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Thursday, October 15, 2015

The HPV Vaccine: Why Aren’t Our Kids Getting It?

Posted By: Advancing Care

Reader Poll: Has your child been vaccinated against HPV?

There’s a shot that preteens can receive that can prevent them from getting several types of cancer someday. But, surprisingly, many parents aren’t racing to their pediatricians to get it, and many pediatricians aren’t mentioning it at all.

Sheila Nolan, MD, is working to change that.

In February, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices recommended Gardasil 9 as one of three human papillomavirus vaccines that can be used in routine vaccination for children ages 11 or 12. The 9-valent HPV vaccine protects against five more strains of HPV than the last version, which covered four. Trial results show the three-dose vaccine series administered to preteen girls prevents 99 percent of cervical pre-cancers, according to the committee’s Morbidity and Mortality Weekly Report released March 27.

“It really is a very important vaccine,” says Dr. Nolan, Chief of Pediatric Infectious Diseases at Maria Fareri Children’s Hospital, a member of the Westchester Medical Center Health Network. “Why would you let your children get cancer if you had a way to prevent it?”

Well, any issue involving sex and children is a sensitive one.

As the most common sexually transmitted disease in the United States, HPV infects more than half of American men and women—14 million every year—at some time in their lives, according to the CDC. Most infected people have no symptoms of HPV and, subsequently, don’t realize they have it, according to the Immunization Action Coalition. While most HPV infections don’t lead to cancer, the coalition estimates 29,600 HPV-associated cancers do occur annually in the US, including about 9,300 HPV-associated cancers in men.

The Gardasil 9 vaccine fights HPV strains that cause cervical, vulvar, vaginal, penile, throat, and anal cancers, as well as genital warts.

Women are more at risk, but only 35 to 40 percent of female teens are getting the shots, Nolan says. “The uptake of this vaccine is pretty low compared to other vaccines,” she says, indicating vaccines for measles and mumps. “The reasons are generally unfounded.”

The Kaiser Family Foundation, a national health policy research nonprofit group, lists the reasons parents are resisting. Among them: a lack of knowledge about the vaccine; concerns about the vaccine’s safety and side effects; their doctors didn’t recommend the vaccine; and their adolescent isn’t sexually active.

Cervical cancer doesn’t usually show up until women are in their 20s or later, so “it’s not seen as an immediate threat,” Nolan says.

Parents can be squeamish about their children receiving an STD shot years before they believe their children will be sexually active, yet the vaccine is most effective when given in the preteen years.

“A lot of pediatricians aren’t comfortable bringing up the discussion of sexual debut and STDs, especially with both parents and children present,” Nolan says. Opponents say the vaccine can encourage promiscuity by providing a false sense of security. But the vaccine only prevents infection by certain strains of HPV, it doesn’t protect against HIV or other STDs.

Others fear the vaccines haven’t been around long enough to be safe, but the CDC reports no serious side effects. The vaccine is especially safe because it’s made from a viral-like protein, the shell of the virus, Nolan says. It doesn’t replicate in the body like measles, rubella and mumps vaccines do.

Some people worry about losing parental autonomy over their child’s healthcare. For example, Washington, DC, and Virginia require the vaccine for girls to enter the sixth grade. (New York State does not require the vaccine.)

Vicki Iannotti, MD, Associate Chief, Section of General Pediatrics and Pediatric Hospitalist at Maria Fareri Children’s Hospital, is the primary investigator for a CDC-funded project aimed at bumping up those low uptake rates. “The goal of the project is to improve adolescent immunization delivery,” Iannotti says, “specifically looking at [the] HPV vaccine.” Beginning in the spring of 2014, the project involves 31 centers nationwide, including Maria Fareri Children’s Hospital patients.

“The HPV vaccine is an amazing scientific breakthrough: a vaccine that literally prevents cancer,” states Dr. Nolan. “In this country, we spend so much time, money and effort fighting cancer, but this vaccine is an incredibly safe and effective method that prevents HPV–associated cancers. The choice to vaccinate and prevent cancer seems a simple one to me.” •