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Review
. 2024 Dec 25:12:25151355241308313.
doi: 10.1177/25151355241308313. eCollection 2024.

Acceptability of human papillomavirus vaccination in the United Kingdom: a systematic review of the literature on uptake of, and barriers and facilitators to HPV vaccination

Anna Karakusevic  1 , Anna M Foss  2
Affiliations
Review

Acceptability of human papillomavirus vaccination in the United Kingdom: a systematic review of the literature on uptake of, and barriers and facilitators to HPV vaccination

Anna Karakusevic et al. Ther Adv Vaccines Immunother. .

Abstract

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide, with HPV and HPV-related diseases representing a substantial disease burden. HPV vaccination has reduced HPV infections and HPV-related diseases; however, there is growing evidence of delayed or refused vaccination due to a lack of trust in vaccines. Understanding the factors that impact vaccine uptake will allow the development and implementation of successful vaccination programmes.

Objectives: This study aimed to evaluate the acceptability of HPV vaccination among adolescents and parents in the United Kingdom (UK).

Design: Systematic review.

Methods: Online databases (Embase, Medline and Cochrane) and grey literature sources were searched to identify publications pertaining to 'adolescents', 'parents', 'vaccine uptake', 'vaccine hesitancy' and 'barriers or facilitators to vaccination'. Searches were limited to English language and articles published specific to the United Kingdom between 2017 and 2023.

Results: Following a review of 152 abstracts, 24 publications met the inclusion criteria. While HPV vaccination is widely accepted in the UK, with coverage reported ⩾80% in peer-reviewed literature, the UK Health Security Agency report that vaccine coverage estimates in England between 2020-2023 remain below 80% and are lower than pre-COVID levels. Several important barriers were identified that may impact vaccine uptake, including system-level (challenges with obtaining consent), psychological/behavioural (perception of HPV risk vs vaccine risks), and sociodemographic factors, with similar factors reported among adolescents and parents.

Conclusion: HPV vaccination coverage remains below pre-COVID levels in the UK and common barriers among adolescents and parents have been identified that must be addressed to improve coverage rates. There is currently limited evidence among adolescent boys to fully evaluate any differences in vaccination coverage, or barriers, compared to girls. More research is required into facilitators to vaccination (especially to address sociodemographic barriers), to identify approaches to tackle the barriers that currently impede HPV vaccination uptake.

Keywords: HPV vaccine; adolescents; human papillomavirus; vaccination coverage; vaccine hesitancy.

Plain language summary

Acceptability of human papillomavirus vaccination in the United Kingdom: a systematic review.

Why was the study conducted?: Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide, with HPV and HPV-related diseases representing a substantial disease burden. HPV vaccination has reduced HPV infections and HPV-related diseases, however, there is growing evidence of delayed or refused vaccination due to a lack of trust in vaccines. Understanding the factors that impact vaccine uptake will allow the development and implementation of successful vaccination programmes.

What did the researchers do?: A literature review was conducted using online databases to identify publications reporting on ‘adolescents’, ‘parents’, ‘vaccine uptake’, ‘vaccine hesitancy’, and ‘barriers or facilitators to vaccination’ in English and published in the United Kingdom, between 2017 and 2023.

What did the researchers find?: After reviewing 152 publications, 24 met the inclusion criteria. While HPV vaccination is widely accepted in the UK, reported vaccine coverage estimates are mixed, with UK Health Security Agency estimates remaining below pre-COVID levels. Several important barriers were identified that may impact vaccine uptake, including challenges with obtaining consent for vaccination, perception of risks of vaccination, and sociodemographic factors. Similar barriers were reported among adolescents and parents.

What do the findings mean?: HPV vaccination coverage remains below pre-COVID levels in the UK and common barriers among adolescents and parents have been identified that must be addressed to increase vaccine uptake. The limited evidence identified for adolescent boys prevented a full comparison of differences in vaccination coverage between boys and girls. More research is required on the factors that increase vaccine uptake, to identify approaches that could address the barriers currently limiting high vaccine coverage in the UK.

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Figures

Figure 1.
Figure 1.
PRISMA diagram. *Record removed due to being a duplicate (secondary publication on the same dataset as an included publication), as opposed to duplicates of the same publication identified during abstract screening.
Figure 2.
Figure 2.
Venn diagram illustrating barriers to vaccination reported by adolescents and parents.,–,,,,– *Vaccination was not recommended for adolescent boys in the NIP at the time of the study.
Figure 3.
Figure 3.
Venn diagram illustrating facilitators to vaccination reported by adolescents and parents.,–,,,,,,,
See this image and copyright information in PMC

References

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    1. Burd EM. Human papillomavirus and cervical cancer. Clin Microbiol Rev 2003; 16: 1–17. - PMC - PubMed
    1. Centers for Disease Control and Prevention. Genital HPV Infection – Fact Sheet, https://www.cdc.gov/std/hpv/stdfact-hpv.htm (2021, accessed 26 June 2024).
    1. de Martel C, Plummer M, Vignat J, et al.. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer 2017; 141: 664–670. - PMC - PubMed
    1. Serrano B, Brotons M, Xavier Bosch F, et al.. Epidemiology and burden of HPV-related disease. Best Pract Res Clin Obstet Gynaecol 2018; 47: 14–26. - PubMed

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