Awareness of Human Papillomavirus (HPV) and HPV Vaccination amongst the General Population in Germany: Lack of Awareness and Need for Action

Abstract

Introduction: The oncogenic human papillomaviruses (HPV) types 16 and 18 contribute to more than 73% cases of all HPV-related cancers and commonly affect the anogenital and head and neck region, with rapidly rising incidence rates of HPV-related oropharyngeal squamous cell carcinomas (OPSCC). HPV vaccination has the potential to decrease the burden of HPV-related disease but vaccination rates remain low in many countries. We investigated the level of awareness of HPV, and HPV-OPSCC in particular, in a representative sample of the German population. Materials and Methods: As part of an online, population-based survey, an electronic questionnaire was administered to a representative sample of 1095 adult individuals with a specific emphasis on awareness of HPV, transmission, as well as indicator symptoms of oropharyngeal cancer. Statistical analysis of levels of awareness and relation of these to age, gender and socioeconomic background were conducted using the IBM SPSS Statistics Version 25.0. Results: 699/1095 (63.8%) subjects had never heard of HPV. Of the subjects with awareness for HPV, 210 knew that HPV could be transmitted during sex (58.3%) and 138 recognized HPV as a risk factor for OPSCC (14.2%), unrelated to gender (p=0.357), educational status (p=0.581) or family status (p=0.719). 416 subjects knew that a preventive vaccine against HPV existed (44.9%). Women were significantly more aware of HPV (34.2% vs 22.8%, p<0.001) and the vaccination (56.4% vs 32.7%, p<0.001) as were men. Younger individuals (age group 25-34) were significantly more aware of HPV (p<0.001), likely as they were offered and/or had received the HPV vaccination. There was no regional variation of HPV awareness within the German state (p=0.051). Conclusion: Here we demonstrate a significant lack of awareness of HPV and HPV vaccination in a representative sample of the German population. Levels of awareness of the link of HPV and oropharyngeal cancer are particularly low, bearing in mind that this cancer is commonly affecting men and incidence rates are rapidly rising in many European countries and the US. Awareness programs and further education are required to tackle the low awareness rates and increase the uptake of the vaccination program not only in Germany, but also worldwide.

Uptake of HPV vaccination among boys after the introduction of gender-neutral HPV vaccination in Germany before and during the COVID-19 pandemic

“…The reasons for the poor uptake in Germany are not well studied, but it is likely that there are several factors that contribute: (1) Awareness about HPV and HPV vaccination. In a population-based survey 64% of adults in Germany had heard about HPV, but only 45% of those knew that there are vaccines available to prevent HPV [ 19 ]. Hence, increasing awareness among the public seems to be one opportunity to improve coverage.…”

Barriers and Facilitators of Romanian HPV (Human Papillomavirus) Vaccination

“…In the last couple of years and more during the COVID-19 pandemic, there was an obvious decrease in HPV vaccination rates along with a significant lack of awareness of HPV and HPV vaccination in many countries worldwide, such as: Germany [ 21 ], Austria [ 22 ], Italy [ 23 ], Saudi Arabia [ 24 ], United States [ 25 , 26 ], Japan [ 27 ], and Spain [ 28 ], as well as in Romania [ 1 , 12 , 13 , 16 ].…”

“…So, since for HPV vaccination until 18 years of age parental consent is needed in Romania, an important factor that may raise the HPV vaccination rate in our country may be the parent. In Austria, for example, consent to receiving vaccines is regulated at the federal-state level, and, for example, in Tyrol, children aged 14 years are allowed to consent to receive vaccination [ 21 ]. In our study, we found out that women, female parents, are more likely to vaccinate their children against HPV p < 0.001.…”

Enhancing Human Papillomavirus Vaccination Rates through Better Knowledge? Insights from a Survey among German Medical Students

“…In comparison with European countries, HPV vaccination rates in Germany are very low [ 5 ]. Furthermore, according to a study with a representative sample of the German population, awareness of HPV and HPV vaccination in the German population is significantly lacking [ 6 ].…”