Human Papilloma Virus Vaccination in Patients with Rheumatic Diseases in France: A Study of Vaccination Coverage and Drivers of Vaccination

Abstract

Objectives: To describe human papillomavirus (HPV) vaccination practices in adolescent girls with systemic lupus erythematosus (SLE) and juvenile idiopathic arthritis (JIA) and to identify barriers to and motivators for vaccination. Methods: Cross-sectional, multicenter study on girls aged 9 to 19 years and their accompanying adults. The measurement criteria were the proportion of girls who were vaccinated against HPV, compliance with the vaccination schedule, factors associated with vaccination, and reasons for vaccination and non-vaccination through a self-administered questionnaire. Results: Seventy-one patients (16 with SLE and 55 with JIA) were included with a mean age of 13 years old (rank 11–18). According to parental questioning, 39% of patients were vaccinated against HPV or in progress (44% and 38% of SLE and JIA, respectively). This rate was 82% for the 22 patients ≥ 15 years of age. The vaccine was administered as often by a general practitioner (39%) as by a hospital pediatrician (also 39%). Two factors were significantly associated with vaccination: Older age (OR 53.68, 95% CI 5.85–429.29, p < 0.001) and previous hepatitis B vaccination (OR 4.97, 95% CI 1.03–24.01, p = 0.040). Recommendation of the vaccine by a health professional and fear of HPV-related diseases were the main facilitators. Lack of knowledge about the vaccine, lack of recommendation by a health professional, and fear of vaccine side effects were the main barriers. Conclusions: HPV vaccination coverage remains insufficient among patients with autoimmune disease. Education and awareness of health professionals about HPV infections are crucial elements in vaccine acceptance.

Vaccine Hesitancy among European Parents—Psychological and Social Factors Influencing the Decision to Vaccinate against HPV: A Systematic Review and Meta-Analysis

“…A systematic search was performed in four databases on 13 September 2023, resulting in 9322 articles; after removing the duplicates, 4206 publications were screened by title and abstract. In total, 133 were assessed for full-text, and 25 [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] were included in the systematic review and meta-analysis ( Figure 1 ).…”

“…Fourteen studies were included in the parent’s level of education comparison (ISCED 0–4 vs. 5–8), with 284,944 guardians and 232,063 vaccinated children [ 17 , 18 , 19 , 20 , 21 , 22 , 24 , 27 , 29 , 30 , 31 , 32 , 33 , 34 ]. The results showed an OR of 0.93, with a 95% CI between 0.79 and 1.09, at a Z of 0.94 and a p = 0.35, with no statistical significance; Random Effects (RE) were used for an I 2 of 93% (see Figure 4 ).…”

“…Seven studies were included in the meta-analytical comparison between mothers with attendance and non-attendance at CCS and comprised 204,073 responders, of whom 160,699 had vaccinated children [ 19 , 20 , 23 , 30 , 32 , 33 , 36 ]. No differences were shown between groups, with OR = 0.83, with a 95% CI between 0.45 and1.52, at a Z value of 0.61, p = 0.54 and a 98% heterogeneity.…”

“…Seven studies summing up 189,039 mothers, of whom 149,766 had vaccinated their children, were included in the meta-analysis comparing mothers’ Pap smear histories (normal vs. abnormal results) [ 19 , 20 , 23 , 30 , 33 , 36 , 37 ]. Mothers who had a history of abnormal Pap smear results were 46% more likely to vaccinate their child, evidencing an OR = 0.54, with a 95% CI between 0.36 and 0.79, at a Z = 3.16, with p = 0.002 and I 2 = 90%, using RE (See Figure 11 ).…”

“…Eight studies [ 20 , 21 , 22 , 23 , 25 , 30 , 37 , 38 ] were included in the meta-analysis containing 96,211 parents and 74,442 vaccinated children. Pooled analysis showed an OR of 0.22, CI = 0.12–0.4, Z = 4.94 and p < 0.00001.…”