Intended for healthcare professionals

Rapid response to:

Practice 10 Minute Consultation

Discussing human papilloma virus vaccination

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2730 (Published 22 June 2017) Cite this as: BMJ 2017;357:j2730

Rapid Response:

Re: Discussing human papilloma virus vaccination

Many thanks for the numerous feedbacks and responses to our article since its publication.

In response to Dr Peter M English, we do agree that providing too many details may create ‘unnecessary anxiety’ in patients, and this applies to many aspects of healthcare provision. However, physicians ought to be well versed with the indications, contraindications, adverse effects, alternatives of any treatment proposed in order for patients to make an informed consent. It is therefore imperative to explore your patients’ knowledge regarding HPV vaccination prior to clarification of any doubts or misconceptions that they may have. This article is designed to guide the flow of the conversation, but each discussion should be individualized to your patient’s concerns.

Dr Noel Thomas raises an important point regarding the risk of deaths that have been reported following the administration of HPV vaccines. We do agree that it should be emphasized to patients or parents should they question, that there is no proven linkage between HPV vaccination and mortality following the vaccination. The World Health Organization Global Advisory Committee for Vaccine Safety (GACVS), the UK Medicines and Healthcare Products Regulatory agency (MHRA) and the European Medicines agency have previously reviewed and still continue the surveillance on safety of HPV vaccines.

As discussed in the paper, the published studies regarding the vaccine efficacy are based on the immunogenicity studies and hence it is even more important to highlight to patients the significance of regular cervical cancer screening.

We also recognize the importance of safe sex practices which is out of the scope of this article. As wisely pointed out by Dr JK Anand, careful weightage of the risk profile of your patient is required in order to tailor an individualized discussion with your patients (and their parents) regarding this sensitive topic. Should there be a need for a more thorough discussion, the discussion could, and should stretch more than a 10-minute-consultation. It should be emphasized that while the vaccine is proven to be effective while administered at a younger age, this does not equate encouraging onset of sexual intercourse at an earlier age. Delaying sexual intercourse indeed, does decrease the risk of contracting the infection.

Competing interests: No competing interests

07 July 2017
Yan Ling Quah
Resident Physician
Singapore