Low Uptake of Cancer Preventing Human Papillomavirus Vaccine Linked to Lasting Injection Fear Formed in Preschool

ATLANTA, June 28, 2017 /PRNewswire/ -- Dr. Amy Baxter, CEO of noninvasive pain relief leader MMJ Labs, published a study demonstrating a new factor influencing teens' decision to vaccinate. "The number of injected same-day preschool vaccines relates to preadolescent needle fear and HPV uptake," by Amy L. Baxter MD; Lindsey L. Cohen Ph.D.; Mark Burton, MA; Anaam Mohammed, MPH; M. L Lawson, Ph.D. DOI: 10.1016/j.vaccine.2017.06.02; appears in the journal Vaccine, published by Elsevier.

Each year 40,000 people die from influenza, and 4,000 from cancers caused by the vaccine-preventable Human Papillomavirus (HPV). Despite demonstrated health benefits, a growing number of patients are opting out of vaccinating themselves or their children. A new study demonstrated that the number of injections given in preschool is fueling the abrupt rise in adolescent and adult needle phobia, and suggests that children made fearful in preschool are less likely to get vaccinated against HPV as teens.  

"It is critical that we discuss ways to improve the 4-6 year vaccination experience, because the risks and the long-term impact are significant," said Amy Baxter MD, Clinical Associate Professor at Medical College of Georgia. "Vaccines save kids' lives. We're responsible if the way we give boosters threatens adult compliance and herd immunity."

Dr. Baxter, along with colleagues from Georgia State University and Kennesaw State University, evaluated a vaccine pain relief device as part of a grant funded by the National Institutes of Health (NIH) Eunice Shriver Institute of Child Health and Human Development. As the team realized that there was a higher than expected rate of needle fear in the preteens getting vaccinated, they began a new study evaluating the injection history to identify any patterns causing the increase in fear.

Dr. Anna Taddio, Ph.D. at the University of Toronto, published data in 2012 demonstrating that needle fear had increased 252 percent since 1995. In her sample of over 1,000 people, a quarter of adults and ⅔ of children feared needles. Most importantly, 7 percent of adults said fear impacted their decision to vaccinate their own children. Reimbursement, parents' schedules, and a 600 percent increase in the number of life-saving vaccine injections have resulted in preschoolers receiving up to 6 pokes on the same day. Baxter's study suggests the 63 percent of pediatric fear found in Taddio's study persists; when these children grow up, fear in the population may undermine widespread immunity.

"Vaccination delivery is even more complicated than we thought. We have to consider the impact of pain and fear on later healthcare compliance," stated Dr. Taddio.

Data included the number of visits for injections, number of injections per day, and age at the time of vaccination, as well as subsequent HPV vaccination. The researchers analyzed records for the 120 participants and correlated a 100mm rating of "How much anxiety do you have about your shots today?" as preteens with their vaccination records since birth.

The number of injections in infancy through the toddler years didn't relate to later fear. The 4-6 year booster vaccination schedule, however, was significantly related. "When preschoolers got one injection on multiple visits," noted Baxter, "None of them were in the high fear quartile as preteens. If they got 4 or more injections on one day in preschool, 50 percent were in the most fearful preteen group." She added that this highest fear quartile reported more pain with injections as preteens, and were 2.5 times less likely to go on to start the HPV vaccination series, though Baxter said there were too few subjects for the HPV finding to be statistically significant.  

While manufacturers try to combine as many vaccines as possible, prior to this study there has not been direct evidence that fewer injections at one time has long-term benefits. "Our study demonstrates needle fear persists at least 10 years. It suggests fear can impact teens' health decisions, which will be extremely important as our needle-fearful kids begin to make decisions for their health and the next generation's."

In this group, the researchers reported no difference in the total number of vaccines between ages 0 – 6 years, but caution that not every practice may have good compliance if the 4-6 year schedule accommodates fewer injections per visit. They also noted infant and toddler vaccines didn't relate to later fear, supporting that there is no reason to alter the vaccine schedule for children aged 0-3 years. They were unable to assess whether pain management had been used at the 4-6 year visits. Future research should evaluate pain management's impact on fear development, and should verify with larger numbers how much fear of needles impacts teens' health decisions.     

NOTES FOR EDITORS

About Vaccine

Vaccine is the pre-eminent journal for those interested in vaccines and vaccination. It is the official journal of The Edward Jenner Society and The Japanese Society for Vaccinology and is published by Elsevier (www.elsevier.com/locate/vaccine).

About MMJ Labs LLC

MMJ Labs is an Atlanta-based company manufacturing and researching physiology-based pain relief. Their VibraCool high-frequency anti-inflammatory pain product and Buzzy Needle Pain devices stimulate nerves to block the pain sensation while improving blood flow. They advocate increasing preventive medicine and vaccination.

Copies of this paper are available to credentialed journalists upon request; please contact Elsevier's Newsroom at [email protected] or +31 20 485 2492.

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