Reviewer's report
Title:HPV vaccination in women aged 27 to 45 years: What do general
practitioners think?
Version:2Date:8 May 2014
Reviewer: EMMANUEL ONYEBUCHI O UGWU
Reviewer's report:
HPV vaccination in women aged 27 to 45 years: What do general practitioners
think?
General comments:
I find it difficult to understand the justification for this study and hence the
relevance of the study with regard to the target age group (women between
27-45 years).
Both vaccines (Gardasil and Cervarix) were studied in thousands of people from
9 through 26 years old and found to be safe and effective for these ages. Even
though the vaccine was licenced in Australia for use in women up to 45 years of
age, the vaccine is not licenced in most countries including the United States for
persons over age 26 years, as GARDASIL has not been demonstrated to prevent
HPV-related outcomes in a general population of women and men older than 26
years of age. Thus one wonders the relevance of studying for barriers and/or
facilitators for the delivery/uptake of vaccines in a group of women where the
benefit is not clear.
Even though the authors noted in lines 92-94 that “up to two-thirds of females
aged 24 to 45 years are estimated to potentially be susceptible to all four HPV
types covered in Gardasil®, and that yet very little is known about HPV vaccine
uptake in this population”, the authors should note that the main objective of HPV
vaccination at the younger age (9-26 years) is to build sufficient immunity against
HPV infection before the 24-45 years age range when two-thirds of the female
population are vulnerable to HPV infections.
SPECIFICS:
1. Is the question posed by the authors well defined?
The research question is well defined, however the justification is poor.
2. Are the methods appropriate and well described?
The methodology is not clear. “Letters of invitation were sent to a random sample
of 400 GPs from the 111 Australasian Medical Publishing Company database of
Australian medical practitioners.” What formed the authors’ decision to send
invitation to only 400 GPs to participate in the study? No sample size calculation.
What kind of random sampling was used to select these 400 GPs? Secondly,
only 44 GPs out of the 400 invited to participate in the study agreed to participate
and eventually 24 completed the study. This number (24) cannot in any way be
said to be representative of the GPs in the study population and hence the
conclusion from the study cannot be generalized.
3. Are the data sound?
The method of collection of data was clear; however the presentation of the data
was not clear.
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition?
The way the data was presented in the ‘result section’ whereby the authors
repeatedly presented the individual responses of the respondents in prose
instead of analyzing and summarizing them do not seem to be appropriate. The
repeated use of the term “almost all the GPs”, “most of the GPs”, etc without
stating the actual proportion(s) of the GPs involved may not be appropriate.
5. Are the discussion and conclusions well balanced and adequately supported
by the data?
The discussion is ok but the conclusion does not seem to be appropriate
considering the flaws in the methodology.
6. Are limitations of the work clearly stated?
Yes. However, using limitations to cover up “faulty design” may not be
acceptable in scientific research.
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished?
Yes
8. Do the title and abstract accurately convey what has been found?
Yes
9. Is the writing acceptable?
The presentation and interpretation of data do not seem to be acceptable even
though the authors claim to have done a qualitative survey only.
CONCLUSION
This paper requires ‘Major Compulsory Revisions.’
Level of interest: An article of limited interest
Quality of written English: Needs some language corrections before being
published
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests