What Parents Need to Know About the HPV Vaccine

If you are like me and have younger children at home, you probably have run into questions about vaccination schedules. My oldest son is about to turn 11, and at that age there are 3 recommended vaccines for all children, which are TDap, Meningitis, and HPV. The first two are routinely accepted vaccines but I have had many parents question the HPV vaccine. They seem to be suspicious, or uneasy about their child receiving the HPV vaccine. Maybe that is because this vaccine is relatively new, or because it deals with a sexually transmitted virus. Let’s look at some of the questions I hear, and what the answers are.

What is HPV?

Human Papillomavirus (HPV) is a group of over 150 viruses. HPV can cause warts on various parts of the body, including genital warts. It can also cause certain types of cancer including cervical, rectal, or oral cancer. HPV is transmitted through sexual contact. HPV is so common that nearly all men and women will get it at some point in their lives. Most types of HPV infections are not symptomatic and will resolve on their own. Signs and symptoms of HPV can be dormant for years, which means it is very difficult to determine when someone first became infected, or what the source of exposure was. This also means an infected person can unknowingly spread HPV to others.

The most serious types of HPV can cause cancer. The problem with HPV cancers is that they often don’t present with symptoms until they are at an advanced stage. The most common type of cancer caused in females is cervical cancer (12,000 new cases per year in the US). Most cases of cervical cancer are caused by HPV. Cervical cancer can be screened for and caught early. For males, oropharangyl (cancer of the back of the throat) is the most common HPV cancer with around 9,000 new cases per year. This type of oral cancer can not be screened for and can be very serious by the time it shows symptoms.

HPV Vaccine

The HPV vaccine, which is called Gardasil 9, can protect against 9 different types of HPV. The 9 types of HPV included in the vaccine have been identified as the types which cause most cases of HPV-related cancer. Some of the HPV types in the vaccine are also linked to non-cancerous genital warts. By receiving the HPV vaccine at the recommended time, a person can possibly prevent themselves from developing cancer later in life. Yes, a vaccine that can prevent cancer. Pretty amazing.

The Centers for Disease Control and Prevention (CDC) recommends vaccination against HPV at age 11 or 12. It follows a 2-dose schedule if initiated before the patient’s 15 birthday. One dose will be administered at the initial appointment, and the second dose will follow 6-12 months later. If the series is started after the patient turns 15, it should then be administered in 3 doses. One dose at the initial appointment, followed by doses 2 months and 6 months after the initial dose. Patients above age 26 haven’t shown to benefit as much as younger patients from the HPV vaccine, therefore it is not recommended for patients above age 26.

Timing of HPV Vaccine

HPV is transmitted sexually, so why give it to an 11-year-old? Isn’t this a bit premature? The goal here is to protect children before they become sexually active. If someone has already been exposed to the types of HPV contained in the vaccine, then the HPV vaccine probably will not protect them. It will be too late. I do agree that 11 years old seems early, but if not then, when? I hate to break it to you, but it is very likely that you will not know when your child becomes sexually active. The older they get, the more likely they are to become active. Protecting them early is the best policy.

This is a touchy subject at the pharmacy, or the pediatrician’s office. It can be hard to initiate a conversation to parents about the HPV vaccine, because some parents think we are assuming their children are sexually active. This is not the assumption we are making at all, but it is difficult to explain sometimes. Parents of 11 year olds do not usually want to talk about sexually transmitted diseases. Education is the key, so the difficult conversations are usually necessary ones to have. Please be open to discussing this with your health care professionals.

History and Prevalence

The original HPV vaccine protected against 4 types of HPV, which are the four types that cause the majority of cases of HPV-related cancer. The current version has added 5 more types to further the protection provided by the vaccine. The CDC began recommending the HPV vaccine to children starting in 2006. Early research was centered around preventing cervical cancer, which caused most people to believe that this vaccine should only be administered to girls. However, males can be carriers and infect their female partners. It is just as important for boys to be vaccinated as it is for girls. A person who was vaccinated with the original formulation of the vaccine (the one with 4 types) does not need to go back and be re-vaccinated with the new formulation (9 types). The differences between the two are not significant enough to require re-vaccination.

As of 2016, a national study of teenage vaccination rates showed that 65% of girls and 56% of boys aged 13-17 had received at least one dose of HPV vaccine. These numbers tell us two important facts. The first is that we are doing a good job of getting our kids vaccinated against HPV. Sixty percent is not bad. Those numbers need to be closer to 90 percent but we are making good progress. Secondly, vaccination rates for boys are catching up. Education efforts to target boys for HPV vaccination are working. Oral cancers in men have been on the rise, which emphasizes the need to vaccinate boys at the appropriate time.

Protection is long-lasting with the HPV vaccine. Studies have shown no decrease in effectiveness for patients who had the vaccine when it was first recommended in 2006. Studies will continue to monitor these patients to see if immunity begins to wane at some point in the future. This will determine if booster doses will ever be needed.

Safety studies have shown there is very little risk of serious side effects with the HPV vaccine. Most cases of reported side effects involved pain at the injection site, dizziness, or fainting after administration. Usually, when a patient faints after a vaccination, it is because they were scared to get a shot, not because of the vaccine.

Effectiveness

Because of the relative newness of the HPV vaccine, there has not been a marked decrease in the number of new HPV-related cancers as of yet. I believe we will see these numbers decrease in the near future as the HPV protected generation begins to age, and the number of people vaccinated overall continues to increase.

Now the decision rests with you. Do you want to help protect your children against HPV-related cancer now? The experts say you should. With 12,000 new cases of cervical cancer per year in the US, you might think the odds are pretty slim of it happening to your daughter. The scary part is that 4,000 of those women will die from it. About the same percentage of the 9,000 men who are diagnosed with HPV oral cancer will not survive it. These cancers usually don’t surface until long after initial exposure so there is not a way to determine when the patient was initially infected.

Some parents decide to wait until their children are old enough to make their own decisions about some vaccines. That is their right. However, getting vaccinated is so simple and so safe. It is hard for me to see the downside. If we are all diligent about protecting ourselves and our children, we could potentially eliminate virtually all cases of HPV cancer in the future. In addition, cases of embarrassing genital warts can be greatly reduced via vaccination. Parents are able to make better decisions than teenagers in a lot of cases, and I believe choosing the HPV vaccine for your child is a good decision.

For more thoughts on vaccines in general, you can check out this previous article from Helpful Pharmacist. 

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