What is the appropriate response to a mother who declines the human papillomavirus (HPV) vaccine for her 11-year-old son due to his lack of sexual activity and cultural beliefs about premarital sex?

From the Guidelines

The HPV vaccine should be strongly recommended for this 11-year-old boy, regardless of his current sexual activity status, as it provides protection against human papillomavirus infections that can lead to various cancers and genital warts later in life. The vaccine is most effective when administered before any potential exposure to HPV through sexual contact, and the CDC recommends routine vaccination beginning at ages 11-12 for both boys and girls 1. The American Cancer Society also recommends routine HPV vaccination between ages 9-12 years, with the goal of achieving higher on-time vaccination rates and increasing the numbers of cancers prevented 1.

Key Points to Consider

• The HPV vaccine is not a live vaccine, but a killed (recombinant) vaccine, and its side effects are minimal, primarily injection site reactions and occasional fever 1.
• The vaccine provides protection against HPV types 16 and 18, which are responsible for approximately 70% of HPV-related cancers in the United States 1.
• The 9-valent HPV vaccine (9vHPV) is the only available HPV vaccine in the United States and provides coverage for the original 4 HPV types (6,11,16, and 18) and for the high-risk HPV types 31,33,45,52, and 58 1.
• Health care provider recommendation and physician attitude play a major role in the decision to vaccinate against HPV, and a strong endorsement is more influential than a weak one 1.

Addressing Cultural Beliefs and Concerns

The physician should respectfully acknowledge the mother's cultural values and concerns about her son's sexual activity, while emphasizing that the vaccine is preventive healthcare that protects her son's future health, regardless of when he becomes sexually active. The vaccine is a critical strategy for cancer prevention, and its benefits outweigh the risks 1. By recommending the HPV vaccine, the physician can help prevent HPV-related cancers and diseases, and promote the health and well-being of the patient.

From the Research

Addressing Concerns about HPV Vaccination

• The mother's concern about her 11-year-old son's lack of sexual activity and cultural beliefs about premarital sex can be addressed by explaining that the HPV vaccine is recommended for both males and females at age 11 or 12, regardless of sexual activity 2, 3.
• The vaccine is most effective when administered before exposure to the virus, which can occur through sexual contact or other means 2, 4.
• It's essential to emphasize that the HPV vaccine is not just about preventing a sexually transmitted infection, but also about preventing HPV-related diseases, including cancers 2, 5.

Provider Recommendation and Education

• A strong provider recommendation is a key factor in increasing HPV vaccine initiation among adolescents 5, 6.
• Providers should be educated about the importance of recommending the HPV vaccine to both males and females, regardless of sexual activity or cultural beliefs 3, 6.
• Providers can play a crucial role in addressing concerns and misconceptions about the HPV vaccine, and in encouraging parents to vaccinate their children 5, 6.

Cultural and Social Factors

• Cultural and social factors, such as beliefs about premarital sex, can influence parents' decisions about HPV vaccination 6.
• Providers should be sensitive to these factors and address them in a respectful and culturally sensitive manner 3, 6.
• Education and awareness campaigns can help to promote the importance of HPV vaccination and address misconceptions and cultural concerns 4, 5.