The Sacramento Bee

It’s about cancer, not sex, say doctors, as CDC urges HPV vaccine for preteens

February 2, 2017

By Claudia Buck

Of all childhood vaccines, it’s the one that makes many parents – and even some physicians – squeamish.

HPV, or human papillomavirus, is a common sexually transmitted infection that can lead to cancers of some of the most private places: the cervix, vagina, penis and throat.

Although there’s been a vaccine to prevent HPV for about a decade, vaccination rates among kids and teens have stayed relatively low, both in California and nationwide. Because HPV is sexually transmitted, some parents shy away from the vaccine, feeling it isn’t necessary for their preteens. Others contend the vaccine isn’t proven.

That reluctance alarms health officials and pediatricians, who are renewing their efforts to get more U.S. and California children inoculated against HPV, starting at age 11 or 12. Calling it a “serious public health threat,” the UC Davis Comprehensive Cancer Center and 60 other cancer centers nationwide recently urged parents to have their sons and daughters vaccinated before age 13 so they “don’t grow up to become cancer patients.”

“It’s not about sex. It’s about cancer and cancer prevention,” said Dr. Dean Blumberg, chief of pediatric infectious diseases at the UC Davis Children’s Hospital in Sacramento. He calls it “a tragedy” that some parents have delayed or refused the HPV vaccine, which health officials say could prevent a majority of the estimated 30,700 HPV-caused cancers diagnosed annually.

Among California teens, about 48.4 percent of girls and 29.5 percent of boys ages 13 to 17 had completed the recommended three doses of HPV vaccine in 2015, according to the federal Centers for Disease Control and Prevention. That’s better than the overall U.S. rates, which are 42 percent of girls and 28 percent of boys.

In October, the CDC changed its national guidelines, saying only two doses are needed to protect 11- and 12-year-olds against HPV, instead of three. For teens and young adults, three vaccine doses are still recommended. The vaccine is considered most effective when given at younger ages, before adolescents or teens are exposed to HPV.

There are 40 to 50 HPV infection types, ranging from the low-risk variety that cause genital warts to more serious types that lead to cancer. In most cases, an HPV infection causes no symptoms and the body’s immune system knocks out the virus naturally within two years, according to the CDC. But in cases where a high-risk HPV isn’t eliminated, the infection can linger, causing abnormal cells that can morph into cancers, sometimes years later.

In January, research found that nearly half of all U.S. males, ages 18 to 59, had HPV-caused genital infections, according to a study published in JAMA Oncology. Of those, roughly one in four men had a high-risk HPV infection that could lead to cancers of the mouth and throat. Given that trend, the study predicted that men’s HPV-related rates of oral cancer could surpass those of women’s cervical cancers by 2020.

“You never want to think of these (cancers) happening to your child,” said state Sen. Richard Pan, D-Sacramento, a pediatrician and father of two boys, who endorses the vaccine as an effective deterrent. “This is a simple thing to protect our children against something that can be very, very deadly. No one would want their son or daughter to go through that.”

The HPV vaccine has run into opposition from the same fervent parent groups that object to mandatory vaccinations for school-aged children, contending they are not risk-free and can have unintended side effects. They note that Japan withdrew its recommendation for HPV vaccinations in 2013 following reports that some girls experienced chronic limb pain and elevated heart rates after getting inoculated.

Those reports, widely shared on social media in Japan, caused HPV vaccination rates to plummet in that country. Since then, the European Medicines Agency, which oversees medication safety for 28 European countries, reviewed the evidence and concluded that HPV vaccines are safe and do not cause chronic pain or rapid, elevated heart rate syndromes.

In the U.S., clinical studies of three HPV vaccines concluded they were “safe and effective,” according to the CDC. Two Gardasil vaccines, for instance, were monitored for side effects in more than 44,000 boys and girls; Cervarix, a female-only vaccine, was monitored in 30,000 girls and young women.

According to the CDC, the most common side effects of HPV vaccines are mild: fever; headache; nausea; muscle or joint pain; and redness or swelling in the arm where the shot was given. In rare cases, the vaccine has caused fainting or allergic reactions, the agency said. In general, the CDC said, people with severe allergies to components of any vaccine should not receive that vaccine.

Christina Hildebrand is president and founder of Voice for Choice Inc., a Mountain View-based nonprofit that advocates for parental choice when it comes to childhood vaccines. The mother of two “fully unvaccinated” children who attend private school in the Bay Area, Hildebrand believes not enough research has been done on potential side effects of the HPV vaccine.

“Most parents roll up their sleeves and do what the doctor says. I want every parent to do their own research. Most parents who are questioning vaccines are parents who have done research, talked to their doctors and done the risk-to-benefit ratio for their child,” she said.

Amy Salmon, a Sacramento mother of eight, said she was persuaded by both medical science and her family pediatrician to have all of her age-eligible children inoculated.

“I trust science and I trust my pediatrician. … It wasn’t about sex; it was about their long-term health and preventing cancer.”

Another factor was a friend who confided she was infected with HPV during her “wild college years.”

“Now that she is married with children, she has to live with the possibility she might eventually get cervical cancer,” Salmon said. “She highly recommended I get the shot for my kids so they might escape the same situation.”

On college campuses, students who may have missed the vaccine in their younger years are urged to consider getting inoculated. Both Sacramento State University and UC Davis include HPV information on their health care websites. CSUS, for instance, lists the HPV vaccine Gardasil, along with other vaccinations, such as Hepatitis A or meningitis. At $148 per dose, HPV is the second-most-expensive vaccine of 12 listed, but students are linked to a financial assistance program offered by Merck, the vaccine’s manufacturer.

Given the sexual nature of how HPV is spread, discussing the vaccine can take doctors and parents into uncomfortable territory. To help physicians navigate the potentially treacherous terrain, medical centers like UC Davis offer tip sheets on how to discuss the topic.

“Parents say, ‘But my child hasn’t even started having sex or even dating.’ It’s a very uncomfortable conversation for both sides to have,” said Blumberg, the UCD doctor. Although some parents worry that the HPV vaccine is “like a green light to have sex,” he said, there have been multiple studies that show “kids don’t increase their sexual activity because of the vaccine.”

Blumberg said the message from physicians should be simple: Here’s a proven vaccine for your son or daughter that can protect them from cancer. Unless that message is clearly delivered, he said, “People are going to get HPV, have persistent infections and end up with cancers that could have been prevented. That’s why it’s so concerning."