Human Papillomavirus vaccination in general practice in France, three years after the implementation of a targeted vaccine recommendation based on age and sexual history

Abstract

In France, vaccination against human papilloma virus (HPV) was recommended in 2007 for all 14-year-old girls as well as "catch-up" vaccination for girls between 15-23 y of age either before or within one year of becoming sexually active. We evaluated the vaccine coverage according to the eligibility for vaccination in a sample of young girls aged 14 to 23 years, who were seen in general practices. A survey was proposed to 706 general practitioners (GPs) and carried out from July to September 2010. GPs, also called "family doctor," are physicians whose practice is not restricted to a specific field of medicine but instead covers a variety of medical problems in patients of all ages. Each participating GP included, retrospectively, the last female patient aged 14-17 y and the last female patient aged 18-23 y whom he had seen. A questionnaire collected information regarding the GP and the patients' characteristics. The vaccine coverage was determined according to the eligibility for vaccination, i.e. the coverage among younger women (14-17) and among those sexually active in the second age range (18-23). Sexual activity status was assessed by GP, according to information stated in the medical record. The 363 participating physicians (response rate 51.4%) included 712 patients (357 in the 14- to 17-year-old group and 355 in the 15- to 23-year-old group) in their responses. The rate of the vaccination coverage in the 14- to 17-year-old group was 55%. Among the girls in the 18- to 23-year-old group, 126 were eligible, and their vaccination coverage rate was 82%. The evaluation of the eligibility by the GPs was incorrect in 36% of the cases. Of the 712 patients, 6% of the girls had been vaccinated without a need for the vaccination, and 26% of the girls had not been vaccinated, although they needed to be vaccinated. Regarding the vaccine uptake, vaccination at the age of 14 was not as effective as vaccinating the older population for which vaccination was indicated as a catch-up program, based on sexual history. However, in more than one-third of the older population, difficulties remained regarding the determination of eligibility, according to the sexual history of the patient.

Cognitions and behaviours of general practitioners in France regarding HPV vaccination: A theory-based systematic review

“…Among the 25 studies identified for this review ( Agrinier et al, 2017 ; Barjhoux and Glatigny, 2009 ; Bouvret et al, 2016 ; Casimont, 2015 ; Chauvet, 2016 ; Collange et al, 2016 ; Degoue, 2019 ; Erpeldinger et al, 2012 ; Gougenheim-Fretin, 2014 ; Houdjal, 2017 ; Killian et al, 2016 ; Lamirand, 2015 ; Lasset et al, 2014 ; Leicht, 2016 ; Lutringer-Magnin et al, 2011 ; Manolitsi, 2012 ; Martinez et al, 2016 ; Pelissier and Bastides, 2008 ; Piana et al, 2009 ; Plessis et al, 2012 ; Raude et al, 2016 ; Sadki, 2016 ; Thierry et al, 2016 ; Tutala, 2019 ; Verger et al, 2015 ), 18 reported quantitative and seven qualitative designs ( Table 1 ). The majority of the studies were conducted either before 2011 ( Barjhoux and Glatigny, 2009 ; Erpeldinger et al, 2012 ; Lasset et al, 2014 ; Lutringer-Magnin et al, 2011 ; Pelissier and Bastides, 2008 ; Piana et al, 2009 ; Plessis et al, 2012 ; Thierry et al, 2016 ) with some around 2007–2008 i.e.…”

“…Among the 25 studies identified for this review ( Agrinier et al, 2017 ; Barjhoux and Glatigny, 2009 ; Bouvret et al, 2016 ; Casimont, 2015 ; Chauvet, 2016 ; Collange et al, 2016 ; Degoue, 2019 ; Erpeldinger et al, 2012 ; Gougenheim-Fretin, 2014 ; Houdjal, 2017 ; Killian et al, 2016 ; Lamirand, 2015 ; Lasset et al, 2014 ; Leicht, 2016 ; Lutringer-Magnin et al, 2011 ; Manolitsi, 2012 ; Martinez et al, 2016 ; Pelissier and Bastides, 2008 ; Piana et al, 2009 ; Plessis et al, 2012 ; Raude et al, 2016 ; Sadki, 2016 ; Thierry et al, 2016 ; Tutala, 2019 ; Verger et al, 2015 ), 18 reported quantitative and seven qualitative designs ( Table 1 ). The majority of the studies were conducted either before 2011 ( Barjhoux and Glatigny, 2009 ; Erpeldinger et al, 2012 ; Lasset et al, 2014 ; Lutringer-Magnin et al, 2011 ; Pelissier and Bastides, 2008 ; Piana et al, 2009 ; Plessis et al, 2012 ; Thierry et al, 2016 ) with some around 2007–2008 i.e. the period where HPV vaccination was implemented in France ( Barjhoux and Glatigny, 2009 ; Erpeldinger et al, 2012 ; Lutringer-Magnin et al, 2011 ; Pelissier and Bastides, 2008 ; Piana et al, 2009 ), or over the 2011–2015 period ( Agrinier et al, 2017 ; Bouvret et al, 2016 ; Casimont, 2015 ; Collange et al, 2016 ; Gougenheim-Fretin, 2014 ; Killian et al, 2016 ; Lamirand, 2015 ; Manolitsi, 2012 ; Martinez et al, 2016 ; Raude et al, 2016 ; Verger et al, 2...…”

“…The sample size ranged from ten to 31 GPs in the qualitative studies and from 96 to 1598 in the quantitative studies. Except for five articles in which the participants represented a national panel ( Agrinier et al, 2017 ; Collange et al, 2016 ; Leicht, 2016 ; Thierry et al, 2016 ; Verger et al, 2015 ), the studies included participants from local panels. Only one study used random sampling to select participants ( Leicht, 2016 ).…”

“…The quality of the included articles varied widely, with ten articles ( Bouvret et al, 2016 ; Gougenheim-Fretin, 2014 ; Killian et al, 2016 ; Lamirand, 2015 ; Lasset et al, 2014 ; Martinez et al, 2016 ; Piana et al, 2009 ; Raude et al, 2016 ; Sadki, 2016 ; Verger et al, 2015 ), considered at low risk (i.e., high-quality studies), six ( Agrinier et al, 2017 ; Collange et al, 2016 ; Lutringer-Magnin et al, 2011 ; Manolitsi, 2012 ; Pelissier and Bastides, 2008 ; Thierry et al, 2016 ) at moderate risk (i.e., moderate-quality studies), and nine at high risk of bias ( Barjhoux and Glatigny, 2009 ; Casimont, 2015 ; Chauvet, 2016 ; Degoue, 2019 ; Erpeldinger et al, 2012 ; Houdjal, 2017 ; Leicht, 2016 ; Plessis et al, 2012 ; Tutala, 2019 ) (i.e., low-quality studies) (Appendix, Tables A.2 and A.3).…”

Background paper for the recommendation of HPV vaccination for boys in Germany

“…To achieve high HPV vaccination coverage, a nationwide school-based vaccination programme should be considered for Germany to reach those children who have not visited a doctor between the ages of 9 and 14 years, who have not attended the J1 health check-up, or whose doctors have not yet recommended HPV vaccination. School vaccination programmes are most common in Anglo-Saxon and Nordic countries, where they normally lead to a vaccination coverage of >70%, as in Australia (2016: girls 79%, boys 73%; [120]), Canada (2013: girls 73%; [121] [127]). One exception is Denmark, which initially achieved vaccination coverage of >70% after introduction of the vaccination without a school vaccination programme [128].…”