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Monday, Sep 24, 2018
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Despite benefits, vaccination rate for HPV remains low in Florida

— When a vaccine for the human papillomavirus was made available in 2006, doctors hailed it as a medical breakthrough. The HPV vaccine helps prevent several forms of cancer, including cervical cancer, a particularly important advance in Florida, which has one of the highest rates of cervical cancer in the country.

Nearly a decade later, the vaccine’s promise is far from fulfilled.

Vaccination rates remain low nationally, with Florida near the bottom. According to 2013 statistics, 50 percent of girls ages 13 to 17 in Florida had received the first dose of the vaccine, which is given in a three-dose regimen. Only 34 percent of girls in the state had completed all three doses.

For Florida boys age 13 to 17, 29 percent had received the first dose in Florida, and only 13 percent had received all three doses.

The medical community, including Moffitt Cancer Center in Tampa, is working hard to dramatically raise those rates in the next five years, to an 80 percent rate in both girls and boys for all three doses.

One tactic: More of an emphasis on HPV as a vital tool in preventing cancer, and less emphasis on sex.

The vaccine does target cancers that are transmitted through sexual activity, a connection that has turned off some parents who were concerned vaccinating their children was tantamount to telling their children it was OK to have sex.

“It was put forth very much in the popular press as a vaccine against a sexually transmitted infection rather than how we should be presenting this vaccine, which is a vaccine against cancers of many different types which are associated with HPV,” said Susan Vadaparampil, senior member at the Moffitt Cancer Center’s Division of Population Science.

Some pediatricians and family doctors haven’t done a good enough job of reaching out to their patients and their parents to convince them of the safety and the benefits of the vaccine, said Debbie Saslow, the director of the Breast and Gynecologic Cancer for the American Cancer Society.

The HPV vaccine helps prevent cervical, vaginal and vulvar cancer in females and penile cancer in males. The vaccine can prevent anal and mouth and throat cancer in both males and females.

“There is a disconnect with the public, but there’s a bigger disconnect with the providers,” Saslow said.

Pediatricians know the childhood diseases, such as mumps, measles and chickenpox, Saslow said. But the HPV virus doesn’t manifest into cancer until a person is an adult.

“They (pediatricians) have the ability to prevent cancer in these kids, but the cancer is not happening until the kids are adults,” Saslow said. “So there is that disconnect.”

The Centers for Disease Control and Prevention recommends giving the vaccine as early as age 11 or 12 so the recepient has time to develop an immune response before becoming sexually active, but because the virus doesn’t become cancer until adulthood, pediatricians and patients may think that inoculating the child with the HPV vaccine can wait, Saslow said.

“They view the HPV vaccine as either optional or something that can wait another year or two or three,” Saslow said.

There are other barriers that prevent the conversation about HPV vaccine between doctor and patient, experts said.

“There are a lot of competing demands for a provider’s attention,” Vadaparampil said. “There are many things that are mandatory or must be done that have to, in essence, take priority over recommending the vaccine.”

Gene Hiben, a Florida pediatrician for 20 years who is based in Temple Terrace, said he has had parents take their child out of his practice when he brings up the HPV vaccine.

“From my side of the table, sometimes there are certain communities or certain populations that are just flat out, ‘No way, no how, you’re never going to do this to my kid,’” Hiben said. “You run the risk (of upsetting) them to bring it up to them. If every time somebody is in with their kid I’m pushing HPV vaccine, it will make people uncomfortable enough that they will go elsewhere. There are certain populations that you might back off just a little bit. They’re not going to give in on this one, so you don’t even mention it anymore.”

Overall, Hiben said, it is getting easier to discuss the topic than when the vaccine was first introduced. Hiben said most parents of the patients he sees now are willing to have their child receive the HPV vaccine.

The Moffitt Cancer Center has received a grant from the National Cancer Institute to help improve the state’s HPV vaccination rate. The Moffitt Cancer Center hosted a conference earlier this month with health experts from throughout the country to address HPV, and the center has created a group, Partnership to Immunize Teens and Children Against HVP or PITCH, to create a strategy to increase HVP vaccination rates, Vadaparampil said.

“HPV is a very common sexually transmitted infection,” Vadaparampil said. “The estimates are that at some point in their lifetime 80 percent of people will have had an HPV infection. Those folks where the infection remains and they don’t clear it, there’s the potential to develop HPV-related cancers.”

The vaccine is recommended for females ages 9 up to 26 and for males ages nine up to 21. The target age to get vaccinated, however, is 11 to 12 years old for both males and females because the vaccine is most effective at that age, Vadaparampil and Saslow said.

The vaccine is administered in a series of three doses given within six months. The cost for each dose is about $130. Most insurance plans cover the vaccine shots. For children who are under insured or have no insurance, there is assistance through government plans, such as the Vaccines for Children Program, Vadaparampil said the goal of having 80 percent of adolescent boys and girls receive all three doses by 2020 is ambitious but doable.

“We have a lot of work to do in a relatively short amount of time,” Vadaparampil said.

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