Letter to the editor referring to the manuscript entitled: “Increasing fear of adverse effects drops intention to vaccinate after the introduction of prophylactic HPV vaccine” reported by Sotiriadis et al. (Arch Gynecol Obstet. 2012 Jun;285(6):1719–24)

Abstract

In a previous publication we reported the results of the LYSITRATA study (2005–2010) on the implementation of cervical cancer prevention methods and the acceptability of HPV vaccination in Greece [1]. The most important finding was that the acceptability of HPV vaccination decreased significantly after the introduction of the vaccine in 2008, which was attributed to fear about its potential adverse effects, and despite the fact that vaccination was subsidized by the Greek state. The LYSISTRATA study ended in December 2010, but its standardized questionnaire remained accessible online and was also distributed to women fulfilling the criteria of the original study, in order to monitor how the attitude towards HPV vaccination might have changed the following years. The first observation was that the acceptance of vaccination slightly increased after the significant decrease that was observed since the introduction of the HPV vaccine on 2008. Specifically, the percentage of women willing to vaccinate themselves, their 13-year-old daughter and their 13-year-old son against HPV in 2011 was 76.9 and 73.8 and 73.5 %, respectively, and the corresponding figures for 2012 were 74.7 and 74.7 and 73 % respectively (data not shown). Compared to the previous years, the increase in vaccination acceptance was significant in terms of the women willing to vaccinate their daughter or son (p \ 0.0001), but not themselves (p = 0.09). The second observation was that, compared to the two previous years, fear for adverse effects as a reason for vaccination rejection increased during 2011–12 regarding vaccination for the women themselves (67.1 vs. 46.7 %, p \ 0.0001), for their daughter (60.3 vs. 46.2 %, p = 0.001) and for their son (62 vs. 47.9 %, p = 0.0013). The opposite was observed for lack of information. This parameter decreased significantly, during the same period, for the women themselves (44.9–16.4 %, p \ 0.0001), for their daughter (45.2–17.7 %, p \ 0.0001) and for their son (44.9–25.9 %, p \ 0.0001) (Fig. 1). The main outcome of our survey was that, although there is an increase of the percentage of women that are informed about HPV vaccination, there is also an increase on the fear of the adverse effects that vaccination might have, i.e., the more informed parents get, the more concerned they become on HPV vaccination. Other studies have also shown that the level of HPV knowledge was not associated to vaccination acceptance for daughters [2], or that HPV knowledge did not increase acceptability for the vaccine [3]. This highlights the importance of the source and quality of information for the attitude of women towards the vaccine. A study showed that the main source of information about HPV vaccine was advertisements, which did not contribute to accurate understanding of the subject or to an increase in vaccination acceptance rates [4]. Parents, actually, state that they would prefer more information and reassurance concerning HPV vaccine’s safety provided by their physicians [5] and, as it is reported in a study, they would trust the recommendation from authorities [6]. K. Chatzistamatiou (&) A. Sotiriadis 2nd Department of Obstetrics and Gynecology, Hippokratio Hospital of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece e-mail: kimon.chatzistamatiou@gmail.com