Dr. Alix Casler is medical director of outpatient pediatrics for Orlando Health Physician Associates, assistant clinical professor of pediatrics for the UCF and FSU Colleges of Medicine, and a consultant for Merck and Sanofi Pasteur. (Editor's note: Neither Merck nor Sanofi Pasteur sell an HPV vaccine in the U.S. market). Casler contributed this column to Live Science's Expert Voices: Op-Ed & Insights.
Before the introduction of the measles vaccine in 1963, nearly 4 million people in the United States were diagnosed with the disease each year, according to the U.S. Centers for Disease Control and Prevention (CDC). The agency reports that in 2015 there have been fewer than 200 cases across the country. Prior to the introduction of the Haemophilus Influenza type B (HIB) vaccine in 1990, one in every 200 children in the United States suffered from invasive HIB diseases such as meningitis, bone and joint infections, and epiglottitis. Now, the HIB vaccine prevents about 12,000 cases of disease each year, with minimal or no side effects. As a result of immunization, smallpox has been eliminated worldwide, and there are hopes that the same will be said for polio by 2020.
Like seat belts and bike helmets, vaccinations make sense. They are simple and safe. And yet, despite these facts, immunization rates for one of the nation's deadliest diseases remain low in the United States.
Bringing an end to HPV
Human papillomavirus (HPV) is known to cause at least 26,000 cases of cancer every year in the United States — 18,000 cases in women and 8,000 in men, according to the CDC. In 2006, several vaccines were licensed to prevent most of these cancers, as well as venereal warts (most common in girls ages 10 to 14 and boys ages 25 to 29). Initially, the HPV vaccine was recommended only for girls because they tended to be the victims of more HPV-related cancers, but the vaccine became recommended for boys only a few years later .
The CDC recommends HPV immunization for all boys and girls ages 11 to 12, well before there is any risk of exposure. This age was deemed the best time to immunize based upon data on age of sexual debut from the National Survey on Family Growth, as well as data on vaccine response, including duration of immunity. This is the same time in life that we immunize against diphtheria, pertussis (whooping cough), tetanus and meningitis. Three of those four diseases are rare — compared to HPV, which is exceedingly common.
Almost every sexually active person will contract HPV at least once in their lives. Fortunately, most HPV infection is cleared by the immune system without long-term consequences. But, an unfortunate few go on to develop the devastating disease:
CDC data reveal that between 2006 and 2010, the average number of cancer cases caused by HPV in the United States were 10,400 for cervical, 4,000 for anal, 9000 for oral, 700 for penile, 600 for vaginal, and 2,200 for vulvar cancers.
Still, among U.S. teens, the immunization rate against HPV, which can cause common and aggressive cancers, is very low . As of 2013, less than half of all teens had received even one dose of an HPV vaccine.
Currently, only 24 percent of young people ages 11 to 12 have been given a single dose, despite the fact that vaccine efficacy is nearly 100 percent for prevention of cervical cancers and pre-cancers caused by the specific HPV types covered by the vaccine, and 75 percent effective in preventing anal cancers caused by those types. As a pediatrician, whose sole job is to deliver my patients into adulthood as healthy as they can be, this is a sad fact. Improving immunization rates among young people in our country has now become a personal mission.
Get past the stigma
HPV can be hard for parents to think about because most cases of the virus are transmitted by some form of sexual contact. There are rare and unfortunate cases of transmission to an infant from mother during the birth process, leading to infection of the vocal cords, but by far, most HPV is transmitted by some form of skin-to-skin contact, whether it be intercourse, other forms of genital contact, or oral sex.
The simple fact is that, as much as parents don't want to think about their youngsters becoming sexual beings, it's inevitable. Parents should want their children to grow up and have families, so acknowledging that they may one day contract HPV is our responsibility.
One major reason for low rates of HPV immunization is that people often receive misinformation about the vaccine. Getting a vaccine is less risky than driving across town in a car, cheering in a competition or playing a football game. Vaccines are safe, effective and easy.
Although they can result in some side effects, severe responses such as allergic reactions or neurologic complications occur in fewer than one in a million doses of our current vaccines. Moreover, those side effects have specific causes.
For example, if a patient has a latex allergy, there are certain vaccines with latex in the packaging that should be avoided. Patients with yeast allergies should avoid vaccines that contain yeast. Patients with asthma may have an episode of bronchospasm associated with getting a vaccine.
Specific data on the HPV vaccine indicates that it has been associated with fainting (many teens hold their breath and then faint after vaccination in general), though there have been otherwise no serious side effects associated with the vaccine. The U.S. Food and Drug Administration (FDA)-mandated package insert for all vaccines includes all of this data in detailed form for anyone who is interested in reviewing it.
The health consequences associated with not immunizing far outweigh the true risks of receiving a vaccine.
Raising the rates
In 2013, our pediatric group at Physician Associates Orlando Health looked at our HPV immunization rates. We were displeased with our performance. Our rates were on a par with the state of Florida average rate of immunization (among the lowest in the United States), meaning that we were leaving hundreds of our patients vulnerable to preventable cancer later in life. We set about to fix that. We re-educated ourselves and all of our staff about HPV disease and the importance of immunization according to the CDC's guidelines. And we all learned to listen to parents, answer their questions and offer valid information so that families understand the value of this vaccine in protecting their children from certain types of cancer.
HPV vaccines are given as three separate shots, delivered over a six-month period. This schedule alone can prevent patients from receiving the vaccinations. So we developed scheduling and call-back systems to make it easier for families to ensure that their children not only start, but complete, the series.
Our doctors and nurses are all on the same page now, making it our goal to assess our patients' immunization status at every office visit, and to offer any needed vaccines regardless of why a child has come to see us. We stress to patients and parents that the vaccine offers the best protection to girls and boys who receive all three doses at age 11 or 12, per experts' recommendations.
As a result of our efforts, our patient population of just fewer than 18,000 teens is better protected against HPV disease. Over 16 months, our "series start rates" (patients 11 to 12 years old who have had at least their first dose of the HPV vaccine) have increased from a dismal 20 percent or so to more than 50 percent for our patients ages 11 to 12, with some of our partners exceeding a 70 percent immunization rate. National immunization rates for this same age group remain at about 24 percent.
The success of our immunization project shows the power of awareness and education. As pediatricians and parents, we share the common goal of delivering our community's children into adulthood with the greatest possible health. If your teen or preteen has not yet started the HPV immunization series, please make it a priority for your next visit to his or her doctor.
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