Taking aim at a preventable cancer

Texas vaccination rates among adolescents against the human papilloma virus are lower than the national average, and vaccination rates in Bexar County are lower than the state average, experts said at a conference held by the Texas Pediatric Society at University Health System’s Robert B. Green Campus.

“HPV vaccine is about preventing cancer,” said Dr. Ryan Van Ramshorst, a pediatrician with Community Medicine Associates, the physician practice of University Health System. “Vaccines are one of the most important things I can do as a pediatrician to keep kids safe and healthy. Any chance that I have to prevent cancer, I will take!”

Human papillomavirus, or HPV, is the most common sexually transmitted virus in the United States. A vaccine exists that can reduce the risk of these cancers, but only if given before a person is infected. However, HPV vaccination rates are much lower than other routinely recommended adolescent vaccines.

The Texas Pediatric Society sponsored the meeting to help healthcare professionals understand HPV-related cancers, vaccine recommendations, and how to communicate with parents who often get conflicting — and erroneous — information about the vaccine.

Dr. Melinda Wharton, acting director for the National Center for Immunization and Respiratory Diseases with the Centers for Disease Control and Prevention, told attendees about the staggering numbers of people in the United States with HPV. An estimated 79 million are infected and about 14 million more will contract it each year. Many of them will never know they had the virus, and often it will clear the system without symptoms.

A national effort to vaccinate girls began in 2006, and later included boys, Dr. Wharton noted. The effort has fallen short, she said, and even so the age groups who were targeted for vaccination showed a dramatic decline in HPV infection rates. The infection rate in young women ages 14-19 dropped 56 percent, with no change in the rates in other age groups that were not targeted for vaccination.

“We still don’t have the coverage we need,” she said, “but that’s amazing.”

In 2014, she said, 60 percent girls in the United States had received at least one dose. In Texas the average was 51 percent, and in Bexar County it was 48 percent. The percentages of girls who had received the complete round of three doses was lower at 40, 34 and 31 percent.

For boys it’s even lower. In 2014 the national average for one dose was 42 percent, state was 37 percent and county was 36 percent. The percentage of boys receiving the complete three doses was 22 percent, 18 percent and 15 percent.

Healthcare providers are part of the problem, Dr. Wharton said.

Healthcare providers should recommend HPV vaccine the same way they do other preteen vaccines, Dr. Wharton said, and they aren’t doing this. Providers tend to underestimate parents’ willingness to accept the vaccines, and they often use language downplaying it, with terms like “optional” and “it can wait”.

Because HPV is associated with sexual activity, many parents are uncomfortable about considering the vaccine for their children at the age it is recommended. Other factors include misinformation regarding safety and rumored side effects like infertility – none of which have been substantiated, Dr. Van Ramshorst said.

“We have 10-plus years of safety monitoring data that show that HPV vaccine is safe and effective,” he said.

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