GYNECOLOGIC ONCOLOGY Increasing fear of adverse effects drops intention to vaccinate after the introduction of prophylactic HPV vaccine Alexandros Sotiriadis • Themistoklis Dagklis • Vaia Siamanta • Konstantinos Chatzigeorgiou • Theodoros Agorastos • The LYSISTRATA Study Group Received: 7 June 2011 / Accepted: 31 December 2011 / Published online: 14 January 2012 Ó Springer-Verlag 2012 Abstract Purpose The purpose of this study was (1) to explore for socio-demographic factors that could potentially affect the intention of women to vaccinate themselves, their 13-year- old daughter and their 13-year-old son against HPV, and (2) to investigate the main reasons for declining vaccination. Methods A structured questionnaire was used in partici- pants of the project (N = 5,249). Logistic regression analysis was applied in order to examine the correlation between vaccine acceptability and a list of potential pre- dictors. In women declining vaccination, the reported rea- sons for decline were analyzed. Results Residence in rural areas and low to medium tiers of family income were the most constant factors in favor of intention to vaccinate. Receiving information from a healthcare professional was found to positively affect vaccine acceptability for the woman herself, but it did not affect her intention to vaccinate her daughter or her son. The acceptance rates decreased significantly after the vaccine became available, both for the women themselves and for their daughters or sons. During the same year, a shift was noted in the reason for declining vaccination; the self-perception of insufficient knowledge significantly decreased and the fear of adverse effects significantly increased in all three cases. Conclusion Apart from demographic factors which may favor or disfavor vaccine acceptability, the intention to vaccinate decreased significantly and the proportion of women rejecting vaccination for safety concerns increased significantly after the introduction of the vaccine, coin- ciding with isolated cases of negative publicity and high- lighting the potential of misinformation by the media. Keywords HPV Á HPV vaccine Á Acceptability Introduction The incidence of and mortality from cervical cancer has been greatly reduced after the implementation of organized screening programs [1, 2]. However, cervical cancer is still a problem, especially in developing countries [3], and its high-grade precursors need to be detected, committing healthcare resources and occasionally leading to over- treatment with potentially unwanted effects. The human papillomavirus (HPV) is the necessary cause for cervical cancer and its high-grade precursors [4], and *70% of cervical cancer cases are caused by two HPV types, 16 and 18. Therefore, the introduction of bivalent and quadrivalent prophylactic vaccine against HPV, which are expected to almost completely prevent high-grade preinvasive and invasive disease from the covered HPV types [5, 6], was hailed as a great advancement. A few years after HPV vaccines have become available, most commonly funded by the state, their uptake rates are commonly lower than hoped for. Although high coverage The members of the LYSISTRATA Study Group are listed in ‘‘Appendix’’. Electronic supplementary material The online version of this article (doi:10.1007/s00404-011-2208-z) contains supplementary material, which is available to authorized users. A. Sotiriadis Á T. Dagklis Á V. Siamanta Á K. Chatzigeorgiou Á T. Agorastos (&) Fourth Department of Obstetrics and Gynecology, Ippokration General Hospital, 49 Constantinoupoleos Street, 546 42 Thessaloniki, Greece e-mail: agorast@auth.gr A. Sotiriadis e-mail: asotir@gmail.com 123 Arch Gynecol Obstet (2012) 285:1719–1724 DOI 10.1007/s00404-011-2208-z