Can your child wait until college to get the HPV vaccine?
Posted May 1
With more than 40 percent of American adults infected with some strain of HPV, a virus that can cause genital warts and increase the risk of some types of cancer, health officials continue urging parents to have their children vaccinated at age 11 or 12.
However, the push to vaccinate for human papillomavirus makes many parents uncomfortable, and not just the people known as anti-vaxxers. Utah, in particular, has one of the lowest HPV vaccination rates in the nation.
Some people see giving the vaccine as an endorsement of premarital sex, akin to handing out condoms to middle-schoolers: Why do it, if your teens aren't sexually active, and you don't want them to be?
Enter the University of Utah, which recently received an award for increasing its HPV vaccination rates among male students.
The school's efforts raise a question: Could letting your kids wait until college to get the series of shots be an option for families who want the best health care for their children but not at the cost of their values?
The answer from federal health officials is, no. They cite rates of infection among Americans aged 18 to 59 to bolster their case.
In data recently released by the Centers for Disease Control and Prevention, 45.2 percent of American men and 39.9 percent of women carried some strain of genital HPV between 2013-2014, with the highest rates among African-Americans.
It's notable, however, that the infection rates decline markedly when the most serious strains of HPV are separated from the comparably benign.
Between 2011 and 2014, 4 percent of Americans were infected with the types of HPV that the CDC deems high risk because of their association with cervical, anal and other types of deadly cancers.
The number drops even lower when confined to women; just 1.4 percent were infected with a high-risk strain of HPV. Moreover, 90 percent of HPV infections resolve on their own within a few years, often without symptoms, according to the CDC.
Parents who are on the fence about the shot might decide against having their children vaccinated after seeing those statistics. But federal health officials believe the shots are so important that they've set a goal of having 80 percent of young people vaccinated by 2020. Here's what parents should know.
The power of reminder
According to the CDC, 75 percent of sexually active people catch one or more strains of HPV, most often when they are teens or young adults. Once you’re exposed, the vaccine doesn’t help, which is why the shots aren’t recommended after the time window closes: age 26 for females and high-risk males, age 21 for low-risk young men.
Low vaccination rates, both worldwide and in the US, are attributed in part to the way the vaccine is given. Until recently, protection required three shots: the second one coming two months after the first, the third one six months later.
The CDC announced last fall, however, that only two shots, given six months part, are necessary for adolescents up to age 14.
The university’s Student Health Center is still giving the shots as a series of three, and Suzanne Martin, a family nurse practitioner and assistant professor, said that even if several years have passed since a teen received the first vaccination, he or she can receive the follow-up shots at any point until the time window closes.
Martin's efforts, and those of her colleagues, are why the university's Student Health Center recently won the Bernard A. Kershner Award for innovations in quality improvement from the Accreditation Association for Ambulatory Health Care.
When Martin and her team first assessed inoculation rates among young men coming to the Student Health Center, they found that just 5.2 percent had received the vaccine.
In an effort to boost the numbers, they began using automated alerts. When male students visited the center, they were asked about their HPV vaccination history, and if they needed the shots, an alert would be set up in their electronic medical records to remind all health-care providers in the system to discuss the vaccination with the men during future visits.
In addition, staff members were trained on how to respond to the alert, and how to field questions from patients.
After implementing the program, the rate jumped to 25.1 percent, 5 percent more than the team's goal. “We’re pretty pleased with ourselves,” Martin said.
Martin and her colleagues are also happy with the cost of the program, which was zero, at least to the school. The vaccines were covered by the students’ health insurance, and there was no cost to design and implement the alert.
‘A cancer vaccine’
There are more than 150 strains of HPV, some of which cause common warts, like those that pop up on a finger or toe.
But the American public became awkwardly aware of the connection between genital HPV and cancer when actor Michael Douglas revealed four years ago that his Stage IV tongue cancer was caused by oral sex.
The numbers of Americans who contract this type of cancer this way are relatively small (12,638 men and 3,100 women each year) but they're rising, according to Sarah Vander Schaaff, writing in The Washington Post. The virus doesn't travel through the body but remains at the site of entry, and it can take 10 to 30 years after exposure before a tumor develops, Schaaff wrote.
It's responsible for 99 percent of cervical cancers, according to a report in The Hill, as well as thousands more cases of cancers of the vulva, vagina, penis and throat. Condoms do not prevent transmission of the virus, and you don't have to have intercourse to get it; HPV is passed through skin-to-skin contact, according to the American Academy of Pediatrics.
Although the FDA approved the vaccine in 2006 and federal officials say it is safe, reports of side effects and concerns about safety have contributed to the low vaccination worldwide. In Japan, vaccination rates plunged to 1 percent after reports of speech problems, paralysis and short-term memory loss, among other reported side effects.
The World Health Organization, however, joins the CDC in insisting that the vaccine is safe and effective, and Rhode Island, Virginia and the District of Columbia require it for children attending public schools. (Virginia, however, only requires it for girls.)
Some studies have shown that religious people, particularly those who attend services frequently, were less likely to have their children vaccinated because they don't expect their children to have sex as teens.
But there was disparity among denominations: Catholics were more likely than unaffiliated people or evangelicals to have their daughters vaccinated in one study published in 2013. And people who go to religious services sporadically were more likely to support vaccination than those who had no religious affiliation at all.
As for the controversy over when the shots are given, Martin, of the University of Utah's Student Health Center, said that if teenagers have no sexual exposure before college, it’s fine for them to wait until college.
But she noted that nearly half of American high-school students have sexual experience, often without their parents’ knowledge, and that even the milder strains of HPV, while not life-threatening, are something teens and young adults will want to avoid.
“Genital warts are not going to kill you, but (getting them) is devastating,” she said.
More importantly, she added, “In my opinion, this is a cancer vaccine. And it’s the only cancer vaccine that I’m aware of.”