Knowledge towards Human Papilloma Virus (HPV) Infection and Attitude towards Its Vaccine in the Kingdom of Bahrain: Cross-sectional Study

"...findings demonstrate the need to provide education to the Bahraini community about HPV infection and the role of HPV vaccine."

In 2008, Abu Dhabi became the first city in the Middle East to introduce the human papillomavirus (HPV) vaccine; as of the time of this writing, it was still available only in some private hospitals in Bahrain. The aim of this study was to provide insights on the knowledge status of HPV infection in the Bahraini society and their attitudes towards the HPV vaccine. The hope is that the study can aid communication between health policymakers as they discuss including HPV vaccine in the national immunisation schedule.

A cross-sectional study was conducted in the Kingdom of Bahrain in February 2018 among 408 men and women aged 18-65 years attending primary healthcare centres. Select findings:

• Only 13.5% (55) of those interviewed had heard of HPV infection, with media being the most common source of knowledge (45.5%, n=25). The two variables that had a significant association with awareness of HPV were female gender and employment in the health sector. Of those who had heard of HPV, 39 (70.9%) identified HPV to be a sexually transmitted infection (STI). When asked if both men and women were infected by the virus, the majority (80%, n=44) answered correctly.
• More than half of the study sample (60%, 244) thought that the vaccine was safe, but 83.6% (341) wanted to be reassured that the vaccine will protect against HPV. When asked about their greatest concern about the vaccine, approximately half of the study population were concerned about side effects (n=198, 48.5%) rather than efficacy and cost (n=122, 29.9%, and n=50, 12.3%, respectively).
• The majority of the participants believed that both genders should be vaccinated (84.8%, 346). However, they were divided in agreement over other issues. While 41.7% (170) believed that the vaccine should be administered before marriage, 34.1% (139) preferred it to be given at school age. While 38.5% (157) believed that vaccination should be a joint decision between parents and the young person, 33.6% (137) thought that it should be decided by the individual.
• Seventy-six percent (313) of the participants showed willingness to take the vaccine if recommended.
• All participants (100%) thought that people need information about HPV infection. More than 90% agreed on providing information to adolescents about HPV infection, health sequelae, and prevention, as well as educating the community as part of a reproductive health programme.

Overall, the findings showed poor awareness of HPV, which is not surprising, considering the lack of public education regarding the virus and the absence of HPV vaccination in the national immunisation schedule. Women were significantly more aware of HPV infection than men in the study (17.9% vs 5%, respectively). One possible reason for this could be the association of the virus with cervical cancer. In addition, the presence of screening programmes such as pap smears could have played a role also in educating women regarding the virus. Poor awareness in men may pose a particular challenge as and when HPV vaccination for men becomes available.

Although demonstrating low knowledge of HPV, the study population showed positive attitudes towards receiving the HPV vaccine. Generally, in Bahrain, vaccine coverage reached almost 100% for routine childhood vaccines as of 2016 reports.

The researchers conclude: "With the prevalence of immigration and the influx of Arab refugees into the Western world, our study can help familiarise physicians abroad with Arab immigrants' background about HPV infection and vaccine. This can aid physicians in using a tailored approach when dealing with such patients."