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Let’s Talk About HPV, Valentine

The need for conversation about vaccinating kids against adult outcomes

By Ambereen Sleemi

Published February 14, 2014

Ah, Valentine’s day. Love it or hate it, it has officially become the American day for sweethearts. Millions of kids celebrate the day by handing out, chocolate,  SpongeBob cards, homemade cookies, and conversation hearts to their classmates. Prosaic messages, such as “Be mine,” abound.

Yet hardly any conversation today among American youth between the tender ages of 9 and 12 is likely to address the series of three doses of the human papilloma virus (HPV) vaccine the CDC recommends for them. That’s a more nuanced conversation.

This week, the President’s Council on Cancers released the 2012-13 annual report highlighting the need to accelerate the acceptance of HPV vaccination for adolescents in the U.S. HPV is a virus that is spread from person-to-person during intimate contact.  It is responsible for several types of cancers in adulthood, including cervical, vulvar and vaginal cancers in women, penile cancers in men, and anal and oropharyngeal cancers. It’s also to blame for genital warts in men and women, and laryngeal papillomatosis (wart-like lesions in newborns spread maternally during vaginal delivery while the virus is shedding). It is the most common sexually transmitted infection in the world.

The Couric Effect

The HPV vaccine has been shrouded in controversy since its release in 2006. Much of the controversy has centered on anecdotes of severe adverse effects, such as seizures, paralysis, and death—side effects reported to the FDA adverse reaction site. Fears were amplified when Katie Couric, a high-profile television journalist, hosted a “fair and balanced” show featuring two mothers whose daughters had severe reactions to the vaccine, an anti-HPV vaccine scientist, and a pro-HPV vaccine physician. Amidst a public relations firestorm, Couric issued a mea culpa several days later in a piece on the Huffington Post. However, the initial dramatic impression made on her loyal viewers—mostly women, who are likely to be mothers of children for whom the vaccine is recommended—may be hard to reconcile.

Vaccination for Cancer Prevention

In 2006, the Food and Drug Administration approved the first HPV vaccine to be used in the U.S. after extensive pre-market testing of over a million girls worldwide. There are now two vaccines available—a bivalent vaccine targeting the two most common HPV strains and a quadrivalent vaccine, targeting the four most common strains.

According to the CDC, there are 12,000 new cervical cancer cases annually, causing 4,000 deaths each year. They estimate about 15,000 HPV-associated cancers in the United States may be prevented by vaccines each year in women, including cervical, anal, vaginal, vulvar, and oropharyngeal cancers. In U.S. males, 7,000 HPV-associated cancers may be prevented by vaccine, with oropharyngeal—the kind Michael Douglas developed—among the most common.

In addition to cancer diagnosis, the impact of pre-cancerous lesions is tremendous.  How many American women dread the phone call from their physician’s office saying their PAP smear was abnormal and they need to come in for a biopsy. Ouch.  What follows is extended monitoring, with more PAP smears, procedures and biopsies. Or, what about the outcropping of cauliflower-like lesions that herald the beginning of a life of repeated treatments for genital warts, like cutting, lasering or caustic creams? Oh, and you should really tell your partners.

Hearts and Hard Conversations

The vaccine has been given to millions of girls and women worldwide. In the U.S., over 54 million doses have been administered since 2006. Data show clearly that the adverse effects have not been out of proportion to those of other vaccines. Its long term-efficacy is still being studied, as is the case with any new vaccine. The current data supports five-year efficacy for the quadrivalent vaccine and slightly attenuated efficacy for the bivalent vaccine.  As with other vaccines, the robustness of an individual’s immune system will dictate its long-term efficacy. It may be that a booster is needed at a later date, just as with tetanus and pertussis shots every 10 years.

Just as with any vaccine, parents and their children need to have all the facts available and make an informed decision. It may be hard to see the benefit of a vaccine whose benefits—the prevention of a multitude of cancers and other potentially problematic health issues, largely in adulthood—are not readily apparent. It’s a very different scenario than the prevention of acute infectious diseases in childhood that are on the rise again because of the vaccine scare seeded by scientifically unsound reports of autism.

That conversation may be difficult for parents and children. After all, today, kids are just counting the number of Valentine’s Day cards they got, or didn’t get. But that harder conversation, made difficult by social mores and religious beliefs that have always made dialogue about sex among youth awkward, has to happen. Perhaps in coming years, those chalky pastel hearts might say something like, “HPV talk,” “3 doses,” or, “HPV-free.”

Edited by Dana March

One Response to “Let’s Talk About HPV, Valentine”

  1. February 14, 2014 at 3:06 pm, Dan Kegel said:

    Great post!

    The reference you gave on HPV vaccine long-term efficacy is great, but it’s seven years old; isn’t there a better one by now? http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0083431 found it’s still working at 6 years, but it was a fairly small study.
    http://www.dagensmedisin.no/Global/Dagens_medicin_norge/Bilder/PDF%20og%20word-dokumenter/018%20extension%20Iversen%20revised%2017May2013.pdf
    is a poster from a study giving a summary of results at 8 years, but it’s not a full paper.
    I suppose a good paper will be out in a year or two, but it’s hard to wait.

    One factoid that might have been suitable to add to the article:
    in Victoria, girls vaccinated by age 14 had a 75% lower rates of CIN2 and CIN3+
    at their first pap smear (see http://hpv.kegel.com/faq/#efficacy-pap );
    girls who weren’t vaccinated until age 15 had much less protection
    (presumably because they were already infected before getting vaccinated).

    Reply

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