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Sunday, May 20, 2018
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What a shame — last in HPV cancer prevention

As a pediatrician I feel that one of my main roles is disease and injury prevention. We spend time at every well visit talking to parents about pool safety, car seats, helmets and child proofing. We talk to teens about safe driving, seat belts, drugs and alcohol. We try to get parents to stop smoking and counsel teens to, hopefully, never start. We have even started trying to prevent adult diseases by checking cholesterol levels in all kids at 10 and 17 years old, and checking patients’ BMIs annually.

But our most successful area of prevention has been in the vaccinations we give our patients. For decades we have been preventing polio, tetanus, whooping cough, diphtheria, measles, mumps and rubella. Since I graduated from medical school 18 years ago, we have added vaccines for chicken pox, rotavirus, hepatitis B, and certain types of meningitis and pneumonia. And now, amazingly, we have a vaccine that prevents cancer: the HPV vaccine.

Given the pediatrician’s huge focus on disease prevention, it is extremely disheartening to me when parents refuse to vaccinate their child. And this happens most commonly with the HPV vaccine. It is difficult for me to understand why a parent would not want to protect their child against cervical cancer, mouth and throat cancers, penile and anal cancers, and genital warts.

Unfortunately, we find misinformation in the media and on the Internet about the safety about the HPV vaccine, and misperceptions from parents that giving the vaccine to their children encourages sexual activity. Some parents also falsely believe that children shouldn’t get the vaccine until they are sexually active.

I recently learned that the state of Florida has the lowest HPV vaccination rate in the country, and not surprisingly one of the highest rates of cervical cancer. A Centers for Disease Control and Prevention report from 2012 showed that the rate of completing all three HPV vaccinations for 13- to 17-year-olds was 33.4 percent for the country and only 25.3 percent for Florida. Compared that to rates in Australia, which has 73 percent completion for its 12- to 13-year-old girls, and Rwanda, where 90 percent of its sixth-grade girls are fully vaccinated.

To be fair, Australia and Rwanda have school-based vaccination programs whereas Americans have to get our kids to the doctor three times due to their busy teen schedules. (Remember that the second shot must be given two months from the first, and the third shot must be four months from the second.) We pediatricians need to be better about reminding parents and not missing opportunities to get teens their HPV vaccines, even if they are not in for a classic “well visit.” But parents also need to make getting their preteens and teens this important vaccine a priority and certainly not refuse to give it to them.

To address the safety concerns, the CDC’s Morbidity and Mortality Weekly Report published the week of July 25 supported that there have been no serious safety concerns linked to the HPV vaccine. The most common side effects are pain, redness and swelling at the injection site, and sometimes dizziness, fainting, nausea and headache. We recently had a teen pass out briefly in our office after his first HPV shot, but we did his second shot of the series lying down and made him wait in our office for 20 minutes and he did just fine.

In the United States, doctors have been giving the HPV vaccine for eight years and have given 67 million doses.

As far as seeing the vaccine as permission for teens to be sexually active or waiting until they are sexually active to give it, the CDC recommends that we give the vaccine at the 11- to 12-year-old well visit, but it can be given to patients as young as 9.

Studies have found that getting the HPV vaccine does not make kids more likely to be sexually active or to start having sex at a younger age. The vaccine provides children with the best protection when given at 11 to 12 years old, before the initiation of sexual activity. I recommend that rather than discussing with an 11-year-old that HPV is a sexually transmitted disease, just let them know it is one more disease that we are protecting them from, like tetanus and meningitis (the other shots that we give at the 11- to 12-year-old visit).

I have very few parents who refuse the Hepatitis B vaccine, which is a three-shot series given in the first year of a baby’s life and also protects against a sexually transmitted disease. Another fact that I think parents don’t realize is that HPV is so common that almost everyone who is not vaccinated will be infected at some point. Most infections are without symptoms, and it is estimated that 79 million Americans are infected with HPV. So waiting until kids are sexually active to give them a vaccine that takes six months to complete for an extremely common disease is not a good plan to protect them.

Personally, I made sure my daughter got all three of her HPV vaccines when she was 12, three years ago. I hope that parents will work together with me to help protect their children against cancers that are now preventable, and to get Florida off the bottom of the list for HPV vaccination rates.

Marcy Solomon Baker, MD, is assistant medical director for pediatrics, BayCare Medical Group, Tampa.

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