For mothers who have an experience with human papillomavirus (HPV) vaccine preventable outcomes such as a cervical biopsy or cancer, would this history make them more likely to have their child receive this vaccine? It may seem likely, but a new study raises questions about this belief.
It seems understandable to presume a mother who had a cervical biopsy or cancer may be more likely to vaccinate her child for human papillomavirus (HPV) as a result of a heightened perception of risk when compared to mothers who did not have this experience, but does this actually happen? A report looked into whether salience bias had an impact on the decision to vaccinate children for HPV.1
The investigators performed a retrospective cohort study, which compared the vaccination rates of children with mothers who had a history of either cervical cancer or cervical biopsy, both vaccine-preventable outcomes, with a control group of children with mothers who had no pertinent history. They found participants using the MarketScan Commercial Database from January 2014 to December 2018, to find children aged 11 years and older.
The final cohort included 757,428 children, of which 38,366 had mothers with a history of cervical biopsy alone and 1084 had maternal history of cervical cancers. A little more than half of the cohort had been administered at least 1 dose of the HPV vaccine by 16 years of age. The investigators found that the rate of HPV vaccine administration did not differ between children with mothers who had cervical cancers versus those with no maternal history of the disease(hazard ratio [HR] for girls, 0.99 [95% CI, 0.86-1.13]; HR for boys, 1.08 [95% CI, 0.94-1.24]). However, they did find a small increase in vaccine administration for the children of mothers who had a history of cervical biopsy alone (HR for girls, 1.06 [95% CI, 1.04-1.09]; HR for boys, 1.04 [95% CI, 1.01-1.06]). To determine whether there were any unknown confounding variables with the HPV vaccine, investigators looked at the rate of tetanus/diphtheria/acellular pertussis and meningococcal vaccinations, which are also recommended for administration at age 11 years, and found no meaningful difference between the control group and the group with a maternal history of a negative outcome.
The investigators concluded that a maternal history of a negative outcome such as cervical cancer was not linked to greater HPV vaccine rates in those mothers’ children, indicating that salience bias likely has little impact on vaccine hesitancy for this specific vaccine. They urged further study to examine the role the bias may play in vaccination rates for other vaccines.
1. Worsham C, Woo J, Zimerman A, Bray C, Jena A. Association of maternal cervical disease with human papillomavirus vaccination among offspring. JAMA Netw Open. 2021;4(12):e2134566. doi:10.1001/jamanetworkopen.2021.34566