This drug could save lives; why aren't kids getting HPV vaccination?

News-DemocratSeptember 21, 2013 

Julie Walsh, of Belleville, chose to get her children vaccinated against the most common sexually transmitted disease -- human papillomavirus, which can cause cervical and other forms of cancer as well as genital warts.

"It is worth it to definitely get the vaccine for both boys and girls," she said. "Anytime you can prevent cancer with a few shots I think it's worth it."

Walsh, 52, a financial consultant, advocates getting the vaccine for children as soon as possible. "You want to catch them before they get exposed to anything," she said.

Both her son, who's now 14, and her daughter, now, 19, got the HPV vaccine when they were 12. Walsh is the daughter of retired Belleville doctor Donald Buser.

Unlike Walsh, a majority of parents in Illinois aren't getting the HPV vaccine for their children, at least according to a recent report from the federal Centers for Disease Control. Illinois has one of the nation's worst vaccination rates for HPV.

About 21 percent of Illinois girls ages 13 to 17 received the recommended three doses of the HPV vaccine, according to the report on 2012 vaccination rates released by the CDC. Only two states -- Arkansas and Mississippi -- had lower rates.

Health professionals in Madison and St. Clair counties are pushing to improve that rate. Statistics regarding how many HPV vaccines were administered in local counties were not available. Educating Illinois residents about the vaccine is also a priority for the Illinois Department of Public Health, according to Bill Moran, chief of the immunization section.

The state recently applied for a $1 million grant from the CDC, Moran said, to increase awareness for the HPV vaccine. Illinois will find out in a few weeks if it will receive the grant; 11 will be awarded nationwide.

Moran attributed Illinois' low percentage of adolescents getting the HPV vaccine to a lack of knowledge. "A lot of parents aren't aware of what it is and what it's for," he said.

The HPV vaccine is also relatively new compared to other vaccines, according to Moran. It was first approved by the Federal Drug Administration in 2006.

Pediatrician Angela Bard encourages her patients, ages 11 and 12, to get the HPV vaccine. "You really have to think of the HPV vaccine as a cancer prevention that can't wait," said Bard of Bard and Didriksen Pediatrics in Glen Carbon.

Chicago's HPV vaccination rates were higher than the rest of Illinois. Nearly 38 percent of Chicago girls got the HPV shots. The rate in the rest of Illinois was about 17 percent. Nationally, one-third of girls received all three doses of the HPV vaccine.

"Our low vaccination rates represent 50,000 preventable tragedies -- 50,000 girls alive today will develop cervical cancer over their lifetime that would have been prevented if we reach 80 percent vaccination rates," CDC Director Thomas Frieden said in a released statement. "For every year, we delay in doing so, another 4,400 girls will develop cervical cancer in their lifetimes."

The nationwide goal for the CDC is to fully vaccinate 80 percent of adolescents against HPV. Countries such as Rwanda in East Africa, have vaccinated more than 80 percent of their teen girls with assistance from the World Health Organization, according to the CDC.

Counties advocate for it

The Madison and St. Clair County health departments encourage the HPV vaccine.

"We are very, very good advocates of the vaccine and promote it every chance we get," said Debbie Knoll, personal health services manager at Madison County Health Department.

"We are hoping to see some effect with this in our younger population and hopefully curtail the incidents of cancer that are spread by that particular virus," said Marsha Wild, manager of infectious diseases at the St. Clair County Health Department.

The vaccine is recommended for 11- and 12-year-old boys and girls. "The Center for Disease Control is recommending the vaccine prior to them becoming sexually active so when they do become sexually active they are protected," Wild explained.

Of the 316 million Americans, the CDC estimates approximately 79 million people, most in their late teens and early 20s, are infected with HPV.

The virus can be spread as genital warts, according to Wild. Those can be treated, she said, but if it's left untreated, it can develop into cancer including cervical, vulvar, vaginal, penile and oropharyngeal (base of the tongue, tonsils and back of the throat).

"There's a big push for the vaccine so it can protect people," Wild said. "A lot of times people can get HPV, and it doesn't develop into cancer, but it can. They're hoping to reduce the incidents of cancer by using the vaccine."

Vaccine specifics

Two kinds of the HPV vaccine are available: Gardasil for both boys and girls and Cervarix for girls. Cervarix (made by GlaxoSmithKline) was licensed by the FDA in 2009, and Gardasil (made by Merck) was licensed in 2006.

Both vaccines are effective against diseases caused by HPV types 16 and 18, according to the CDC. Those two strands of HPV cause most cervical cancers, as well as other HPV-associated cancers.

Gardasil also protects against HPV types 6 and 11, which can cause genital warts in both men and women, according to the CDC.

The HPV vaccine costs about $130 per dose and $390 for the full series. Bard said it's typically covered by private insurance.

The federally sponsored Vaccines for Children program provides it free to qualified patients. The HPV vaccine is available at the St. Clair County Health Department Immunization Clinic and through Madison County Health Department.

"We have very few people who decline it. For us, I think most of the parents go ahead and get the vaccine," said Knoll, of the Madison County department. "Private providers have a little bit of a hard time getting parents to get their kids the vaccine, because it's a vaccine to prevent a sexually transmitted disease. It's not encouraging kids to become sexually active."

For individuals 18 and older who are low-income, Knoll said the drug companies often have a charity program. "It is free for people who can't afford it," she said.

The HPV vaccine is given in three doses during a six-month period. The CDC recommends the second dose be given one to two months after the first, and the third dose be given six months after the first dose.

Even if patients just get the first dose, Bard said they are 82 percent protected. According to the CDC, the percentage of Illinois girls, aged 13 to 17, who got the first dose of the HPV vaccine is 41.2 percent.

"The vaccine is right now good for life," Knoll said, as there's no recommendation for a booster.

Since the vaccine was introduced in 2006, Bard said there have been no "serious safety concerns" reported through the CDC or the American Academy of Pediatrics.

"It's a very good vaccine," Knoll said. "The vaccine is huge in preventing this disease."

The HPV vaccine is not required for children to attend public school.

Doctors' recommendation

Bard, a pediatrician, said she recommends the vaccine to her adolescent patients and their parents during their sixth-grade mandatory physical.

"It's a vaccine to prevent cancer," she said. "Any time you can do something to prevent cancer, it's a good idea."

Administering the HPV vaccine to patients who are 11 or 12 garners a "better immune response," Bard said.

The HPV vaccine can be administered to girls, starting at age 9 and up to age 26, and boys from 9 to 21 years old. The vaccine can be given to men up to 26 years old who have not received all the doses.

With the state of Illinois requiring a mandatory sixth-grade physical, Bard said it's a chance to catch preteens before they are sexually active and a "good time to open up the conversation about it.

Bard said people can get "caught up in the sexuality of the vaccine. It's not giving them permission to have sex," she said. "It's preventing cancer."

Gynecologist Adriena Beatty with Women's Care of Southern Illinois in Belleville also recommends the HPV vaccine to all her patients in the targeted age group.

"I feel that all young girls between 9 and 26 should have the vaccine," she said. "By getting the vaccine, you can protect yourself against the different strands (of HPV) that cause those diseases. It can help prevent cervical cancer and vaginal warts and vaginal cancers you can get at a later age."

The HPV vaccine does not replace a yearly vaginal exam for young women and teenage girls. "If you do both, we should be able to catch all cases of potential cervical cancer before they even become cervical cancer," Beatty said.

Condoms can also protect against HPV, according to Beatty. However, "it may not protect you against the virus that causes warts," she said. "The virus can be on other parts of the person."

There is no cure for genital warts. "Once you have genital warts you can never get rid of it. That's the problem with it. You have it forever," Beatty said. "It's a very valuable vaccine that we have to protect you against something like genital warts."

Beatty recommends condom use to her patients regardless of whether they get the vaccine or not. "You still have to worry about chlamydia, gonorrhea and unwanted pregnancy," Beatty said.

Beatty plans to get the HPV vaccine for her 8-month-old daughter once she is old enough. "I encourage all my family members to get it," she said.

Local reaction

Debra Skaer, of Millstadt, is an advocate for the HPV vaccine for girls. She said all three of her daughters, ages 24, 20 and 17, received the vaccine as a preventative measure against cervical cancer.

Skaer said her 15-year-old son has not gotten the vaccine, and they haven't decide as a family if he will or not.

Kaniesha Bennett, 25, of Belleville, said she received the HPV vaccine when she was 18 years old at the recommendation of her gynecologist.

"I think it's not really worth getting it," Bennett said. "It only protects against four of the strings of HPV. You can still get what you are supposed to be getting protected from."

There are more than 40 types of HPV that can infect the genital areas of men and women, according to the CDC.

Stacey Spearmon, 28, of O'Fallon is in favor of the HPV vaccine despite contracting the virus after getting vaccinated. Spearmon said she was fully vaccinated against HPV in late 2009 and was diagnosed with HPV in November 2011.

"Although I do have the HPV vaccination, it did not protect me against those two strands of the infection," she said. "It does protect against genital warts as I was exposed to that."

Spearmon has strands 16 and 18, which can lead to cervical cancer. She said cervical cancer runs in her family. "I'm still for the vaccine if it can protect against other strands," she said.

Beatty said it's still possible to get HPV even after getting the vaccine as its not 100 percent effective. She explained the vaccine protects against approximately 75 percent of HPV-related cervical cancer and 90 percent of HPV-related genital warts. "It's a very small population, because of a majority of the cases the vaccine will protect you," she said.

A study published in June in the The Journal of Infectious Diseases states that since the HPV vaccine was introduced in 2006, vaccine-type HPV prevalence decreased 56 percent among female teenagers 14 to 19 years old.

For more information about the HPV vaccine, visit http://www.cdc.gov/hpv.

Contact reporter Jamie Forsythe at 239-2562 or jforsythe1@bnd.com.

Contact reporter Jamie Forsythe at 239-2562 or jforsythe1@bnd.com.

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