Pediatric provider vaccine hesitancy: An under-recognized obstacle to immunizing children

Educating healthcare providers to increase Human Papillomavirus (HPV) vaccination rates: A Qualitative Systematic Review

“… More than half reported that >25% of parents deferred vaccination for their 11–12-year-old children 12% of pediatricians and 33% of family physicians were only somewhat likely or unlikely to bring up the HPV vaccine again if parents initially deferred. Physicians reported that knowing the patient is not sexually active as reasons for deferring discussion Berkowitz et al [79] MD, PA, NP Described providers’ practice, recommendations and beliefs about HPV vaccination using national surveys (National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey) Areas for improvement in knowledge: 60% believe there will be fewer numbers of abnormal pap tests among vaccinated females, 60% believe there will be fewer referrals for colposcopy among vaccinated females, 20%-31% recommend vaccination based on the number of sexual partners, contrary to guidelines Berkowitz et al [80] MD, NP Described providers’ beliefs about the effectiveness of the HPV vaccine using 2012DocStyles survey Knowledge about HPV vaccine effectiveness in preventing anal, vaginal, vulvar, and oropharyngeal cancers was low Only 14.5% of providers recommended the vaccine to all age-eligible females and many providers recommend to ages younger or older than ages recommended by the ACIP Suryadevara et al [29] Pediatricians Described vaccine attitudes among pediatric HCP attending immunization conferences 5% do not routinely recommend HPV vaccine to eligible patients and 4% believed it increases the likelihood of unprotected sexual activity HPV vaccine was most commonly identified with safety concerns (26%) 59% believe that media play an influential role in parental vaccine decision making Gilkey et al [10] MD Described HPV vaccine communication practices among primary care physicians Recommendations were often weak in consistency and urgency but should be routine (instead of risk-based) and recommend same-day vaccination. Minority do not strongly endorse HPV vaccine or deliver timely recommendations for girls (26%) or boys (27%) Fewer than half correctly identified gay and bisexual males as being at increased risk of HPV Begin discussions by saying that the child was due for HPV vaccine instead of giving information or eliciting questions Counsel parents that HPV vaccine protects against three disease types (i.e., cervix, other cancers, and genital warts) McRee et al [25] MD, NP Described providers’ vaccine recommendation practices and explored perceptions of parental hesitancy …”

“…CDC/ACIP: Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practices (ACIP) “You are the Key”; AAP: American Academy of Pediatrics “HPV Champion Toolkit”, “Same Way, Same Day”, “Answering Questions About HPV Vaccine: A Guide for Dental Professionals”; American Cancer Society (ACS); National HPV Vaccination Roundtable(NVR); ACOG: American College of Obstetricians and Gynecologists HPV Toolkit 2016; AAFP: American Academy of Family Physicians; AHNS: American Head and Neck Society; ADA: American Dental Society; 4vHPV: quadrivalent HPV vaccine; 9vHPV: nine-valent HPV vaccine. CDC AAP ACS NVR ACOG AAFP AHNS ADA HPV knowledge HPV prevalence in different populations [10] , [42] , [62] , [77] , [79] • • • • • • • • Oncogenic and non-oncogenic strains [27] , [62] , [77] , [83] , [89] • • • • Head and neck HPV manifestations and other HPV associated cancers [10] , [22] , [80] • • • • • • • • HPV vaccine knowledge Safety and Efficacy [26] , [27] , [29] , [39] , [42] , [62] , [63] , [75] , [81] , [85] , [86] , [89] • • …”

Influenza epidemiology among hospitalized children in Stockholm, Sweden 1998–2014

“…The reason for the low uptake of the vaccine is probably multifactorial. In a recent questionnaire study in the USA two factors were highlighted: fear of side effects and the belief that influenza is not a serious threat to children [4].…”

“…During the pandemic, adjuvanted monovalent H1N1 vaccine (Pandemrix ® , GlaxoSmithKline Biologicals, Rixensart, Belgium) was offered to all children from 6 months of age. However, except during the pandemic season, when 60% of all children accepted the offer, the vaccine uptake has been low (<5%), perhaps due to fear of side effects or unawareness of the severity of influenza [2][3][4].…”

Discrepancies between general practitioners' vaccination recommendations for their patients and practices for their children

“…Recent decades have seen great reductions in vaccinepreventable diseases through routine vaccination programmes [1]. Nonetheless, vaccine hesitancy is increasing worldwide, both among the general population [2] and among health-care workers [3,4].…”