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What barriers do you see to HPV vaccination?

Several dilemmas surround community acceptance of the human papillomavirus (HPV) vaccine (Gardasil[R], Merck) in the prevention of cervical cancer and penile warts. My role is a prevention/oncology nurse. Specifically, I focus outreach efforts in minority communities to provide access to care, screening, public education, and awareness.


In my practice community, the state cancer control plan has helped with increasing HPV vaccination, but many issues remain. Should the HPV vaccine be added to the standard immunizations for children? What is the best way to communicate to parents that boys and girls benefit from the vaccine?

Providers should be able to provide a simple, unbiased explanation to parents and guardians so they can make informed decisions. Many healthcare providers do not know the basics about the virus and how a vaccine works. Amazingly, the myth remains that the HPV vaccine is a live virus. The fears are related to the unknown. Some parents, guardians, and providers prefer to wait until an adolescent is older and can make the decision independently.

When speaking with groups, other community leaders, and other healthcare providers, I still find they are uncertain that providing a vaccine to young girls aged 9-10 or the recommended ages of 9-26 would impact cervical cancer in their lives. Some healthcare providers themselves are not sure or have not encouraged their clients to vaccinate their children because they wouldn't do it for their own children.

In October 2009, new controversy emerged regarding boys getting vaccinated as the U.S. Food and Drug Administration (FDA) approved Gardasil for vaccination in males aged 9-26 for the prevention of genital warts caused by HPV types 6 and 11. The FDA also approved HPV bivalent vaccine (Cervarix[R], GlaxoSmithKline) in October 2009, so providers now have to make an additional decision about which vaccine is the best choice for adolescent girls in the prevention of cervical cancer.

Another consideration is to understand the cultural biases surrounding vaccines. For example, many Hispanic parents have encountered great difficulties in acquiring basic immunizations for children, and many African Americans have a cultural bias to not trust certain medications.

RELATED ARTICLE: Society of Gynecologic Oncologists White Papers on HPV Vaccines

Downs, L.S., Jr., Scarinci, I., Einstein, M.H., Collins, Y., & Flowers, L. (2010). Overcoming the barriers to HPV vaccination in high-risk populations in the US. Gynecologic Oncology, 117, 486-490. doi: 10.1016/j.ygyno.2010.02.011

Huh, W., Einstein, M.H., Herzog, T.J., & Franco, E.L. (2010). What is the role of HPV typing in the United States now and in the next five years in a vaccinated population? Gynecologic Oncology, 117, 481-485. doi: 10.1016/j.ygyno.2010.01.037

Massad, L.S., Einstein, M., Myers, E., Wheeler, C.M., Wentzensen, N., & Solomon, D. (2009). The impact of human papillomavirus vaccination on cervical cancer prevention efforts. Gynecologic Oncology, 114, 360-364. doi: 10.1016/j.ygyno.2009.04.005

ONS member Nora Katurakes, RN, MSN, OCN[R], is the manager of the Community Health Outreach and Education program at Helen F. Graham Cancer Center at Christiana Care in Newark, DE.
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Title Annotation:[ONE NURSE'S PERSPECTIVE]; human papillomavirus
Author:Katurakes, Nora
Publication:ONS Connect
Article Type:Report
Geographic Code:1USA
Date:Jul 1, 2010
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