Friday, July 12, 2013

Leaving A Legacy: How The HPV Vaccine Can Change Our Children’s Future

By Rachel Cunningham, MPH
Immunization Project

This blog post first appeared on Medicine | Milestones | Miracles, the Texas Children's Hospital blog providing an important perspective on pediatric health from the voices that care for patients at Texas Children's Hospital.

As summer begins to wind down, parents of school-aged children are starting to think about scheduling that back to school visit to the doctor’s office. For parents of adolescents, this visit will likely include a few routine immunizations. The vaccines recommended for adolescents 11-12 years of age include Tdap, meningococcal, and human papillomavirus (HPV).

While most adolescents receive the Tdap and meningococcal vaccines, sadly, many parents decline the HPV vaccine. A 2010 survey found that 69% and 63% of adolescents aged 13-17 years were vaccinated against Tdap and meningococcal disease, respectively, whereas only 49% of females in the same age group received at least 1 dose of the HPV vaccine and only 32% received the recommended 3 doses.

Let me repeat that. Only 32% of adolescent females between the ages of 13 and 17 years have received the full course of a vaccine that prevents HPV, a disease that causes cervical cancer.

I understand many parents have questions about this vaccine — Why does my 12 year old need a vaccine for HPV, a sexually transmitted infection? Why does my child need the HPV vaccine if we are teaching him or her abstinence? Will this give my child permission to engage in sexual activity?

As a mother of two young girls, I can appreciate these questions. It seems counterintuitive to vaccinate your adolescent son or daughter for protection against a sexually transmitted infection. But let me explain why vaccination is important and why we recommend immunizing during adolescence.

Yes, HPV is a sexually transmitted infection. But the important thing to understand is that HPV causes cervical cancer. In fact, 99% of cases of cervical cancer are caused by HPV. Moreover, HPV also causes genital warts and vulvar, vaginal, penile, anal, and oro-pharyngeal cancers.

But wait, there’s more.

Approximately 79 million Americans are currently infected with HPV and approximately 14 million more become newly infected each year. In 2013 alone, the National Cancer Institute estimates that more than 12,000 women will be diagnosed with cervical cancer of which more than 4,000 women will die.

So why do we recommend immunizing at the young ages of 11 and 12?

Here’s why — we want adolescents to be vaccinated against HPV long before their first sexual encounter. By recommending vaccination at this age, we aren’t suggesting that they are already or about to be sexually active. We want them to start the vaccine series early so that they have time to receive all 3 doses and develop protection from the vaccine. Furthermore, evidence has shown that the immune response to the vaccine is much stronger when given at this age as compared to older teens.

Fortunately, the HPV vaccines are very effective. A study published just last month in the Journal of Infectious Diseases found that the rate of HPV has declined 56% among adolescent females following introduction of the vaccines. Given the low vaccine uptake among adolescents, consider the potential disease reduction if ALL adolescents were immunized.

Maybe you’re still asking yourself why your child needs a vaccine when they aren’t sexually active. It’s an important question. And the truth is that it isn’t just about the choices your child makes.

I appreciated the way Jennifer Grant, blogger and mother of four, addressed the issue: “…the [HPV] vaccines are most effective when given long before sexual activity begins. Even when men and women do not have sexual contact until they’re married, parents can’t guarantee that their sons’ or daughters’ spouses will have made parallel decisions.”

This is the heart of the matter — choosing to protect my daughters against HPV doesn’t affect how I teach them to regard sex. My husband and I will continue to guide our children according to the principles by which we live and hope our children make wise choices. However, choosing to protect my daughters from HPV means I am protecting them from cervical and other HPV-related cancers.

If we allow our fears to overwhelm our ability to make a logical medical decision then we have done our children a tremendous disservice. Instead, let’s be the generation that ends cervical cancer. That is a legacy worth leaving.

Rachel Cunningham is the Immunization Registry and Educational Specialist at Texas Children's Hospital in the Immunization Project, which is dedicated to developing, implementing, and evaluating strategies to help keep Houston area children free of vaccine preventable diseases. She is the primary author of Vaccine-Preventable Disease: The Forgotten Story.

1 comment :

Dr Pullen said...

Such a shame, as this vaccine is proving to be such an effective and safe vaccine. In Washington, where the vaccine is paid for 100% by state tax dollars, it is still tough to get some kids vaccinated. Parents want to wait until their children are older. Data shows the best vaccine response in younger teens, and I've found this the most convincing arguement to parents who want to delay. Give the vaccine when it works best, which is also usually prior to first exposure

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