NEWPORT BEACH, CALIF. A study of 61 parents of infants and children up to 10 years of age suggests that parents may favor the idea of giving the human papillomavirus vaccine at a very young age rather than during adolescence.
The study also found that parents with higher socioeconomic status and education levels were more likely to reject human papillomavirus (HPV) immunization for their children at any age, a finding that could help target educational efforts for the HPV vaccine toward those demographics, Dr. Ellen S. Rome said at the annual meeting of the North American Society for Pediatric and Adolescent Gynecology.
One HPV vaccine, Gardasil, is approved for use in females aged 926 years, and another is being considered for approval by the Food and Drug Administration. Dr. Rome is on the speaker's bureau of Merck & Co., which markets Gardasil.
The HPV vaccine could follow the example of the hepatitis B vaccine, she suggested, which started as a vaccine for teenagers and later shifted to administration during infancy. Studies on the use of HPV vaccine in infants and children would need to be conducted for that to happen, added Dr. Rome, head of adolescent medicine at the Cleveland Clinic. She presented the current study on behalf of the lead investigator, Dr. Laura Gillespie, also of the Cleveland Clinic, and her associates.
Parents recruited from the clinic's main campus, emergency department, and regional satellite offices answered a questionnaire about demographics, attitudes about immunization, knowledge about HPV, and willingness to have their children vaccinated against HPV. The parents then were given a one-page educational sheet from the Centers for Disease Control and Prevention about HPV; after reading it, they completed a second questionnaire.
Before the intervention (the educational sheet), 25 parents said they wanted their children to get the HPV vaccine, 6 did not, and 30 were undecided. The higher the socioeconomic statuseither income or educational levelof the parents, the less likely they were to want their children to get the HPV vaccine.
"Low-income families may have more realistic fears about what a sexually transmitted disease or HPV could mean for their child," Dr. Rome speculated.
None of the parents who initially were for or against the vaccine changed their minds after reading the educational sheet. Among the 30 undecided parents, 12 favored vaccination after they read the sheet, 15 opposed it, and 3 did not answer the question about whether they would accept the HPV vaccine if it was offered.
Beliefs that the HPV vaccine is safe and effective were significantly associated with acceptance after the intervention. Parents with higher education or income may require more aggressive education from physicians about the vaccine's safety and efficacy, the investigators suggested.
Among the 37 parents who approved of the HPV vaccine after the intervention, 29 (78%) said they'd prefer that it be given to young children instead of to teenagers.
"They wanted to make it a baby shot," Dr. Rome said.
The reason for that echoes findings from two previous studies of HPV vaccine acceptance by parents of children aged 10 years or older. "Parents still think that this shot is a license to have sex" if it is given to adolescents, Dr. Rome said. "That's a myth that we're still continuing to try to work towards busting."
Parents with more boys in their homes were more favorable toward the HPV vaccine, "giving us hope that when the shot is available for boys," parents will approve, she said. Merck is pursuing approval for the vaccine in boys.
She does not believe that religious beliefs played a significant role in accepting or rejecting the vaccine, based on her knowledge of participants, but the influence of religion was not analyzed specifically.
Since the completion of the study, the investigators began a separate study looking at current vaccination rates within their institution. They're finding near-100% acceptance of the HPV vaccine by physicians and parents in the clinic's urban offices, but the regional satellite offices have higher rates of "late adopters" who are resistant to use of the vaccine or who reserve it for older adolescents, she said.
"The more yuppified the practice, the higher the rates of late adopters among physicians and parents," she said.