but says vaccination can begin as early as age 9. The AAP recommends starting the HPV vaccine series between ages 9-12 years.
HPV vaccine protects against certain types of cancer, but vaccination rates continue to lag behind other vaccines. About 68% of teens had received at least one dose in 2018, and 51% were fully vaccinated against HPV, according to the 2018 National Immunization Survey — Teen. Girls continue to be vaccinated at a higher rate than boys.
Researchers from the University of Colorado and the National Center for Immunization and Respiratory Diseases surveyed 302 pediatricians and 228 family physicians to learn about their recommendation styles. Results are reported in “HPV Vaccine Delivery Practices by Primary Care Physicians,” (Kempe A, et al. Pediatrics. Sept. 16, 2019, https://pediatrics.aappublications.org/content/early/2019/09/12/peds.2019-1475).
About 65% of pediatricians reported always or almost always using a presumptive recommendation style compared to 42% of family physicians. In this style, they announce it is time for the vaccine instead of indicating it is merely something to consider. More physicians are using this style than five years prior, especially pediatricians, according to the study.
Teenagers tended to get stronger recommendations from both physician groups compared to younger children. Among pediatricians, 99% made strong recommendations to girls ages 15 and older, while they were least likely to do so for 11- to 12-year-old males (83%). Similarly, family physicians were most likely to make strong recommendations to girls 15 and older (90%) and least likely to make a strong recommendation to 11- to 12-year-old males (66%)
Physicians said parents seeing misinformation about the vaccine online can lead to a refusal as well as parental concerns about safety, questions about whether the vaccine is necessary or religious opposition. Refusals and deferrals were more likely when patients were young or male.
When physicians did not use a strong recommendation or presumptive style or if they anticipated an uncomfortable conversation, their 11- to 12-year-old patients were more likely to refuse or defer the vaccine, according to the study.
“The circular nature of provider anticipation of refusal or deferral potentially leading to a weaker recommendation style and less persistence in responding to parental hesitancy could be creating a self-perpetuating cycle within a subgroup of physicians,” authors wrote.
Physicians also reported they believe the two-dose schedule approved by the CDC’s Advisory Committee on Immunization Practices in late 2016 has helped boost completion rates for the HPV vaccine series, but some also reported they aren’t as knowledgeable about the new recommendations.
Authors encouraged physicians to continue to improve their communication with families regarding HPV vaccine.
“Increased use of available communication training materials and applications as well as further development of evidence-based messages for parents may be helpful in improving the way HPV vaccination is introduced,” they wrote.
