Human papillomavirus vaccine delivery practices among pediatricians and pediatric trainees in a tertiary hospital in Singapore

Abstract

Human Papillomavirus (HPV) is the most common sexually transmitted infection and is associated with cervical, anogenital, and oropharyngeal cancers. It is crucial to improve vaccination uptake in both genders as primary prevention for these conditions. Pediatricians play an active role in advocating for HPV vaccination and our study aims to assess the level of knowledge, attitudes, barriers, and practices among pediatric trainees and general pediatricians regarding HPV infection and vaccination. A survey-questionnaire was administered to our target groups. It comprised 14 questions regarding demographics of the healthcare provider, knowledge of HPV infection and vaccination, practices and barriers of recommending HPV vaccination, and effective strategies for improving HPV vaccine uptake. Among survey respondents, majority did not recommend for HPV vaccination (66.7%) or receive any enquiry about it (80.6%) within the preceding 12 months. The most common perceived barrier was inadequate knowledge, which was consistent with the misconceptions regarding HPV infection and vaccination that were identified in this survey. Strategies which physicians felt would be most effective in increasing vaccine uptake include educating and providing resources for both physicians and caregivers as well as making the vaccine free. Our study revealed a low advocacy rate for HPV vaccination. Physicians need to be equipped with the knowledge, skills, and resources to better counsel caregivers as well as focus our efforts on vaccinating male patients in order to increase vaccine uptake in both genders.

Keywords

HPV-related cancers / human papillomavirus infection / human papillomavirus vaccine / immunization / pediatricians / vaccine advocacy / vaccine barriers / vaccine knowledge

References

[1] SungH, FerlayJ, SiegelRL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249.

[2] BruniLAG, Serrano B, MenaM, et al. Human Papillomavirus and Related Diseases in Singapore. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre); 2023. Accessed January 24, 2024.

[3] OkunadeKS. Human papillomavirus and cervical cancer. J Obstet Gynaecol. 2020;40(5):602-608.

[4] Howell-JonesR, BaileyA, BeddowsS, et al. Multi-site study of HPV type-specific prevalence in women with cervical cancer, intraepithelial neoplasia and normal cytology, in England. Br J Cancer. 2010;103(2):209-216.

[5] LuB.-B, KumarA, CastellsaguéX, GiulianoAR. Efficacy and safety of prophylactic vaccines against cervical HPV infection and diseases among women: a systematic review & meta-analysis. BMC Infect Dis. 2011;11(1):13.

[6] Health Hub MoS. Preventing HPV Infection: HPV Vaccination. Ministry of Singapore. https://www.healthhub.sg/a-z/diseases-and-conditions/701/faqs-on-hpv-and-hpv-immunisation. Accessed January 24, 2024.

[7] ChirayilEI, Thompson CL, BurneyS. Predicting human Papilloma virus vaccination and pap smear screening intentions among young Singaporean women using the theory of planned behavior. SAGE Open. 2014;4(4):215824401455496.

[8] FuEWZ, Chilagondanahalli N, BundeleMM, GanJY, LiH, LimMY. Trends in HPV-related oropharyngeal cancers in Singapore. Ann Acad Med Singap. 2021;50(6):508-509.

[9] MarićG, Birčanin Đ, KisićV, et al. Parental perspective on human papillomavirus (HPV) vaccination in Serbia: knowledge, attitudes and practice. Sex Reprod Healthc. 2018;16:192-198.

[10] TaySK, OonLLE. Prevalence of cervical human papillomavirus infection in healthy women is related to sexual behaviours and educational level: a cross-sectional study. Int J STD AIDS. 2014;25(14):1013-1021.

[11] KombeKAJ, LiB.-F, ZahidA, et al. Epidemiology and burden of human papillomavirus and related diseases, molecular pathogenesis, and vaccine evaluation. Front Public Health. 2021;8:552028.

[12] Anna SzymonowiczK, Chen J.-J. Biological and clinical aspects of HPV-related cancers. Cancer Biol Med. 2020;17(4):864-878.

[13] GribbJP, Wheelock JH, ParkES. Human Papilloma virus (HPV) and the current state of oropharyngeal cancer prevention and treatment. Dela J Public Health. 2023;9(1):26-28.

[14] KahnBZ, HuangQ, ThompsonP, Gilkey MB, Alton DaileyS, BrewerNT. Getting human papillomavirus vaccination back on track: a national survey. J Adolesc Health. 2023;72(6):950-957.

[15] HolmanDM, BenardV, RolandKB, Watson M, LiddonN, StokleyS. Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr. 2014;168(1):76-82.

[16] TungILY, Machalek DA, GarlandSM. Attitudes, knowledge and factors associated with human papillomavirus (HPV) vaccine uptake in adolescent girls and young women in Victoria, Australia. PLoS One. 2016;11(8):e0161846.

[17] DicksonT, HirkoKA, FordS. Provider confidence and perceived barriers when recommending the human papillomavirus vaccine to parents. J Cancer Educ. 2023;38(4):1193-1199.

[18] HansenK.-T, WardM, AvashiaS, Duc J, SpielbergF. What impacts HPV vaccination recommendations? An exploration of medical residents’ knowledge, training, barriers, and practices. Fam Med. 2020;52(10):745-751.

[19] Morales-CamposDY, Flores BE, DonovanE, BurdickS, Parra-Medina D, KahnJA. A qualitative descriptive study of providers’ perspectives on human papillomavirus vaccine administration among Latino/a adolescents in South Texas clinics: barriers and facilitators. BMC Publ Health. 2022;22(1):443.

[20] ZhuangQY, WongRX, ChenWMD, Guo XX. Knowledge, attitudes and practices regarding human papillomavirus vaccination among young women attending a tertiary institution in Singapore. Singapore Med J. 2016;57(6):329-333.

[21] BrouwerAF, Delinger RL, EisenbergMC, et al. HPV vaccination has not increased sexual activity or accelerated sexual debut in a college-aged cohort of men and women. BMC Publ Health. 2019;19(1):821.

[22] LeiJ.-Y, PlonerA, ElfströmKM, et al. HPV vaccination and the risk of invasive cervical cancer. N Engl J Med. 2020;383(14):1340-1348.

[23] Van DyneEA, HenleySJ, SaraiyaM, Thomas CC, MarkowitzLE, BenardVB. Trends in human papillomavirus-associated cancers - United States, 1999-2015. MMWR Morb Mortal Wkly Rep. 2018;67(33):918-924.

[24] ClayPA, Thompson TD, MarkowitzLE, EkwuemeDU, Saraiya M, ChessonHW. Updated estimate of the annual direct medical cost of screening and treatment for human papillomavirus associated disease in the United States. Vaccine. 2023;41(14):2376-2381.

[25] ShapiroGK, Guichon J, KelaherM. Canadian school-based HPV vaccine programs and policy considerations. Vaccine. 2017;35(42):5700-5707.

[26] TileyK, Tessier E, WhiteJM, et al. School-based vaccination programmes: an evaluation of school immunisation delivery models in England in 2015/16. Vaccine. 2020;38(15):3149-3156.

[27] CartmellKB, Young-Pierce J, McGueS, et al. Barriers, facilitators, and potential strategies for increasing HPV vaccination: a statewide assessment to inform action. Papillomavirus Res. 2018;5:21-31.

[28] TopazianHM, KunduD, PeeblesK, et al. HPV vaccination recommendation practices among adolescent health care providers in 5 countries. J Pediatr Adolesc Gynecol. 2018;31(6):575-582.e2.

[29] VijayalakshmiK, GoeiAHY. Improved population coverage of the human papillomavirus vaccine after implementation of a school-based vaccination programme: the Singapore experience. Singapore Med J. 2023;64(5):294-301.

[30] EgemenD, KatkiHA, ChaturvediAK, LandyR, CheungLC. Variation in human papillomavirus vaccination effectiveness in the US by age at vaccination. JAMA Netw Open. 2022;5(10):e2238041.

RIGHTS & PERMISSIONS

2024 The Author(s). Pediatric Discovery published by John Wiley & Sons Australia, Ltd on behalf of Children’s Hospital of Chongqing Medical University.