A young woman receives one of three shots of the HPV vaccine.
A young woman receives one of three shots of the HPV vaccine. Credit: Courtesy / CDC Public Image Gallery.

Most kids have warts at some point in their lives, usually on their hands or feet. They’re caused by human papilloma viruses (HPVs) and nearly every person will become infected at some point in their lives. But not all HPVs are created equal. There are more than 100 types and most cause no real harm. But there are nine HPV strains definitively linked to various cancers. Two of these strains, 16 and 18, are the most dangerous.

The good news? There’s a vaccine for that. Yes, there is a vaccine to prevent cancer and it’s been around since 2006. The first vaccine included four strains, including 16 and 18, which cause 70% of cervical cancer cases. The latest vaccine, released in 2015, protects against five additional strains.

Although 79 million Americans are currently living with HPV and 14 million new infections occur each year, only 34% of girls in the US aged 13-17 have been fully vaccinated. Only 18% of boys in the U.S. are protected. In San Antonio, only 31% of girls and 15% of boys have completed the vaccination series of three doses. That means the vast majority of our teenagers are at risk for HPV infection and developing cancer.

Most people infected don’t have any symptoms: they are silent carriers and can pass on the virus for years without knowing it. Since women typically do not develop cervical cancer until their 30s or 40s, it’s easy to dismiss the threat of HPV when you’re young. Dr. Lois Ramondetta, of MD Anderson Cancer Center, spoke last week at University Health System’s Robert B. Green Campus to more than 60 health care providers attending the Texas Pediatrics Society HPV Conference. As she shared stories of her cancer patients, ranging in age from early 20s to 50s, it was difficult to not be overcome with sorrow.

Dr. Lois Ramondetta, of the University of Texas MD Anderson Cancer Center and LBJ General Hospital, talks about her young patients with cervical cancer. Photo by Cherise Rohr-Allegrini
Dr. Lois Ramondetta, of the University of Texas MD Anderson Cancer Center and LBJ General Hospital, talks about her young patients with cervical cancer. Photo by Rachel Jew

Some of these young women, many with young kids, won’t live out the year. If you’re on social media, you’ve seen the heartbreaking story of country and bluegrass singer Joey Feek, 40, as she said “Goodbye” to her two-year-old daughter. Joey was diagnosed with cervical cancer in 2014. Though Joey was likely infected before the vaccine became available in 2006, nearly 80% of women are infected by the time they are 26. Many of Ramondetta’s patients are in that target age range for vaccination, nine-26, when the vaccine became available in 2006.

Most of the attention in the press has been focused on cervical cancer, but HPV infection can lead to vulvar, anal, vaginal, penile cancers, and most significantly, oropharyngeal cancer.

“Since 1995, there’s been a huge jump in the number of HPV-related cancers in men,” Ramondetta said.

HPV mostly affects men in their 40s and 50s. More than 15,000 new oral cancer cases were reported in the US in 2015 and 2,793 of these were in Texas.

“If there were a vaccine against cancer, wouldn’t you get it for your kids?” said Dr. Melinda Wharton, acting director for the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control.

Since the vaccine was introduced in 2006, there has been a significant reduction in HPV infection in girls and young women aged 14-19, and more recently in women aged 20-24. The vaccine is working, but not enough people are getting it.

The U.S. lags far behind much of the world in protecting our kids against HPV.
The U.S. lags far behind much of the world in protecting our kids against HPV.

In Rwanda, 99% of the at-risk population has been vaccinated. In the United Kingdom, 86% are protected. In the U.S., less than 40% are vaccinated. Why do we lag so far behind other countries?

Understandably, people worry about anything that is new.

“They wonder if it’s safe,” said Dr. Ryan van Ramhorst, a pediatrician with University Health System. Most of the families he sees at the UHS Southeast Clinic have concerns.

However, the HPV vaccine has been available for 10 years. It’s been studied in tens of thousands of people and is continually monitored by the Centers for Disease Control. The worst reaction is a sore arm. While there has been some concern with teenaged girls fainting, all studies have shown this is not linked to any component of the vaccine.

But my kid is not sexually active, some parents might say.

We worry our teenagers might get in a car accident, but do we stop them from driving cars? No, we teach them how to drive cautiously, responsibly. We require them to take a course, to pass a test. We give them the tools to be safe drivers, to respect their passengers so as to not put them at risk. We instill in them the enormous responsibility of being a safe driver. We insist on seat belts. Importantly, we have a dialogue with our teenagers. Adolescents deserve the same level of education about their sexual health.

Most parents don’t expect their kids to be sexually active, but one day, our kids will become young adults. Most of us want loving and healthy relationships for our children. We want the best health for our children, so of course, we want to prevent them from getting cancer. Studies have found that sexual activity has not increased in girls and women who have been vaccinated.

But why recommend it for 11 year olds? Why not let our children decide for themselves when they’re 18?

For a vaccine to work, you need to have it long before you’re exposed to give it time to produce an adequate response. Since three doses over six months are most effective, it takes time to complete the course. We need to protect our kids early and give them enough time to develop immunity, long before they come into contact with the virus. If you wait until your child is likely to be exposed, it’s too late.

Many parents report that although their son or daughter is in eighth grade, their pediatrician did not recommend the HPV vaccine. Now is the chance for you to educate your provider. The perfect time is when your child is starting middle school, updating their required adult tetanus, diphtheria, and pertussis (Tdap) and meningococcal vaccines.

If there was a vaccine for lung cancer, would you give it to your kids? Or would you say “If I give my kid this vaccine, they’ll start smoking?”

It’s not about the sex. It’s about preventing cancer.

https://rivardreport.wildapricot.org

*Top Image: A young woman receives one of three shots of the HPV vaccine. Photo courtesy CDC public image gallery.

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Cherise Rohr-Allegrini

Cherise Rohr-Allegrini is an infectious disease epidemiologist and consultant. She is currently the San Antonio Program Director for The Immunization Partnership. Dr. Rohr-Allegrini was the Pandemic Flu...