Safety concerns in HPV vaccine refusal


There are many reasons why a caregiver may refuse to have his or her child receive the human papillomavirus (HPV) vaccine, including safety concerns. A research letter examines whether those concerns have increased.

In spite of the fact that the human papillomavirus (HPV) vaccine is highly effective in preventing a variety of squamous cell carcinomas, the uptake of the vaccine in the United States remains low. A research letter in JAMA Pediatrics examines the concerns that may be contributing to nonvaccination.1

The investigators used data from the National Immunization Survey-Teen from 2008 to 2019. The survey is a population-based survey of caregivers of adolescents aged 13 to 17 years and their primary care professionals. The primary outcome for the research was caregivers reporting safety concerns or adverse effects as the main reason behind the refusal for the HPV vaccine, using the survey question “What is the MAIN reason teen will not receive HPV shots in the next 12 months?” to find caregivers with those concerns.

During the studied period, self-reports of concerns about safety or adverse effects being the main reason for vaccine refusal increased in prevalence, from 5.3% (95% CI, 4.4-6.5) in 2008 to 12.9% (95% CI, 12.0-13.9) in 2015 and then a sharp increase between 2015 to 2019 with a 26.2% (95% CI, 24.3-28.2) increase. Higher rates of concern as the main reason for nonvaccination were seen by non-Hispanic White caregivers as well as by parents or guardians of teenaged girls. Mothers who had college degrees and mothers who had less than 12 years of completed education had roughly the same rates of reporting safety concerns between 2008 to 2013. However, there was a statistically significant increase in the college educated mothers reporting safety concerns or adverse effects as the main reason for nonvaccination when compared to mothers who had less than 12 years of completed education (eg, 28.3% [95% CI, 25.5-31.2] among mothers with college degrees vs 13.7% [95% CI, 9.5-19.4] among mothers with less than 12 years of education in 2019).

The investigators concluded that a concern about safety or adverse effects as the main cause for HPV vaccine refusal has increased over the years. This increase could have a negative effect on the already sluggish uptake of the vaccine. During parent-caregiver encounters, clinicians should prepare to address HPV vaccine hesitancy and particularly safety concerns when discussing the vaccine at age-appropriate appointments.

This article was originally posted on Contemporary Pediatrics®.


1. Chido-Amajuoyi O, Talluri R, Shete S, Shete S. Safety concerns or adverse effects as the main reason for human papillomavirus vaccine refusal. JAMA Pediatr. June 28, 2021. Epub ahead of print. doi:10.1001/jamapediatrics.2021.1585

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