ATLANTA — Family physicians and pediatricians are knowledgeable about several key aspects of human papillomavirus epidemiology and have largely adopted use of the HPV vaccine in their practices, but some important knowledge gaps about the disease and vaccine remain, results of a survey suggest.
Findings from a national HPV vaccination practices survey of 331 family physicians and 349 pediatricians, which was conducted 18 months after licensure of the HPV vaccine Gardasil, indicate that both groups understand that most genital HPV infections are asymptomatic (86% and 85%, respectively, responded correctly on a related survey item), and that almost all cervical cancers are caused by HPV (95% and 85%, respectively, responded correctly).
However, only 58% of family physicians and 43% of pediatricians correctly answered “false” to an item stating that genital warts are caused by the same HPV types as cervical cancer.
The findings, reported at the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices fall meeting by Dr. Matthew F. Daley, also show that 88% of family physicians, and 98% of pediatricians who responded are administering HPV vaccine to female patients.
When surveyed about whether parents feel vaccination might encourage earlier or riskier sexual behavior, 49% of family physicians and 42% of pediatricians said they strongly agree or somewhat agree that parents have such concerns, but only 6% and 4%, respectively, had such concerns themselves.
As for which patient populations are targeted for vaccination, physicians (82% of family physicians and 89% of pediatricians) said they more strongly recommend vaccination for 13- to 15-year-olds than for 11- to 12-year-olds (49% and 56%, respectively), said Dr. Daley of the department of pediatrics at the University of Colorado at Denver.
After adjustment for respondents' specialty and region of the country, factors found to be associated with not strongly recommending vaccination in 11- to 12-year-olds were considering it necessary to discuss sexuality before recommending vaccination (odds ratio, 1.6); reporting that parents of 11- to 12-year-olds have been more likely to refuse vaccination than parents of 16- to 18-year-olds (odds ratio, 4.0); and believing that the time it takes to discuss HPV vaccination is definitely or somewhat of a barrier (odds ratio, 1.9).
Parents' refusal to have a child vaccinated and deferral of vaccination were also addressed in the survey. Parents are more likely to defer than to refuse vaccination, the results suggested. Also, refusal is most common for 11- to 12-year-olds, with about 25% of parents reportedly refusing vaccination in that age group, he noted (see box).
The most common reported reasons for refusal or deferral were the “newness” of the vaccine, patient age, lack of sexual activity on the patient's part, and lack of insurance coverage/inability to pay. Factors reported as definitely or somewhat of a barrier to vaccination included lack of insurance coverage, lack of adequate reimbursement, and up-front costs for purchase of vaccine.
Elsevier Global Medical News