Geburtshilfe Frauenheilkd 2016; 76(10): 1074-1080
DOI: 10.1055/s-0042-112813
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

HPV Vaccination: Attitude and Knowledge among German Gynecologists

HPV-Impfung: Einstellung und Wissensstand unter Gynäkologen in Deutschland
T. M. Kolben
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
,
C. Dannecker
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
,
K. Baltateanu
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
,
C. Goess
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
,
T. Starrach
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
,
A. Semmlinger
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
,
N. Ditsch
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
,
J. Gallwas
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
,
S. Mahner
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
,
K. Friese
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
,
T. Kolben
Department for Obstetrics and Gynecology, University Hospital of Munich, Ludwig-Maximilians-University, Munich, Germany
› Author Affiliations
Further Information

Publication History

received 21 June 2016
revised 17 July 2016

accepted 18 July 2016

Publication Date:
14 October 2016 (online)

   Permissions and Reprints

Abstract

Purpose: In order to achieve a higher vaccination rate, education on HPV as well as options for prophylaxis performed by doctors is of great importance. One opportunity to increase the protection against HPV would be vaccinating boys. This study evaluated attitude and knowledge among German gynecologists regarding HPV vaccination, especially in boys.

Material and Methods: A questionnaire with 42 questions about demographics, attitude and knowledge about HPV and HPV vaccination was sent to members of the German Society for Gynecology and Obstetrics (DGGG).

Results: 998 out of 6567 addressed gynecologists participated. Knowledge about HPV, associated diseases and possible HPV vaccines was high among participants. The attitude towards vaccination in boys as well as girls was positive. Only 8.2 % refused to vaccinate their sons whereas 2.2 % refused to do this for their daughters. However, only few gynecologists vaccinated their daughters and sons against HPV. Main reason for girls was an age outside of vaccination guidelines; for boys it was the lack of cost coverage.

Conclusion: The willingness of gynecologists to perform HPV vaccination in boys is as high as for girls. However, sons of gynecologists are only rarely vaccinated against HPV. Main reason is the lack of cost coverage. Vaccinating boys could decrease the disease burden in males, as well as protect women by interrupting ways of transmission. Since the main argument against vaccination of boys is only of financial nature, the necessity of a vaccination recommendation for boys needs to be re-evaluated taking into account the cost-reduced 2-dose vaccination scheme.

Zusammenfassung

Ziel: Zur Erreichung einer höheren Durchimpfungsrate ist die Aufklärung über HPV sowie Möglichkeiten der Prophylaxe durch den Arzt enorm wichtig. Eine Möglichkeit zur Optimierung des Schutzes gegenüber HPV besteht in der Impfung von Jungen. Diese Studie untersucht daher Einstellung und Wissensstand unter Gynäkologen bezüglich der HPV-Impfung insbesondere bei Jungen.

Methoden: Ein Fragebogen mit 42 Fragen zu demografischen Daten sowie Haltung und Wissen über HPV und die HPV-Impfung wurde an Mitglieder der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) versendet.

Ergebnisse: Es beteiligten sich 998 von 6567 angeschriebenen Ärzten. Das Wissen zu HPV, assoziierten Erkrankungen sowie möglichen HPV-Impfungen unter den Teilnehmern war hoch. Es bestand eine hohe Bereitschaft zur Impfung von Mädchen, aber auch hinsichtlich der Impfung von Jungen waren die Befragten positiv gestimmt. Nur 8,2 % der Befragten würde eine HPV-Impfung ihres Sohnes ablehnen, 2,2 % würden dies bei ihren Töchtern tun. Letztlich haben jedoch nur wenige die Impfung bei ihren Töchtern und Söhnen durchgeführt. Hauptgrund bei Mädchen war hierfür ein außerhalb der Impfempfehlung liegendes Alter, bei Jungen die aktuell fehlende Kostenübernahme der Krankenkasse.

Folgerung: Die Bereitschaft unter Gynäkologen, die HPV-Impfung an Männern durchzuführen, ist ähnlich hoch wie bei Frauen. Dennoch sind die Söhne der Befragten eher selten geimpft. Ursächlich ist hauptsächlich die fehlende Kostenübernahme. Eine Impfung von Jungen könnte jedoch die Krankheitslast bei Männern senken und über eine Unterbrechung der Übertragungswege ebenso Frauen schützen. Da das Hauptargument gegen eine Impfung von Jungen lediglich finanzieller Natur ist, sollte, in Anbetracht des kostengünstigeren 2-Dosen-Impfschemas, die Notwendigkeit einer Impfempfehlung für Jungen neu überdacht werden.

Key words

HPV - HPV vaccination - Gardasil - Cervarix - Gardasil-9

Schlüsselwörter

HPV - HPV-Impfung - Gardasil - Cervarix - Gardasil-9
 

  • References

  • 1 Trottier H, Franco EL. The epidemiology of genital human papillomavirus infection. Vaccine 2006; 24 (Suppl. 01) S1-S15
    Google Scholar
  • 2 Varma S, Lathrop E, Haddad LB. Pediatric condyloma acuminata. J Pediatr Adolesc Gynecol 2013; 26: e121-e122
    CrossrefGoogle Scholar
  • 3 Forman D, de Martel C, Lacey CJ et al. Global burden of human papillomavirus and related diseases. Vaccine 2012; 30 (Suppl. 05) F12-F23
    CrossrefPubMedGoogle Scholar
  • 4 International Agency for Research on Cancer. Human Papillomaviruses. IARC Monographs on the Evaluation of carcinogenic Risks to Humans. Volume 90. Lyon, France: WHO press; 2007
    Google Scholar
  • 5 Munoz N, Bosch FX, de Sanjose S et al. Epidemiologic classification of human papillomavirus types associated with cervical cancer. N Engl J Med 2003; 348: 518-527
    Google Scholar
  • 6 Kim KS, Park SA, Ko KN et al. Current status of human papillomavirus vaccines. Clin Exp Vaccine Res 2014; 3: 168-175
    CrossrefGoogle Scholar
  • 7 Walboomers JM, Jacobs MV, Manos MM et al. Human papillomavirus is a necessary cause of invasive cervical cancer worldwide. J Pathol 1999; 189: 12-19
    Google Scholar
  • 8 Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006; 55: 1-94
    Google Scholar
  • 9 Villa LL, Costa RL, Petta CA et al. Prophylactic quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial. Lancet Oncol 2005; 6: 271-278
    Google Scholar
  • 10 Villa LL, Costa RL, Petta CA et al. High sustained efficacy of a prophylactic quadrivalent human papillomavirus types 6/11/16/18 L1 virus-like particle vaccine through 5 years of follow-up. Br J Cancer 2006; 95: 1459-1466
    Google Scholar
  • 11 Harper DM, Franco EL, Wheeler C et al. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial. Lancet 2004; 364: 1757-1765
    Google Scholar
  • 12 Harper DM, Franco EL, Wheeler CM et al. Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial. Lancet 2006; 367: 1247-1255
    Google Scholar
  • 13 Saslow D, Boetes C, Burke W et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin 2007; 57: 75-89
    CrossrefPubMedGoogle Scholar
  • 14 Kirby T. FDA approves new upgraded Gardasil 9. Lancet Oncol 2015; 16: e56
    Google Scholar
  • 15 Joura EA, Giuliano AR, Iversen OE et al. A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med 2015; 372: 711-723
    CrossrefGoogle Scholar
  • 16 Ogilvie GS, Remple VP, Marra F et al. Parental intention to have daughters receive the human papillomavirus vaccine. CMAJ 2007; 177: 1506-1512
    CrossrefGoogle Scholar
  • 17 Hesse BW, Nelson DE, Kreps GL et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med 2005; 165: 2618-2624
    CrossrefGoogle Scholar
  • 18 Gray NJ, Klein JD, Noyce PR et al. Health information-seeking behaviour in adolescence: the place of the internet. Soc Sci Med 2005; 60: 1467-1478
    CrossrefPubMedGoogle Scholar
  • 19 Schwarz TM, Honsberg T, Stephan N et al. HPV vaccination: acceptance and influencing factors among young men in Germany. Future Microbiol 2016; 11: 227-234
    CrossrefGoogle Scholar
  • 20 Zimet GD, Mays RM, Fortenberry JD. Vaccines against sexually transmitted infections: promise and problems of the magic bullets for prevention and control. Sex Transm Dis 2000; 27: 49-52
    CrossrefGoogle Scholar
  • 21 Riedesel JM, Rosenthal SL, Zimet GD et al. Attitudes about human papillomavirus vaccine among family physicians. J Pediatr Adolesc Gynecol 2005; 18: 391-398
    CrossrefGoogle Scholar
  • 22 Gerend MA, Lee SC, Shepherd JE. Predictors of human papillomavirus vaccination acceptability among underserved women. Sex Transm Dis 2007; 34: 468-471
    Google Scholar
  • 23 Tolunay O, Celik U, Karaman SS et al. Awareness and attitude relating to the human papilloma virus and its vaccines among pediatrics, obstetrics and gynecology specialists in Turkey. Asian Pac J Cancer Prev 2014; 15: 10723-10728
    Google Scholar
  • 24 Wong MC, Lee A, Ngai KL et al. Knowledge, attitude, practice and barriers on vaccination against human papillomavirus infection: a cross-sectional study among primary care physicians in Hong Kong. PLoS One 2013; 8: e71827
    CrossrefGoogle Scholar
  • 25 Hopkins TG, Wood NJ, West RM et al. UK health professionalsʼ attitudes and knowledge regarding Human Papillomavirus (HPV) vaccination: a West Yorkshire Study. J Paediatr Child Health 2009; 45: 652-655
    CrossrefGoogle Scholar
  • 26 Schwarz TF, Leo O. Immune response to human papillomavirus after prophylactic vaccination with AS04-adjuvanted HPV-16/18 vaccine: improving upon nature. Gynecol Oncol 2008; 110: S1-S10
    Google Scholar
  • 27 Carter JJ, Koutsky LA, Hughes JP et al. Comparison of human papillomavirus types 16, 18, and 6 capsid antibody responses following incident infection. J Infect Dis 2000; 181: 1911-1919
    Google Scholar
  • 28 Giuliano AR, Palefsky JM, Goldstone S et al. Efficacy of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med 2011; 364: 401-411
    CrossrefGoogle Scholar
  • 29 Centers for Disease Control and Prevention (CDC). Recommendations on the use of quadrivalent human papillomavirus vaccine in males—Advisory Committee on Immmunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep 2011; 60: 1705-1708
    Google Scholar
  • 30 Australian Government Department of Health. Pharmaceutical Benefits Advisory Committee: Outcomes – Positive Recommendations. 2011 Online: http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/pbac-outcomes/2011-11/positive-recommendations last access: 23.07.2016
    Google Scholar
  • 31 An Advisory Committee Statement (ACS), National Advisory Committee on Immunization (NACI): Update On Human Papillomavirus (HPV) Vaccines. Canada communicable disease report 2012; 38 Online: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-1/index-eng.php last access: 23.07.2016
    Google Scholar
  • 32 Eurosurveillance editorial team. Updated version of ECDC guidance on human papillomavirus vaccines in Europe available. Euro Surveill 2012; 17: 20274
    Google Scholar
  • 33 Brisson M, van de Velde N, Franco EL et al. Incremental impact of adding boys to current human papillomavirus vaccination programs: role of herd immunity. J Infect Dis 2011; 204: 372-376
    CrossrefGoogle Scholar
  • 34 Bodemer N, Müller SM, Okan Y et al. Do the media provide transparent health information? A cross-cultural comparison of public information about the HPV vaccine. Vaccine 2012; 30: 3747-3756
    CrossrefGoogle Scholar