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Vaccine. 2017 Jul 24;35(33):4213-4219. doi: 10.1016/j.vaccine.2017.06.029. Epub 2017 Jun 21.

The number of injected same-day preschool vaccines relates to preadolescent needle fear and HPV uptake.

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Medical College of Georgia, Department of Emergency Medicine, Augusta, GA, USA. Electronic address:
Georgia State University, Department of Psychology, Atlanta, GA, USA. Electronic address:
Case Western Reserve University, Cleveland, OH, USA. Electronic address:
Pediatric Emergency Medicine Associates, Atlanta, GA, USA. Electronic address:
Kennesaw State University, Department of Statistics and Analytical Sciences, Kennesaw, GA, USA. Electronic address:



Fear of needles develops at approximately five years of age, and decreases compliance with healthcare. We sought to examine the relationship of preschool vaccine history, parent and preadolescent needle fear, and subsequent compliance with optional vaccines.


As part of a private practice randomized controlled trial, parents and 10-12year olds rated needle anxiety on a 100mm visual analog scale. This follow-up cohort study compared their needle anxiety to previous vaccination records, including number of vaccinations between ages four and six years (total and same-day maximum), and subsequent initiation of the HPV vaccine through age 13.


Of the 120 preadolescents enrolled between 4.28.09 and 1.19.2010, 117 received preschool vaccinations between ages four and six years. The likelihood of being in the upper quartile of fear (VAS≥83) five years later increased with each additional same-day injection (OR=3.108, p=0.0100 95%CI=1.311, 7.367), but was not related to total lifetime or total four-to-six year injections. Only 12.5% (15) of parents reported anxiety about their preadolescents' vaccines (VAS>50). Parent and child anxiety was weakly correlated (r=0.15). Eight children in the upper fear quartile began their HPV series (26.67%) compared to 14 in the lower quartile (48.28% VAS<32) (OR 2.57, p=0.0889, 95%CI 0.864-7.621); there was no difference in HPV uptake between upper and lower quartile of parent anxiety.


The more same-day preschool injections between 4 and 6years of age, the more likely a child was to fear needles five years later. Preadolescent needle fear was a stronger predictor than parent vaccine anxiety of subsequent HPV vaccine uptake.


Adherence; HPV; Needle fear; Pain; Vaccine Hesitancy; phobia

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