HPV vaccination of boys in primary care practices

Abstract

Objective: In October 2011, the Advisory Committee on Immunization Practices (ACIP) recommended the quadrivalent human papillomavirus vaccine (HPV4) for the routine immunization schedule for 11- to 12-year-old boys. Before October 2011, HPV4 was permissively recommended for boys. We conducted a study in 2010 to provide data that could guide efforts to implement routine HPV4 immunization in boys. Our objectives were to describe primary care physicians': 1) knowledge and attitudes about human papillomavirus (HPV)-related disease and HPV4, 2) recommendation and administration practices regarding HPV vaccine in boys compared to girls, 3) perceived barriers to HPV4 administration in boys, and 4) personal and practice characteristics associated with recommending HPV4 to boys.

Methods: We conducted a mail and Internet survey in a nationally representative sample of pediatricians and family medicine physicians from July 2010 to September 2010.

Results: The response rate was 72% (609 of 842). Most physicians thought that the routine use of HPV4 in boys was justified. Although it was permissively recommended, 33% recommended HPV4 to 11- to 12-year-old boys and recommended it more strongly to older male adolescents. The most common barriers to HPV4 administration were related to vaccine financing. Physicians who reported recommending HPV4 for 11- to 12-year-old boys were more likely to be from urban locations, perceive that HPV4 is efficacious, perceive that HPV-related disease is severe, and routinely discuss sexual health with 11- to 12-year-olds.

Conclusions: Although most physicians support HPV4 for boys, physician education and evidence-based tools are needed to improve implementation of a vaccination program for males in primary care settings.

Keywords: HPV vaccine; immunization; physician attitudes.

Figure 1

Physicians’ attitudes about HPV4 for boys for pediatricians and family physicians combined (n =602). Excluded are physicians who responded, “I do not see patients in this group” (total excluded <2%). Some percentages do not add up to 100% because of rounding.

Figure 2

Physicians’ strength of recommendation for HPV vaccine in girls and boys in different age groups (n = 609). The survey was conducted between July 2010 and September 2010 before the recommendation for routine vaccination of boys with HPV4. Excluded physicians who responded, “I do not see patients in this age group” (total excluded <2%). Some percentages do not add up to 100% because of rounding. P < .05 for Cochran-Armitage test for trend for percent who “strongly recommend” and “recommend, but not strongly” across the 3 age groups for both genders.