Evaluation of the acceptability in France of the vaccine against papillomavirus (HPV) among middle and high school students and their parents.

Jean-François Huon,Morgane Péré,Antoine Grégoire,Anita Meireles,Valérie Briend-Godet,Charlotte Biron,Maëva Lefebvre,François Raffi,Julie Coutherut,Nelly Rwamba Mugo

doi:10.1371/journal.pone.0234693

Abstract

The pathogenic and oncogenic roles of papillomavirus (HPV) infections have been documented and shown to occur in women as well as in men. While other countries have already extended their vaccination guidelines to include boys, in 2019 the French National Authority for Health validated implementation of HPV vaccination in the 2020 vaccination schedule. There is, however, a climate of distrust in regard to vaccination in France, and there have been few studies to date regarding the acceptability of HPV vaccination in boys in France. The aim of this study was, therefore, to evaluate the acceptability of extending the recommendations for HPV vaccination in men, among middle and high school students and their parents. Our study (HPVac) was a prospective, multicenter, departmental, and descriptive survey applied to a sample of male middle and high school students attending schools in the Loire-Atlantique department and their parents. It took place from January 2017 to January 2018. We analyzed the information obtained from 127 parent questionnaires and 145 children questionnaires. In terms of acceptability, 36.6% (n = 53) of the children and 37.8% (n = 48) of the parents were in favour of being vaccinated or of having their children vaccinated against HPV (51.7% (n = 75) and 50.4% (n = 64), respectively, were undecided). The perception of a risk stemming from HPV infection was positively associated with acceptability of the HPV vaccine. Being against vaccines in general, being discouraged by their parents, parents thinking that their child is not at risk, and the belief that the vaccine is not mandatory were arguments cited and significantly associated with a willingness to be vaccinated. This study revealed a lack of information among boys and their parents about HPV and its vaccination. It also clearly showed that taking time to discuss the consequences of an infection and the merits of being vaccinated can help parents overcome their reluctance. The children then generally go along with their parent's choice.

Highlights

36.6% (n = 53) of the children and 37.8% (n = 48) of the parents were in favour of being vaccinated or of having their children vaccinated against human papillomavirus (HPV) (51.7% (n = 75) and 50.4% (n = 64), respectively, were undecided)
The perception of a risk stemming from HPV infection was positively associated with acceptability of the HPV vaccine
Being against vaccines in general, being discouraged by their parents, parents thinking that their child is not at risk, and the belief that the vaccine is not mandatory were arguments cited and significantly associated with a willingness to be vaccinated

Summary

Introduction

Infection by human papillomavirus (HPV) is one of the three main sexually transmitted infections (STIs) involving the general population, and it is the most common viral STI [1,2,3,4].The pathogenic and oncogenic role of HPV infections has been documented and shown to occur both in women and in men (condylomas, and cancers of the cervix, the vulva, the anus, and the oropharynx, as well as of the penis) [5, 6].Vaccination against HPV has been shown to be effective in real-life situations, as it decreases the incidence of infections by papillomavirus (types 6, 11, 16, and 18) as well as the occurrence of condylomas, and of low- and high-grade lesions of the cervix [7].Vaccination against HPV has been recommended in France since 2007 in girls of 11 to 19 years of age, with the aim of reducing the incidence of cervical cancer, [8, 9]. In addition to the recommendation to extend the vaccination to individuals of up to 26 years of age for men who have sexual relationships with other men, it concluded that the cost-efficacy ratio of universal vaccination becomes favourable when all of the pathologies linked to HPV are considered and/or subject to elevated vaccination coverage in boys when the vaccination coverage in girls is low (< 40%, as is the case in France) [10]. This has led the HAS to recommend extending HPV vaccination to boys of 11 to 14 years of age for the vaccination schedule in 2020. The aim of this study was, to evaluate the acceptability of extending the recommendations for HPV vaccination in men, among middle and high school students and their parents

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