Low coverage of HPV vaccination in the national immunization programme in Brazil: Parental vaccine refusal or barriers in health-service based vaccine delivery?

Background

The World Health Organization has recommended the introduction of HPV vaccines into national immunization programme (NIP), but vaccination coverage remains low worldwide. We assessed the coverage and the parental acceptance of female and male HPV vaccination in Brazil after its introduction into the NIP.

Methods

We conducted a random-digit-dial survey of parents in seven major Brazilian cities from July-2015 to October-2016. A knowledge, attitude and practices questionnaire was developed and validated by expert analysis, semantic analysis, and pre-testing.

Results

826 out of 2,324 (35.5%) eligible parents completed the interview. Parental acceptance of the HPV vaccine for daughters and sons 18 years of age or less was high (92% and 86%, respectively). Parents refusing vaccination were less likely to know that: HPV is sexually transmitted and causes genital warts, HPV vaccination is more beneficial before sexual debut, and HPV vaccine reactions are minor, and they were more likely to believe HPV vaccination can cause severe adverse events. Parents accepting HPV vaccine for daughters but not forsons were more likely to ignore that the vaccine is recommended for boys. Attitudes associated with HPV vaccine acceptance included: general belief in vaccines, trust in the NIP and in the HPV vaccine efficacy. Among girls eligible for HPV vaccination through the NIP, 58.4% had received a two-dose scheme and 71.1% at least one dose. “No vaccination/missed vaccination at school” was the most common reason for missed HPV vaccination in theNIP.

Conclusions

One year after introduction in the NIP, most parents surveyed in Brazil accepted HPV vaccination for their daughters and sons. Low coverage in the NIP seemed to be due to challenges in adolescent vaccine delivery and HPV vaccination barriers at health-care centers, rather than to vaccine refusal.

The influence of "preparedness" on autoshaping, schedule performance, and choice

Two groups of experimentally naive pigeons were exposed to an autoshaping procedure in which the response key was mounted on the wall (the conventional location) or on the floor of the chamber. In two experiments, subjects readily responded to the wall key, but floor-key subjects required shaping. A subsequent experiment compared performance of wall- and floor-key groups on an ascending series of fixed-ratio schedule values, resistance to extinction, differential reinforcement of other behavior, and reversal of key assignment. Each experiment was followed by several sessions of fixed-ratio training; the performance of the wall- and floor-key groups was almost identical throughout. In the final experiment, a fixed-ratio requirement could be completed on either or both keys. Birds initially chose the key on which they had responded during the preceding (reversal of key assignment) experiment. However, within a few sessions both groups showed almost exclusive preference for the floor key. Preference for a key located on the floor may follow from the fact that pigeons are ground feeders and may thus be more "prepared" to peck the floor than to peck a wall. However, autoshaping, under the conditions prevailing here, occurred much more readily to the wall key, suggesting that pecking a vertical surface is more highly prepared. Difficulties in determining relative preparedness seem moot, however, given the lack of between-group differences in the intervening experiments. It is thus unlikely that schedule performances critically depend upon the specific operant response involved.

A low-cost, high-capacity maintenance feeding device for primates

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