Parental Acceptance of Human Papillomavirus Vaccination Among Females Treated for Childhood Cancer and/or With Hematopoietic Stem Cell Transplantation: A Cross-Sectional Study

Background: Survivors of childhood cancer (CCS) and hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of human papillomavirus (HPV)-associated malignancies. Although HPV vaccination is recommended for these groups, parental acceptance remains uncertain.

Procedure: We recruited caregivers of female CCS/HSCT aged ≥9 years from the Shanghai Children's Medical Center (SCMC) vaccination clinic. Caregivers of females who were at least 6 months post treatment, off immunosuppressants, and disease-free were eligible. Caregivers completed a questionnaire assessing demographics, HPV knowledge, and their willingness to vaccinate their daughters.

Results: Of the 219 caregivers enrolled, 195 (89.0%) completed the survey. Among the children of caregivers who responded, 44.6% (87/195) had undergone HSCT. All respondent caregivers lacked awareness that the HPV vaccine was recommended for their daughters. Willingness to vaccinate was endorsed by 65.1% (127/195) of caregivers, and was significantly associated with a household income over ¥50,000 (p = 0.02), the mother's HPV vaccination status (p < 0.001), and their daughter receiving any vaccination post therapy (p = 0.02). The most common reasons for vaccine refusal included concerns about its impact on the child's primary disease (64.7%, 44/68), vaccine safety (58.8%, 40/68), and the belief that their child was too young for HPV vaccination (50.0%, 34/68). Only 15 of the 127 (11.8%) caregivers who initially expressed willingness to vaccinate their children had actually initiated vaccination.

Conclusion: A substantial minority of Chinese caregivers of female CCS/HSCT are hesitant to vaccinate their daughters against HPV. Addressing caregivers' knowledge deficits and misperceptions about vaccine safety and barriers to accessing HPV vaccination is important to improve uptake.