Since the human papillomavirus (HPV) vaccine was introduced in the United States in 2006, it has been administered to millions of teens and young adults, reducing their risk of several types of cancer. But it’s still not nearly enough, says UNC pediatrician and internist Tamera Coyne-Beasley, MD, MPH.
Today, about 60 percent of teens ages 13 to 17 have received at least one dose of the vaccine; that’s far behind the compliance for other teen vaccines, such as Tdap (tetanus, diphtheria and whooping cough).
Dr. Coyne-Beasley has researched and assisted in the development of vaccine policies as a member of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. She’s part of the committee’s HPV work group.
She answered our questions about the HPV vaccine and why some parents remain hesitant.
What is the HPV vaccine?
The HPV vaccine is a vaccine against human papillomavirus. It helps prevent not only cervical cancer, as many people know, but it also prevents anal cancer, vulvar cancer and vaginal cancer, as well as genital warts.
It’s important for people to know that HPV is the most common sexually transmitted infection. It’s so common, in fact, that many people have it and don’t know they do. The majority of people won’t have any signs or symptoms whatsoever. People are transmitting it without realizing that they have it.
HPV can cause cancer and genital warts, but not all cases will lead to those outcomes, and most infections will resolve on their own. But there’s no way to know which infections will do so. The best thing we can do is prevent the infection so it doesn’t have a chance to progress into cancer.
How does the vaccine work?
It’s similar to other vaccines that guard against viral infections. The vaccine is made of virus-like particles; it mimics the live virus. It gets the body to form antibodies so that when the body is actually exposed to the real HPV later, those antibodies can bind to the HPV infection and prevent it from infecting cells.
The HPV vaccine itself does not contain a live virus. It cannot cause HPV infections or cancer—that’s a myth.
What are the odds of getting HPV?
The truth of the matter is that most everyone who is sexually active will get an HPV infection at some time in their life. About 80 percent of people will get an HPV infection. Most of them will resolve on their own. Right now, it’s estimated that 79 million people are currently infected; 14 million people are newly infected each year.
Who needs the vaccine?
Many people think of it as being something only girls or women need. The reality is that HPV is incredibly common in males; partners transmit it to each other. If you think about the types of cancers HPV can cause—cervical, vaginal, vulvar, anal, penile, oral cancer—obviously penile cancer happens to men, but so do oral and anal cancer. In fact, men are much more likely to have throat and mouth cancer than women. In 2020, the rates of HPV-related disease linked to mouth and throat cancer are expected to surpass cervical cancers. Both men and women should get the vaccine as recommended, ideally before they are sexually active, as children.
What age do children need to get the vaccine?
The vaccine is licensed for individuals between the ages of 9 and 26. The routine recommendation is to start at age 11 or 12 years. The goal is to make sure young people are vaccinated before they have potential exposure to the virus. It can be started as early as age 9.
We know the vaccine is even more effective at younger ages. Individuals who get the vaccine between 9 and 14 have a better antibody response, and it has been shown to be more effective when given during that age range than when people get it between ages 15 and 26.
That’s why if you give it to children before they’re 15, they only need two doses of the vaccine, separated by six to 12 months. If they start at age 15 or older, they need three doses.
Of course, if your child is older than 15, it’s still beneficial to get the vaccine up to age 26.
What about parents who say their kids aren’t sexually active, particularly parents of very young kids, like 9-year-olds?
I let parents know that this is the best time to give the vaccine to their children, before they are exposed to the virus. Also, while you certainly hope there will not be sexual experiences that young, you never know what can happen. Tragically, some children are molested and sex isn’t always consensual. And as I said earlier, younger children and teens have a better antibody response.
Even for older teenagers, parents don’t want to think about their kids being sexually active, and that’s understandable. But it’s often the reality. And parents may have a limited view of what sexually active means. Some teens aren’t having intercourse, but they are having oral sex. The kids think they’re being safe because they can’t get pregnant, but they can get mouth and throat cancer later. Some teenagers are having anal sex; again, they know it won’t get them pregnant, but it can pass infections.
You talked about the myth that the vaccine causes cancer. What other myths do you have to debunk?
There are many myths; many can be found online. People have worried it will cause infertility, but it doesn’t. Some have thought that it might make youth more promiscuous. Research has demonstrated that getting the HPV vaccine does not increase the sexual activity of males or females.
So what are some possible side effects?
The vast majority of the time, there are no significant side effects to the HPV vaccine. When there are, it’s usually a sore arm from the shot, which goes away in a day or so. Occasionally, the child will have a fever, headache or nausea, but these are usually mild and go away quickly. If your child is allergic to yeast or any other food or drug, talk to your doctor before getting any vaccine, to ensure safety.
Are there any other benefits to the vaccine we haven’t discussed?
The vaccine saves money and anxiety from future abnormal pap smears. When women have HPV precancerous lesions show up during an exam, it causes stress and requires follow-up treatment. This may cost money and keep a woman away from school or work.
HPV also can cause recurrent respiratory papillomatosis in newborns, when the mother passes the infection on to her baby during childbirth. The baby then can develop viral warts in his or her airway, which causes respiratory distress. This is relatively rare.
What will be the long-term effects of this vaccine?
We have the ability in the future to eradicate cancers related to the human papillomavirus—that’s huge. We also can eliminate health disparities caused by the diseases they produce, such as cervical cancer. Black and Hispanic women have higher rates of cervical cancer than white women; conversely, anal cancer and vulvar cancer have higher rates in whites.
In 10 to 20 years we’ll be talking about these diseases differently. My hope is that the HPV vaccine will become like the hepatitis B vaccine. That’s also an infection that can be passed sexually, as well as through intravenous drug use and blood transfusion. When that vaccine was introduced in the late 1980s, some of the concerns were very similar. We introduced it in a middle school population, and it prompted some of the same worry in parents. But now the vaccine is given to infants; the first dose is recommended before they leave the hospital. It would be great if the HPV vaccine were licensed for infants. That takes away the whole sexual connotation. It’s just something to protect your child.
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