Human Papillomavirus Vaccine Recommendations Research Articles

Examining Associations between Knowledge and Vaccine Uptake Using the Human Papillomavirus Knowledge Questionnaire (HPV-KQ).

Objectives: Understanding the relationship between human papillomavirus (HPV) knowledge and vaccination behavior is important to inform public health interventions, yet few validated HPV knowledge scales exist. This study describes development of the Human Papillomavirus Knowledge Questionnaire (HPV-KQ) and its validation with parents residing in the southern United States (US). Methods: Drawing on previously published measures, we developed the 13-item HPV-KQ and administered the scale via Web-based survey to parents (N=1105) of adolescents ages 9 to 17 years. Dimensionality, internal consistency, model fit, and predictive validity were assessed. Results: The scale was bidimensional. One factor captured general HPV knowledge, and the second factor captured perceptions of gender differences in HPV infection and vaccine recommendations. The 13-item scale and 2-factor solution displayed strong internal consistency and good model fit. Parents of vaccinated adolescents scored higher on the 13-item HPV-KQ (Mean = 8.56) than parents of unvaccinated adolescents (Mean = 6.43) (p < .001). In regression models, controlling for key covariates, parents' performance on the HPV-KQ predicted adolescent HPV vaccination (p < .001). Conclusions: Evaluation indicates the HPV-KQ is a reliable and valid tool for measuring knowledge of HPV and the HPV vaccine among parents residing in the southern US. We recommend further efforts to validate the scale with other populations.

National and State-Level Composite Completion of Recommended Vaccines Among Adolescents in the United States, 2015–2018

BackgroundRoutine adolescent vaccination recommendations in the United States include tetanus, diphtheria, and acellular pertussis, quadrivalent meningococcal conjugate vaccine, and human papillomavirus vaccines. Although coverage for these individual vaccines is known, limited data are available on composite completion for all three vaccines. MethodsThis cross-sectional analysis of pooled 2015–2018 National Immunization Survey–Teen data used logistic regression to estimate model-adjusted composite vaccination completion nationally and by state among United States adolescents aged 17 years. National Immunization Survey–Teen data were combined with state-level data to estimate a multilevel model identifying factors associated with composite vaccination completion. ResultsThe pooled model-adjusted composite vaccination completion was 30.6% (95% confidence interval [CI], 30.13%–31.04%) nationally, varying from 11.3% in Idaho (6.91%–17.95%) to 56.4% (49.81%–62.82%) in Rhode Island. Individual-level factors with the greatest impact on composite completion were having a provider's recommendation for human papillomavirus vaccination (odds ratio, 3.24; 95% CI, 2.76–3.80) and a check-up visit at age 16–17 years (odds ratio, 2.35; 95% CI, 1.80–3.07), with other individual-level factors associated with completion including being Medicaid insured, female, Hispanic, or non-Hispanic black. State-level quadrivalent meningococcal conjugate vaccination mandates were also associated with an increased likelihood of composite vaccination completion (odds ratio, 1.64; 95% CI, 1.16–2.33). ConclusionsFewer than one-third of 17-year-old individuals have completed all three recommended vaccines, with rates varying by state. Although this study identified implementable strategies to improve composite completion, additional research is needed to further understand factors associated with adolescent vaccination completion.

A Vax4HPV Mobile Application for Parents of Human Papillomavirus Vaccine-Eligible Children: Iterative Formative Assessments.

Although the human papillomavirus vaccine is efficacious, 40% of 13-year-old adolescents have been vaccinated for human papillomavirus. Implementing theory-based, user-centered applications can address this suboptimal coverage. This formative usability test aimed to develop a theory-based, user-centered interface to stimulate and inform parents' decision making on human papillomavirus vaccination and to help them act upon that decision. Iterative formative assessments were conducted through four focus groups of parents of children aged 9 to 14 years (N = 15). Participants discussed the desired content and features of a vaccine for human papillomavirus smartphone application while reviewing application prototypes. The discussions were recorded, transcribed verbatim, and then underwent qualitative content analysis. Four of the discovered themes were related to the content desired by parents: sources of information, facilitators of human papillomavirus vaccination, addressing the reasons for vaccine hesitancy, and gender-neutral content. The remaining three themes concerned the application's desirable designs and features: clear and descriptive interfaces, accessibility to broad groups of end users, and closing the intention-behavior gap. The need for adolescent human papillomavirus vaccination was generally well received by participants. This study found that theory-based, user-centered applications offering directions to appropriate clinics and human papillomavirus vaccine recommendations offered by nurses, can mitigate hesitancy by providing information via preferred routes and closing intention-behavior gaps.

Development and Implementation of an HPV Vaccination Survey for American Indians in Cherokee Nation.

Improving human papillomavirus (HPV) vaccination rates is a public health priority and a crucial cancer prevention goal. We designed a survey to estimate HPV vaccination coverage and understand factors associated with HPV vaccination among American Indian adolescents aged 9 to 17 years in Cherokee Nation, United States. The final survey contains 37 questions across 10 content areas, including HPV vaccination awareness, initiation, reasons, recommendations, and beliefs. This process paper provides an overview of the survey development. We focus on the collaborative process of a tribal–academic partnership and discuss methodological decisions regarding survey sampling, measures, testing, and administration.

HPV VACCINATION RATE AMONGST WOMEN PRESENTING FOR FERTILITY CARE

Human papillomavirus (HPV) is the most common sexually transmitted disease, affecting about 85% of people in their lifetime. The CDC recommends HPV vaccination for 11 to 26-year-olds (starting as early as age 9), with an option for vaccination through age 45 after a discussion with a clinician. HPV vaccination can prevent the spread of HPV, cervical cancer, oropharyngeal cancer, anal cancer, and genital warts. A consultation with a reproductive endocrinologist provides a unique opportunity to address HPV vaccination status amongst patients.

Disparities in Healthcare Providers' Recommendation of HPV Vaccination for U.S. Adolescents: A Systematic Review.

Infrequent provider recommendations continue to be a key barrier to human papillomavirus (HPV) vaccination, including among adolescents at higher risk for future HPV cancers. To inform future interventions, we sought to characterize disparities in health care providers' HPV vaccine recommendation for U.S. adolescents. We systematically reviewed studies published in 2012-2019 that assessed provider HPV vaccine recommendations for adolescents aged 9-17. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we identified 52 eligible studies and used a standardized abstraction form to assess recommendation prevalence by adolescent demographic characteristics. Studies consistently found that fewer parents of boys than girls reported receiving HPV vaccine recommendations (14 studies, range of difference: -11 to -35 percentage points). Studies also found fewer recommendations for adolescents who were younger (2 studies, -3% to -12% points), non-White (3 studies, -5% to -7% points, females only), lower income (3 studies, -1% to -8% points), or uninsured (1 study, -21% points, males only). Studies identified geographic disparities in southern and rural areas. In conclusion, findings from this systematic review identify disparities in HPV vaccine recommendation that may contribute to suboptimal vaccine uptake. Efforts to improve providers' HPV vaccine communication should focus on increasing recommendation consistency, especially for lower-income, non-White, and rural adolescents.

Knowledge, beliefs, and practice regarding human papillomavirus (HPV) vaccination among American college students: Application of the health belief model

Objective: To identify facilitators and barriers to human papillomavirus (HPV) vaccination among college students. Methods: A cross-sectional survey with college students (N = 306) between the ages of 18 and 26 was conducted using a computer-delivered survey via iPad. A survey was designed to assess HPV/HPV vaccine-related knowledge, beliefs, and vaccination practices. Results: Low completion rates for the HPV vaccination series (females: 28.9%; males: 11.5%) were observed among college students. The compliance was lower among students who were black American and did not speak English at home. In contrast, the compliance was higher among those who had received any recommendation for HPV vaccination, those with higher knowledge about HPV and HPV vaccine, and higher perceived benefits of vaccination. Conclusions: Increasing knowledge of HPV infection, including the benefits of HPV vaccination and health care providers recommending the HPV vaccine, may increase HPV vaccination among college students and reduce the incidence of the disease.

The gynecologic oncologist as the HPV champion: missed opportunities for cancer prevention

Objectives: The Human Papillomavirus (HPV) vaccine is FDA approved up to age 45 and emerging evidence suggests it may prevent recurrent infections. This has important implications for patients commonly seen by gynecologic oncologists. Our objective was to describe factors that influence HPV vaccine recommendation amongst gynecologic oncologists and identify barriers and missed opportunities for vaccination. Methods: A pilot-tested online survey was electronically sent to all members of the Society of Gynecologic Oncology in the U.S. Questions evaluated the following domains: demographics, practice patterns, barriers and knowledge regarding the HPV vaccine. We defined HPV vaccine champions as providers who both recommended and either administered, stocked or prescribed the vaccine in the outpatient setting, and surveyed their practice patterns to identify possible missed opportunities for vaccination. Descriptive statistics were used to calculate the rate of HPV vaccine recommendation, explore barriers to vaccination and identify practice patterns. Univariate logistic regression was used to identify factors associated with vaccine recommendation. Results: A total of 183 gynecologic oncology providers completed the survey, representing 10% of invitations sent. Most were ≤ 45 years old (65%, n=99), practicing in urban (57%, n=105) and academic settings (67%, n=122). Eighty-one percent (n=147) had completed training, and of these, 68% (n=101) had been in practice for > 5 years. Ten percent (n=18/174) of respondents had not recommended the HPV vaccine in the past 12 months. Vaccine recommendation was associated with better HPV vaccine knowledge (Odds Ratio (OR) 1.7, 95% Confidence Interval (CI) 1.0-2.9), being a non-trainee (OR 3.8, CI 1.3-11.2) and practicing in the South (OR 10.8, CI 1.3-90.7). Among all providers, the most commonly reported barriers to vaccinating were that the patient's cancer diagnosis took precedence (88%, n=146/165), the cost to the clinic (48%, n=79/165), uncertainty about insurance coverage (43%, n=71/165) and that the vaccine history was not asked (48%, n=79/165). Forty eight percent (n=87) met criteria as HPV vaccine champions. Of those, 96% (n=78/81) at least sometimes offer the HPV vaccine at a visit for vulvar or cervical dysplasia. Eighty-three percent (n=67/81) offer it to patients with an HPV-related cancer diagnosis. In contrast, only 35% (n=29/82) were likely to offer it in a consultation for BRCA management and 28% (n=23/82) were likely to offer it at a surgical consultation for fibroids (Figure). Download : Download high-res image (89KB) Download : Download full-size image Conclusions: Gynecologic oncologists have a unique opportunity to educate and increase vaccination rates in eligible women. There are significant barriers to HPV vaccine administration in the gynecologic oncology office, and we identify examples of missed opportunities to vaccinate in non-HPV related clinical scenarios.

Ten-year questionnaire study on human papillomavirus vaccination targeting new female medical school students: Follow-up to the 2015 report.

We aimed to conduct a fixed-point observation questionnaire survey of changes in young women's human papillomavirus (HPV) vaccination status over the course of 10 years. We also investigated the influence of suspension of governmental recommendation for HPV vaccination since June 2013. During 2011-2020, we conducted a self-completed questionnaire survey among newly enrolled female medical school students in Yokohama, Japan. The questionnaire featured items regarding HPV vaccination status, age, previous sex education, and knowledge about cervical cancer and HPV vaccination. HPV vaccine uptake rates in 2011 (5.4%) and 2012 (13.5%), when vaccination was self-funded, increased after 2013 (48.7%), when vaccination fees were subsidized. The rate dropped drastically in 2019 (14.3%) and 2020 (5.1%), after suspension of recommendation by the government. Comparisons between new students in 2015/2016, who had high vaccination rates (65.2%), and new students in 2019/2020, who had low vaccination rates (9.8%), showed decreased levels of HPV vaccination awareness, with fewer students having covered cervical cancer prevention in sex education and with respondents having less knowledge about the details of HPV vaccination. After the suspension of proactive HPV vaccine recommendation, markedly fewer students have been vaccinated against HPV, even those at the vaccination target age. This situation has substantially influenced the lower awareness about cervical cancer prevention, even among medical school students. To protect young women from cervical cancer in Japan, it is crucial for the government to resume proactive recommendation of HPV vaccines as soon as possible.

Sexually Transmitted Infections Treatment Guidelines, 2021.

SummaryThese guidelines for the treatment of persons who have or are at risk for sexually transmitted infections (STIs) were updated by CDC after consultation with professionals knowledgeable in the field of STIs who met in Atlanta, Georgia, June 11–14, 2019. The information in this report updates the 2015 guidelines. These guidelines discuss 1) updated recommendations for treatment of Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis; 2) addition of metronidazole to the recommended treatment regimen for pelvic inflammatory disease; 3) alternative treatment options for bacterial vaginosis; 4) management of Mycoplasma genitalium; 5) human papillomavirus vaccine recommendations and counseling messages; 6) expanded risk factors for syphilis testing among pregnant women; 7) one-time testing for hepatitis C infection; 8) evaluation of men who have sex with men after sexual assault; and 9) two-step testing for serologic diagnosis of genital herpes simplex virus. Physicians and other health care providers can use these guidelines to assist in prevention and treatment of STIs.

Polish Medical Students' Knowledge Regarding Human Papillomavirus's Ways of Transmission, Risk of Cancer Development and Vaccination, and Their Intention to Recommend Vaccination.

Introduction: Human papillomavirus (HPV) is associated with six types of cancer in men and women. A vaccine against HPV, preferably administered before initial sexual intercourse, has been proven to be highly effective in preventing these cancers. An effective healthcare provider recommendation has significant influence on HPV vaccine uptake; therefore, it is critical that medical students receive comprehensive training in this area. Aim: The aim of the study was to assess the knowledge of medical students regarding Human Papillomavirus’s (HPV) ways of transmission, risk of cancer development, and vaccination against HPV. This study also investigated factors among medical students that would affect their intention to recommend HPV vaccination to others. Materials and Methods: The study was conducted among 1061 (678 women and 383 men) medical students who filled in our questionnaire. The medical students were divided into two subgroups: (1) pre-clinical medical students (MS pre-clinical; first-to third-year students; n = 683) and (2) clinical medical students (MS clinical; fourth-to six-year students; n = 378). Results: A total259 (24.41%) of the 1061 medical students were vaccinated against HPV. We found a significant improvement in the general level of knowledge in the later years of education (4–6) compared to the early years of education (1–3). However, it was demonstrated that, despite medical education advancements, there are still significant gaps of knowledge about the relationship between HPV infection and cancers other than cervical cancer, as well as in relation to the routes by which HPV is transmitted. Medical students’ intentions to recommend HPV vaccine to others were related to their own HPV-related knowledge and their own vaccination status. Conclusion: Medical students have gaps of knowledge regarding particular issues and aspects of HPV. It is necessary to further educate medical students in the field of prevention and in the treatment of lesions caused by HPV infection. Medical students’ intention to recommend the HPV vaccine can be improved by including them and members of their families in the HPV vaccination program.

Human Papillomavirus Vaccination Knowledge, Barriers, and Recommendations Among Healthcare Provider Groups in the Western United States.

This study compared human papillomavirus (HPV) vaccination occurrences on the same day as provider recommendations at clinics in the Western United States stratified by healthcare provider groups. In addition, the relationships between provider groups' perceived challenges associated with HPV vaccination, HPV vaccination knowledge, HPV recommendation practices, and same-day HPV vaccinations and recommendations are described. Eligible participants included pediatric healthcare providers and staff with influence on patient/parental-level decisions regarding HPV vaccination. Participants filled out a 40-question survey. Results for study participants (N = 99) showed providers reported a higher number of challenges limiting HPV vaccination, higher HPV vaccination knowledge, and more favorable HPV vaccination recommendation practices compared to other healthcare team members (OTM) suggesting providers may have a better overall understanding of the HPV vaccination climate than OTMs. Clinics should examine OTMs' training, expectations, and opportunities to increase the frequency and strength of HPV vaccination recommendations to adolescent patients and parents.

Recommending Inequality? Patterns of US Healthcare Providers' HPV Vaccine Recommendations

Abstract Purpose: Infrequent provider recommendations continue to be a key barrier to human papillomavirus (HPV) vaccination, including among adolescents at higher risk for future HPV cancers. To inform future provider- training programs, our study sought to synthesize the findings of existing studies of disparities in provider recommendation of HPV vaccination among adolescents. Methods: We conducted a systematic review of studies that quantitatively assessed the prevalence of provider recommendation of HPV vaccination among US parents of adolescents aged 9–17. We excluded studies that were not empirical, not peer-reviewed, or collected data before 2012. Following PRISMA guidelines, two independent coders extracted and screened 3,158 unique titles and abstracts from multiple databases. Next, two independent coders reviewed the full text of eligible studies, systematically collecting data using a standardized abstraction form. We resolved coding disagreements via discussion with the whole team. Results: Fifty-four of 252 reviewed studies met eligibility criteria, including 33 studies of parents and 21 studies of providers. Parental report of receiving a provider recommendation for HPV vaccination ranged from 22% to 78%. These studies most often assessed disparities by adolescents' sex, with almost all finding that provider recommendations were less common for boys vs. girls. Most studies of provider reports confirmed disparate recommendations by sex. Fewer studies stratified recommendation disparities by income or race/ethnicity; these studies found that recommendations were less common among lower-income households, but reported mixed findings by race/ethnicity. Geographic assessments found variation across states and urbanicity, with recommendations being lower including in some Southern states and in rural areas. Conclusion: Findings suggest differences in provider recommendation by sex, household income, geography, and possibly race/ethnicity, in spite of national guidelines for routine HPV vaccination. National efforts to improve provider communication about HPV vaccination should focus on improving recommendation consistency, especially for populations such as lower-income and rural adolescents who are at higher risk for future HPV cancers.

Have you ever heard of Human Papillomavirus (HPV) vaccine? The awareness of HPV vaccine for college students in China based on meta-analysis

ABSTRACT Objective: To evaluate the awareness of College Students (CSs) of HPV vaccine in China and provide evidence-based recommendations for HPV vaccine’s publicity and promotion. Methods: Web of Science, PubMed, Science of Direct, EBSCO, China National Knowledge Infrastructure and Wanfang Data were searched. A random effects meta-analysis was conducted to determine pooled estimates of Awareness Rate (AR) for HPV vaccine. Results: Of the 36 studies included, the estimated AR of HPV vaccine was 40.27% (95% CI: 30.86%, 50.06%) among Chinese CSs. The AR of HPV vaccine was stratified by factors as gender, major, area, city, survey time, and sampling method of the study. The pooled AR of HPV vaccine among CSs was as follows: 44.17% (95% CI: 31.65%, 57.09%) and 31.93% (95% CI: 13.25%, 54.30%) for females and males; 44.47% (95% CI: 29.90%, 59.55%) and 12.02% (95% CI: 7.69%, 17.15%) for medical-related and nonmedical majors; 44.47% (95% CI: 28.71–60.82%) and 41.16% (95% CI: 26.48–56.64%) for Eastern and Midwestern region; 48.86% (95% CI: 30.63–67.25%) and 33.19% (95% CI: 22.27–45.12%) for first-tier and second- and third-tier city; 29.67 (95% CI: 11.44–52.16%) and 38.81 (95% CI: 27.14–51.21%) for AR before and after HPV vaccine entered in China; 51.51% (95% CI: 32.21%, 70.53%) and 26.21% (95% CI: 17.41%, 36.10%) for nonrandom and random sampling. Conclusion: This review indicates that awareness of HPV vaccine among CSs remains relatively low in China compared with European countries. Our findings may provide useful information to better understand the HPV vaccine awareness status among Chinese CSs.

­­Human papillomavirus and Chinese international students in the United States: attitudes, knowledge, vaccination trends, healthcare behaviors, and sexual activity

ABSTRACT Human papillomavirus (HPV) is the most common sexually transmitted infection in the world, with the ability to cause external genital warts and cancers. The HPV vaccine, first released in the United States of America (USA) in 2006, has been shown to protect against the highest risk HPV strains responsible for the majority of HPV-related cancers. In mainland China, the HPV vaccine was only recently approved in 2016 and is therefore not readily available. As a result, Chinese international students (CIS) studying in the USA continue to have low HPV vaccination rates. This study completed in person and online surveying of 396 CIS at a large Southern California university, with the goal of better understanding CIS knowledge and awareness of HPV disease, vaccination and healthcare behaviors, and sexual activity. Among participants, the reported HPV vaccination rate was 61% (females: 85%; males: 32%). HPV vaccination was significantly correlated with a past visit to the on-campus student health center, having university-sponsored student health insurance, higher self-perceived HPV knowledge, and increased willingness to pay for vaccination. A large portion of participants portrayed low levels of sexual activity, which suggests that CIS can take advantage of catch-up HPV vaccination recommendations through 26 years of age. The results of this study can be used to inform policy initiatives, particularly at the campus level, that attempt to improve HPV vaccination rates amongst CIS.

Knowledge of Chinese dentists on HPV, their willingness and barriers to recommend HPV vaccination to patients

ABSTRACT Objective: This study aimed to assess the knowledge of Chinese dentists on human papilloma virus (HPV), their willingness and factors prevention them from recommending patients for HPV vaccination, and to identify ways through which dentists can acquire HPV-related knowledge. Methods: This was a cross-sectional study based on Chinese dentists. The anonymous self-filled questionnaire method was used to collect demographic information of participants, their knowledge of HPV, willingness and barriers to recommending HPV vaccines to patients, and the strategies they can adopt to obtain HPV-related knowledge. Results: A total of 517 dentists completed the questionnaire, and 89.94% of dentists were willing to recommend HPV vaccination to patients. Participants aged 30–39 years, male dentists and dentist-in-charge had relatively lower knowledge scores than other groups. Besides, participants aged 30–39 years, working in private hospitals, and practicing in Southern China had a lower willingness to recommend HPV vaccination to patients. Recommending HPV vaccination to patients is not within the scope of practicing dentists, and concerns about the safety of the HPV vaccine were found to be the main barriers preventing its recommendation. Notably, 97.87% of dentists were eager to acquire HPV-related knowledge, and agreed for the first time to enroll in relevant educational courses. Conclusion: Chinese dentists had expressed a strong desire to recommend HPV vaccines to patients, even though their knowledge of HPV was scanty. Therefore, measures to improve their understanding of HPV vaccines and eliminate barriers suppressing their willingness to recommend HPV vaccines are urgently needed.

Changes in Strength of Recommendation and Perceived Barriers to Human Papillomavirus Vaccination: Longitudinal Analysis of Primary Care Physicians, 2008-2018

To evaluate among pediatricians and family physicians human papillomavirus (HPV) vaccination recommendation practices for 11- to 12-year-old youth; report parental refusal/deferral of HPV vaccination; and report barriers to HPV vaccination changed over time. We surveyed nationally representative networks of pediatricians and family physicians in 2008, 2010, 2013-2014, and 2018. Male vaccination questions were not asked in 2008; barriers and parental vaccine refusal questions were not asked in2010. Response rates were 80% in 2008 (680/848), 72% in 2010 (609/842), 70% in 2013-2014 (582/829), and 65% in 2018 (588/908). The proportion of physicians strongly recommending HPV vaccination for 11- to 12-year-old patients increased from 53% in 2008 to 79% in 2018 for female patients and from 48% in 2014 to 76% in 2018 for male patients (both P<.0001). The proportion of physicians indicating ≥50% of parents refused/deferred HPV vaccination remained steady for female patients (24% in 2008 vs 22% in 2018, P=.40) and decreased for male patients (42% in 2014 vs 28% in 2018, P<.001). Physician barriers to providing HPV vaccination were rare and decreased over time. Increasing numbers of physicians reported perceived parental barriers of vaccine safety concerns (5% "major barrier" in 2008 vs 35% in 2018, P<.0001) and moral/religious concerns (5% in 2008 vs 25% in 2018, P<.0001). Between 2008 and 2018, more primary care physicians reported recommending HPV vaccination for adolescents, fewer reported barriers, and more physicians reported parents who had vaccine safety or moral/religious concerns.

Human Papillomavirus Vaccination After COVID-19.

The current global novel coronavirus disease 2019 (COVID-19) pandemic threatens to derail the uptake of human papillomavirus (HPV) vaccination in low- and lower-middle income countries with major disruptions to routine immunization and the introduction of new vaccines delayed. This has a major impact on the World Health Organization cervical cancer elimination strategy, where it is dependent on HPV vaccination as well as cervical cancer screening and treatment. We discuss current opportunities and barriers to achieve high uptake of HPV vaccination in low- and lower-middle income countries as well as the impact of COVID-19. Implementation of 4 key recommendations for HPV vaccination in low- and lower-middle income countries is needed: increased global financial investment; improved vaccine supply and accelerated use of a single-dose schedule; education and social marketing; and adoption of universal school-based delivery. With the commitment of the global health community, the adoption of these strategies would underpin the effective elimination of cervical cancer.

HPV Vaccine Recommendations and Parental Intent

* Abbreviations: CI — : confidence interval dPP — : difference in predicted probability HPV — : human papillomavirus NIS — : National Immunization Survey Adolescents’ receipt of the human papillomavirus (HPV) vaccine is primarily a decision of their parents. Health care providers’ recommendation increases parents’ likelihood of initiating the HPV vaccine for their child.1 Rates of HPV vaccine recommendations and the proportion of up-to-date adolescents have improved over time2; however, in 2017–2018, 7.3 million vaccine-eligible US adolescents were unvaccinated.1 Notably, despite a provider recommendation, parents of 60.6% of unvaccinated adolescents had no intention to initiate the HPV vaccine series.1 It is unclear whether the sentiment of HPV vaccine hesitancy is growing (because of the rise of the antivaccination movement), has dissipated (with a growing body of evidence pertaining to postlicensure efficacy and the safety of the HPV vaccine), or has remained unchanged over time. To understand the trajectory of acute HPV vaccine hesitancy, we evaluated trends in the proportion of parents lacking the intent to initiate HPV vaccination for their unvaccinated adolescent despite having received a provider recommendation. We analyzed the 2012–2018 National Immunization Survey (NIS)–Teen, a national … Address correspondence to Kalyani Sonawane, PhD, Center for Healthcare Data, Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, RAS-E 1013, Houston, TX 77478. E-mail: kalyani.b.sonawane{at}uth.tmc.edu

A nationwide post-marketing survey of knowledge, attitudes and recommendations towards human papillomavirus vaccines among healthcare providers in China

Since licensure of human papillomavirus (HPV) vaccine in mainland China, little research has been conducted about healthcare providers' (HCPs) understanding and recommendation of HPV vaccine. A multi-stage convenience sample of Chinese HCPs (N = 5270) were surveyed, involving obstetrician-gynecologists, HCPs from Division of Expanded Program on Immunization (DEPI), Community Health Center (CHC) and other non-HPV closely related professions. Binary logistic regression was conducted to explore factors associated with knowledge and recommendation behaviors. Overall, HCPs showed basic HPV/HPV vaccine knowledge with median (interquartile range) score at 9.5 (7.5–11.6) out of 16 and relatively high recommendation behavior (74.8%). Identified knowledge gaps among HCPs included risk factors of HPV infection, best time to vaccinate, prophylactic functions of HPV vaccine and especially classification of low-risk and high-risk types. Profession-specific analysis in individual knowledge item showed HCPs from CHC were suboptimal on HPV while obstetrician-gynecologists were less competent on HPV vaccine knowledge. Obstetrician-gynecologists also recommended vaccination less frequently than HCPs from DEPI and CHC. Besides being key predictors of recommendation practice (2.74, 95% CI: 2.34–3.21), knowledge shared independent determinants with recommendation behavior on age and ethnicity and additionally associated with education and title by itself. Findings highlight overall and profession-specific gaps on HPV and HPV vaccine knowledge and recommendation practice. Future education and training efforts should be profession-niche-targeting and focus much on HCPs with lower title or education background and from minorities.