, 2012). The findings

presented above may reassure parents and providers who are reluctant to vaccinate due to concerns about risk compensation. However, as noted by Stupiansky and Zimet (2013), “… it is important to remember that risk compensation (real or imagined) is see more not a rationale for withholding vaccine. Instead, it is a rationale for ensuring adequate education both pre- and post-vaccination” (p. 262). Underlying some parental HPV vaccine concerns (e.g., feeling that HPV vaccine is too new) are questions about vaccine safety (Fisher, 2012; Krawczyk et al., unpublished results). Fear-inducing news stories may have contributed to these concerns as they sometimes have misreported Vaccine Adverse Event Reporting System data, incorrectly suggesting that HPV vaccination has often led to severe adverse health effects, including death (see, for example the August, 2007 edition of Maclean’s magazine in Canada; Gulli, 2007). Numerous large-scale studies on HPV vaccine safety have been published and show little or no evidence of severe side-effects associated with vaccination

(Agorastos et al., 2009, Chao et al., 2012, Gee et al., 2011, Klein et al., 2012 and Lu et al., 2011). BIBF1120 The most frequently reported side-effects are similar to those reported with other vaccines and are transient events, such as mild pain and bruising at the injection site, faintness, and syncope (Naleway et al., 2012). It is important to highlight that a reported adverse event after vaccination does not automatically mean that it was caused by the vaccine. A major challenge, however, is how to effectively communicate to parents the evidence that HPV vaccine is quite safe. As noted following, an additional challenge involves communicating below the very substantial risks of non-vaccination, in the context of generalized, relatively early, sexual debut, delayed marriage, serial monogamy, and the accumulation of risk of HPV infection over

time. Development of effective strategies for clearly and accurately communicating information about risk of vaccines has been an enduring focus of vaccine researchers (Ball et al., 1998, Betsch and Sachse, 2013, Davis et al., 2001 and Offit and Coffin, 2003). Best practices in this regard may rest on the nature of the vaccine (routine versus elective), the controversies that may surround the vaccine (e.g., MMR and autism, HPV and risk compensation), and, importantly, whether parents or patients harbor ongoing concerns about HPV vaccine safety, actively ask about vaccine safety, or have no concerns in this area. Suggestions for communication about HPV vaccine safety include asking patients whether they have any questions about the vaccine and providing accurate information (including credible websites) that can address concerns about safety.