The HPV Vaccine
The first widely recommended cancer vaccine for teens and tweens has received a mixed response from families, with only about half of parents in North Carolina immunizing their kids. Vaccination rates for human papillomavirus (HPV), the virus responsible for most cervical cancers, are lagging behind the rates for two other vaccines for adolescents, according to data from the Centers for Disease Control and Prevention.
Immunization rates for Tdap, which protects against tetanus, diphtheria and pertussis, and MenACWY, which protects against meningococcal meningitis, are increasing, but vaccination rates for the HPV vaccine remain low, the study found. In North Carolina, approximately 52 percent of teens ages 13-17 have had the vaccine, according to a 2010 National Immunization Survey. Coverage for teens overall across the country is 64 percent.
Why are parents hesitant to take advantage of a vaccine that protects their daughters from a deadly cancer and has now been recommended for boys as well?
Experts say the topic has become an emotional lightning rod rather than a medical issue because parents don't want to think of their teenage daughter being involved in sexual activity and may consider the vaccine as implicitly giving the parental green light for sex.
"I think it's a natural response for parents," says Dr. Kathleen Barry, a pediatrician at Twin City Pediatrics in Winston-Salem. "It's hard to think of your 11-year-old being sexually active, but the reality is that vaccinating them early on protects them down the road."
The far-off possibility of preventing a cervical cancer could be an additional hurdle for parents, especially when other tests, such as PAP smears, already offer screening for the disease.
Some parents, such as Teri Haddon of Cary, intend to vaccinate children, but just haven't done so yet, particularly since the recommendation that includes boys just came out last year. Haddon, a mother of four children who range in age from 12 to 18, says all of her children will most likely receive the vaccine in the future.
"My daughter will probably receive her vaccine sometime this year," Haddon says. "I haven't given a lot of thought to the boys yet because those guidelines are fairly recent, but they will most likely be immunized."
Haddon feels the benefits of the vaccines for preteens outweigh the risks. The flu vaccine is the only immunization her family doesn't always receive.
About the HPV Vaccine
HPV offers immunity to the virus that most often causes cervical cancer, a disease that results in nearly 4,000 deaths in women each year in this country. At least 50 percent of sexually active women and men will get HPV.
According to the CDC, about 15,000 HPV-associated cancers in the U.S. may be prevented each year by vaccines in women and 7,000 HPV-associated cancers by vaccines each year in men.
In 2006, the Advisory Committee on Immunization Practices of the CDC recommended that girls and young women ages 11 to 26 should be vaccinated. Girls can be vaccinated as young as age 9. In October 2011, the same committee recommended the vaccine for boys. The vaccine is available as Cervarix and Gardasil.
The vaccine also protects against oral HPV as well as cervical cancer. A study released in January by the Journal of the American Medical Association (JAMA) shows an estimated 7 percent of American teens and adults carry HPV in their mouths. This may account for the increased rates of mouth and throat cancer in the past 25 years. Oral sex is a culprit in the spread of the virus.
The HPV vaccine does not protect against all HPV strains, just the main cancer-causing agents.
Evaluating the Vaccine
The most common side effects of the HPV vaccine are soreness at the injection site, fever, headache and fainting. Serious side effects are not common. As of June 2011, 8 percent of adverse effects following Gardasil vaccination in the U.S. were considered serious. For Cervarix, 3 percent were considered serious.
According to a study in the August 2009 issue of JAMA, more fainting and blood clots are associated with the HPV vaccine than with other vaccines given to females of the same age. There also were two reports of unusual neurological illness (Lou Gehrig's Disease) that resulted in the death of two young women. There is no current evidence suggesting that the HPV vaccine caused these illnesses, but researchers continue to study these cases.
Pregnant women should not receive the vaccine.
Eileen Dunne, a medical epidemiologist at the CDC, says the HPV vaccine is safe for the general population and believes that vaccination rates will continue to increase.
"This vaccine is a really effective and safe vaccine," Dunne says. "Although the use has not been as high as predicted, it is still increasing. With time and more understanding of the nature of the vaccine and the safety and the benefits, I think all of that will help parents be more comfortable."
Mixed Response to the Vaccine
Physicians across the state say the acceptance rate for the vaccine is mixed, and many parents have questions about the new recommendations.
"This is the vaccine that I spend by far the most time discussing with parents, and frankly, the one that I have the most parents actually refuse to vaccinate," says Dr. Noelle Robertson, a family practitioner at Carolina Family Practice and Sports Medicine in Cary. Although disappointed by the slow response to the vaccine, Robertson believes the vaccination rates will continue to increase.
"As time goes on and the vaccine becomes more accepted, I think more of both boys and girls will be vaccinated," Robertson says. The mother of a 5-year old girl, Robertson says her daughter will definitely get the vaccine when she is old enough.
"What I try to get across [to parents] is that the vaccine is most effective before children are sexually activity and exposed to the virus," Robertson says.
Dr. Mark Collins of Cotswold Medical Clinic at the Arboretum in Charlotte says the HPV vaccine is "the most talked about, controversial vaccine" he has dealt with in his career. "Parents of 11- to 12-year-olds who are deciding against this are asking if they can wait a few years," he says. Collins tells parents waiting is certainly an option, but reminds them that the best protection is when the vaccine is given prior to the onset of sexual activity.
"It has had some controversy associated with it," Collins says of the vaccine, "but as the father of four — three girls and a son — and as a physician who treats lots of preteens, I think it is a good and valid vaccine that we need to make part of the regimen."
Scientists expect immunity to last 10 years or more, but they can't be certain. A booster shot down the road may be necessary. Obviously, abstinence provides a sure means of protection. At age 15, only 13 percent of teens have had sex, according to the Guttmacher Institute, an institute focused on advancing sexual and reproductive health through research, policy analysis and public education. The average age for sexual activity is 17.
Schools Help Spread the Word
North Carolina is one of dozens of states that requires parents of children in grades five through 12 be educated about the HPV vaccine, and it is part of the N.C. Standard Course of Study. In Guilford County, HPV education is part of middle-school and high-school health classes, and parents are given the opportunity to review materials in advance. Some schools, such as Wake County Public School System, send phone messages to parents of children in grades five through 12 telling parents where they can find additional information. Information is also posted on many school websites.
If parents so choose, these educational campaigns can lead to more general discussions about reproductive health, as well as conversations about a family's moral and ethical views. As for the HPV vaccine itself, only time will tell the full benefits of this groundbreaking immunization strategy in the fight against cancer. The best advice for parents is to stay abreast of new information about this vaccine and discuss concerns with physicians.
Facts About the HPV Vaccine
What is the HPV vaccine?
Cervarix and Gardasil are the two current vaccines. Either vaccine protects against cervical cancer. Gardasil also protects against most genital warts. The vaccine is recommended for both girls and boys ages 11-12.
What is the vaccine schedule?
The CDC recommends three shots over six months.
Why is HPV vaccine recommended at age 11 or 12?
It is most effective to get three shots long before any sexual activity with another person. It is possible to be infected with HPV from a single sexual intercourse. The immune response is stronger at this age compared to older ages.
Why the new recommendations for boys?
Vaccinating boys prevents the spread of HPV in the entire population and prevents genital warts, which can affect one in 100 sexually active adults in the U.S. at any given time.
Will vaccinated women still need preventive testing?
Yes. Women will still need screening tests such as PAP smears. Physicians expect less need for follow-up tests due to a lower incidence of HPV-related cancers.
Do insurance companies cover the vaccine?
Yes, most do.
What are the potential side effects?
Soreness or redness at the vaccination site is most common. Fever and headaches have been reported. Fainting also has been reported, but physicians attribute this to the population they are vaccinating.
Source: U.S. Centers for Disease Control and Prevention
Recommended Immunizations for Teens and Tweens
Many teens and preteens miss vaccinations because of busy schedules. Some teens also are on a "catch-up" schedule for a vaccine that prevents foodborne hepatitis.
HPV was recommended for girls in 2006 and boys in 2011. The meningococcal vaccine was recommended in 2005, and many colleges now require that teens have this vaccination.
If you are the parent of a teen or preteen and you feel like every time you turn around there is another shot on the horizon, you aren't that far from the truth these days!
Vaccination Recommendations for Children Ages 11-12 Years
Tdap — diptheria, tetanus and pertussis (one dose)HPV — Human papillomavirus (three doses in six months)Meningococcal Conjugate Vaccine (MCV4) — Meningococcal vaccine for meningitis (one dose)Influenza — Flu vaccine (annually)
Source: U.S. Centers for Disease Control and Prevention
Carol McGarrahan is a freelance writer and editor based in the Triangle who writes about health and science.