For the general pediatrician who routinely vaccinates pre-adolescent and adolescent patients, the authors have presented a nice nugget of information to consider in our daily attempts to vaccinate girls and boys with the HPV4 vaccine.
That is, parental or child knowledge about the vaccine probably has no impact upon vaccine uptake in your office. For instance, for the more knowledgeable vs. the less knowledgeable, 13.4% and 15.2%, respectively, had received one or more vaccines in the three-dose schedule over a 12-month period.
Several caveats must be acknowledged when assessing these data from Fishman and colleagues.
The data in this study are not generalizable. In this study, 91% of the evaluated population was black, had low-income backgrounds, and living inner city. By contrast, in the rural Kentucky population, which is mostly white (≥90%) and comprised of 50% or more Medicaid patients, our rate of three-dose completion by age 17 years hovers around 65%. Why the difference?
I surmise that it is the “messenger” and not the “message” that is critical here, as these data seem to point out. We both likely present the same basic information to the families. But, private practice pediatricians have the advantage of having the same person or a few persons providing the medical care and recommending other routine vaccines to the child and family for more than a decade before they must make this apparently controversial decision. Thus, rapport and personal trust between the family and the physician may be the key for about two-thirds of these families. It may also help when a routine emphatic personal request to vaccinate is discussed by the physician at most preteen and teen visits as well, if they have not been vaccinated.
Nonetheless, about 10% to 15% of families will completely object to HPV4 for a multitude of reasons, from Internet gossip, to pseudoscience, to celebrity proclamations, to denial of a child’s possible sexuality.
Also, in this study, we are not presented with a stratification of the age groups in the population. What percentage of girls were aged 9 to 12 years?
Once a family has declined HPV4 vaccine during their routine middle school checkups, and the child is now older than 12 years, I can personally attest to the extreme difficulty in convincing these families that the vaccine benefits far outweigh the risks. The parents have declined vaccine for a reason. Now add this to the protests of an upset 13- through 17-year-old female who does not want a shot — which is a true force to be reckoned with. Thus, I would not expect many teenage girls, aged 12 years or older, whose families have already previously declined the vaccine to accept the vaccine at a later age in anyone’s practice.
Stan L. Block, MD, FAAP
Infectious Diseases in Children Editorial Board member
Disclosures: Block reports financial ties with Merck.