Human Papillomavirus Vaccine - Knowledge and Attitudes among Parents of Children Aged 10-14 Years: A Cross-Sectional Study, Tîrgu Mures, Romania

By Voidazan, Septimiu; Tarcea, Monica et al. | Central European Journal of Public Health, March 2016 | Go to article overview

Human Papillomavirus Vaccine - Knowledge and Attitudes among Parents of Children Aged 10-14 Years: A Cross-Sectional Study, Tîrgu Mures, Romania


Voidazan, Septimiu, Tarcea, Monica, Morariu, Silviu-Horia, Grigore, Adelina, Dobreanu, Minodora, Central European Journal of Public Health


INTRODUCTION

Infection with human papillomavirus (HPV) is one of the most common sexually transmitted infections around the world. It is associated with cervical cancer in 99.7% of all cases, and is considered the leading cause of this type of cancer (1, 2).

The role of high-risk HPV genotypes (16 and 18) has been proven in the aetiology of cervical cancer accounting for approximately 70% of all cases, as well as for significant health problems in men, including anal, penile and oro-pharyngeal cancers, while the low-risk genotypes in both sexes may cause genital warts and respiratory papillomatosis (3, 4).

Cervical cancer is the fourth most common cancer in women, the seventh of all cancers, with an estimated incidence rate of 560,000 cases in 2015. A great majority of cases (about 85%) were diagnosed in less developed regions, including East Africa, South Africa, the Middle East, and Eastern Europe. In 2012, approximately 266,000 deaths from cervical cancer were recorded worldwide, accounting for 7.5% of all cancer deaths in women. Nearly nine in ten (87%) deaths from cervical cancer occurred in less developed regions (5).

Vaccination against HPV infection effective for genotypes 6, 11, 16 and 18 brought hope of reducing the incidence of infections, HPV-related morbidity and mortality. The latest recommendations include vaccination of adolescents and young adult women aged between 9 and 26 years and eligible men of similar ages to reduce their likelihood of getting genital warts and to prevent cancer (6).

Two vaccines were licensed in 2006/2007 for the prevention of cervical cancer (7). Quadrivalent vaccine (GardasilVR, Merck & Co., Inc.) showed 99% protection against HPV genotypes 16 and 18 associated with CIN 2/3 and adenocarcinoma in situ among women aged 15-26 years, and against condyloma acuminata (genital warts) caused by HPV genotypes 6 and 11. It is recommended that three doses of Gardasil should be used (8, 9). The other vaccine, Cervarix(TM) (GlaxoSmithKline) is a bivalent vaccine against HPV 16 and HPV 18 genotypes, for which three doses are also recommended: one administered initially, the second at one month, and the third at six months (10).

Romania ranks first in Europe in terms of mortality from cervical cancer (10.77% per 100,000), 6.3 times higher than the mean of EU countries. Of all cancers in women, cervical cancer ranks fourth in terms of mortality after breast, colorectal and lung cancer. The highest mortality rates are found in the age groups of 50-60 (32.9% per 100,000), 60-70 (37.3% per 100,000), and 70-80 (38.5% per 100,000). The incidence rate was an estimated 28.65% per 100,000, with 4,000 new cases discovered after 2012, ranking this type of cancer as the third after breast and colorectal cancer. The highest incidence rates were found in the age groups of 50-60 (82.1% per 100,000), 60-70 (69.0% per 100,000), and 40-50 (60.1% per 100,000) (5).

A voluntary campaign for immunization against HPV types 16 and 18 was introduced in 2008 targeting girls aged 10-11 years. However, a very small percentage of girls were vaccinated. Although there have been other attempts at vaccination launched by healthcare officials in Romania, the acceptance rate remained insignificant and programmes were discontinued (11, 12). A successful vaccination programme requires a high rate of acceptance and accurate information targeting both health professionals and parents.

The aim of this article is to assess the level of parental knowledge about HPV infection and HPV vaccination, including the degree of information from general practitioners (GP), and the identification of barriers in implementing a vaccination strategy.

MATERIALS AND METHODS

We performed a cross-sectional study using the self-administered questionnaire for the parents of pupils in grades 5-8, in three randomly selected secondary schools in Tîrgu Mures, Romania, a city with a population of approximately 134,000. …

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