Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts.
Department of Epidemiology, Harvard University School of Public Health, Boston, Massachusetts.
JAMA Otolaryngol Head Neck Surg. 2023 Oct 1;149(10):870-877. doi: 10.1001/jamaoto.2023.2073.
Human papillomavirus (HPV) vaccination rates remain significantly below rates for other common childhood vaccines, which has implications for future rates of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC).
To assess whether individuals who were aware of the association between HPV and OPSCC would be more likely to have been previously vaccinated.
DESIGN, SETTING, AND PARTICIPANTS: This survey study included patients aged 18 to 45 years who sought routine outpatient care at the otolaryngology clinic at Boston Medical Center from September 1, 2020, to May 19, 2021. A survey (HPV-Associated Head and Neck Cancer Epidemiology, Awareness and Demographics) [HEAD]) composed of validated questions to assess patient knowledge of HPV and HPV vaccination and barriers to vaccination was delivered to participants. The survey was paired with a novel point-of-care vaccination program housed within an otolaryngology department.
The main outcome was prevalence of knowledge of the relationship between HPV infection and OPSCC based on survey responses. The association of knowledge of HPV-associated OPSCC with likelihood of having been vaccinated was assessed in the overall cohort and by demographic characteristics using multivariate logistic regression.
Of 405 patients given the survey, 288 (71.1%) responded. Of these patients, 271 (94.1%) had surveys included; 158 (58.3%) were female, and median age was 29 years (IQR, 24-35 years). The baseline vaccination rate in the surveyed population was low (26.6%; n = 72) overall (10.6% among men [12 of 113]; 37.9% among women [60 of 158]). Few participants understood the relationship between HPV infection and OPSCC (63 of 271 [23.3%]) or that HPV-associated OPSCC is the most common HPV-associated cancer type (9 of 121 [7.4%]). Compared with men, women were more likely to have been previously vaccinated (odds ratio [OR], 6.5; 95% CI, 3.0-13.9), more aware that HPV causes cancer (OR, 3.7; 95% CI, 1.9-7.1), and more likely to have heard about HPV and HPV vaccination from their health care practitioner (OR, 2.6; 95% CI, 1.2-5.7). Knowledge of the relationship between HPV infection and cancer and between HPV and OPSCC was associated with increased likelihood of having been vaccinated (HPV and cancer: OR, 4.1 [95% CI, 1.8-9.5]; HPV and OPSCC: OR, 3.7 [95% CI, 1.8-7.6]). Among 156 unvaccinated participants, 12 of 98 men (12.2%) and 7 of 131 women (5.3%) received point-of-care vaccination.
Most participants in this survey study were unaware that HPV causes OPSCC. Understanding that HPV causes OPSCC was associated with increased likelihood of having been vaccinated. However, most patients surveyed were not informed of this relationship by their health care practitioners. Targeted education aimed at unvaccinated adults establishing the relationship between HPV infection and OPSCC, paired with point-of-care vaccination, may be an innovative strategy for increasing HPV vaccination rates in adults.
人乳头瘤病毒 (HPV) 疫苗接种率仍明显低于其他常见儿童疫苗的接种率，这对未来 HPV 相关口咽鳞状细胞癌 (OPSCC) 的发病率有影响。
评估是否意识到 HPV 与 OPSCC 之间存在关联的个体更有可能之前已接种疫苗。
设计、地点和参与者：这项调查研究纳入了 2020 年 9 月 1 日至 2021 年 5 月 19 日在波士顿医疗中心耳鼻喉科诊所接受常规门诊护理的年龄在 18 至 45 岁的患者。一项调查 (HPV 相关头颈部癌症流行病学、认识和人口统计学) [HEAD]) 包含了评估患者 HPV 知识和 HPV 疫苗接种以及疫苗接种障碍的经过验证的问题，将其提供给参与者。该调查与耳鼻喉科部门内的一项新的即时护理疫苗接种计划相结合。
主要结局是根据调查结果确定 HPV 感染与 OPSCC 之间关系的知晓率。使用多变量逻辑回归评估 HPV 相关 OPSCC 的知晓率与总体队列中及按人口统计学特征进行疫苗接种的可能性之间的关联。
在接受调查的 405 名患者中，288 名(71.1%)做出了回应。在这些患者中，有 271 名(94.1%)的调查结果包括在内；158 名(58.3%)为女性，中位年龄为 29 岁(四分位距，24-35 岁)。调查人群中的基线疫苗接种率较低(26.6%；n = 72)，其中男性接种率为 10.6%(113 人中有 12 人)，女性接种率为 37.9%(158 人中有 60 人)。很少有参与者了解 HPV 感染与 OPSCC 之间的关系(271 人中的 63 人[23.3%])或 HPV 相关 OPSCC 是最常见的 HPV 相关癌症类型(121 人中的 9 人[7.4%])。与男性相比，女性更有可能之前接种过疫苗(比值比[OR]，6.5；95% CI，3.0-13.9)，更了解 HPV 会导致癌症(OR，3.7；95% CI，1.9-7.1)，并且更有可能从他们的医疗保健从业者那里听说过 HPV 和 HPV 疫苗接种(OR，2.6；95% CI，1.2-5.7)。了解 HPV 感染与癌症之间以及 HPV 与 OPSCC 之间的关系与接种疫苗的可能性增加有关(HPV 和癌症：OR，4.1 [95% CI，1.8-9.5]；HPV 和 OPSCC：OR，3.7 [95% CI，1.8-7.6])。在 156 名未接种疫苗的参与者中，98 名男性中有 12 名(12.2%)，131 名女性中有 7 名(5.3%)接受了即时护理疫苗接种。
这项调查研究中的大多数参与者都不知道 HPV 会导致 OPSCC。了解 HPV 会导致 OPSCC 与接种疫苗的可能性增加有关。然而，大多数接受调查的患者并没有从他们的医疗保健从业者那里得到这种关系的信息。针对未接种疫苗的成年人的有针对性的教育，旨在建立 HPV 感染与 OPSCC 之间的关系，并结合即时护理疫苗接种，可能是提高成年人 HPV 疫苗接种率的一种创新策略。
