Most pediatric clinicians who were encouraged to begin human papillomavirus (HPV) vaccination at ages nine to 10 instead of 11 to 12 years reported that early vaccination had little impact on parental concerns, pushback, vaccine hesitancy, or their ability to convince hesitant parents, according to a study published today in Pediatrics.

The study examined clinician perceptions following an intervention designed to shift HPV vaccine initiation to earlier ages. Previous research has suggested that initiating vaccination earlier leaves more opportunities for vaccination before age 13, when health care visits become less frequent.

The study included two arms—one in which clinicians switched quickly to recommending vaccination at ages nine to 10 and a control group in which they continued initiating vaccination at ages 11 to 12. It was conducted in 31 pediatric practices in California and Colorado.

Vaccine hesitancy similar among parents in both groups

Earlier initiation created more opportunities for clinicians to discuss vaccination at subsequent well-child visits and for patients to complete the multi-dose series before adolescence, the study found. Clinicians who adopted early vaccination also said that starting at younger ages made conversations with parents easier and shorter, in part because the vaccine could be framed as routine preventive care rather than linked to discussions about sexual activity. 

While clinicians reported raising the issue of sexual activity less often with parents of patients ages nine to 10, parents in both groups raised the issue frequently and at similar rates. This finding ran counter to the researchers’ hypothesis that sexual activity would come up less frequently in the younger group. 

“Clinicians will need to continue to respond to parental questions about sexual activity, even if initiating at ages 9 to 10 years,” the researchers write. 

Vaccine hesitancy and refusal among parents appeared to be similar in both the earlier and later age-groups, and three-quarters of the clinicians said they felt they could convince hesitant parents about the benefits of vaccination in both groups.

Earlier vaccination appears ‘feasible and acceptable’

Study strengths include the large number of participating practices and clinicians across two states, diverse patient populations, and high survey response rates. At the same time, the findings reflect clinician perceptions, which may be subject to recall bias, and clinicians in the intervention arm may have been inclined to report more favorable experiences. 

Notably, write the researchers, “We do not yet have trial results of HPV vaccination rates; the RCT [randomized controlled trial] is ongoing, with a key objective to measure vaccination rates by age 13. Our findings need to be weighed with respect to vaccination coverage to best assess impact of early HPV vaccine initiation.”

The results suggest that initiating HPV vaccination at ages nine to 10 has minimal impact on parental concerns, hesitancy, or clinician influence, but may help streamline vaccine conversations with parents or caregivers. “Overall, early HPV vaccine initiation appears feasible and acceptable,” write the researchers.