A Pediatrician Responds to Excuses for Avoiding HPV Vaccine

A Pediatrician Responds to Excuses for Avoiding HPV Vaccine by Laura Whitney MD

Vaccine visits for babies generally run very smoothly. Everyone expects the baby will need some shots, and most families accept the recommended vaccine schedule.
The adolescent well check, by contrast, seems fraught with controversy. The patient can clearly communicate that she does not want a shot. Since many schools mandate Tdap (tetanus with whooping cough) but do not require meningococcal, HPV (human papilloma virus), or influenza vaccines, parents have the impression that the other vaccines are not as necessary. Finally, parents and adolescents alike have talked to their friends about their vaccine experiences or looked up immunizations on the internet. The result is often a prolonged discussion which ends with the family making a la carte vaccine selections.
Nowhere is this more evident than with the HPV vaccine. From a scientific standpoint, there is very little controversy. The vaccine is not a live vaccine, meaning it will not produce an infection of any kind. It is very effective in creating immunity to the HPV virus, a virus known to cause cancer. Finally, the vaccine has an excellent safety profile.

The CDC recommendation is that all boys and girls aged 11-12 receive the three-dose series for complete coverage. Catch-up regimens are recommended for all girls up to age 26 and all boys up to age 21. The CDC’s recommendations are supported by the Advisory Committee on Immunization Practices as well as the American Academies of Pediatrics, Family Practitioners, Obstetrics and Gynecology.
A safe, effective vaccine that prevents cancer? Why, then, do families hesitate? Here are the top reasons I hear in the office:
It’s too new.
 
The truth is, the vaccine has been recommended since 2006. Over the last decade, 86 million doses of the vaccine have been given. These large numbers equal a vast amount of experience with the HPV vaccine. It’s really not that new anymore.
 
My child isn’t sexually active, and we teach abstinence.
 
Abstinence at a young age is ideal for numerous reasons. However, most teens do not tell their parents before they decide to have sex. I have yet to have a teen call and request the three-dose HPV vaccine series, given over 6 months, before he becomes sexually active. With nearly 100% lifetime risk of HPV infection for sexually active individuals, even those who wait for a committed relationship are at risk.
 
We’ve heard bad things about the vaccine.
 
Although people like to complain when something goes wrong, it is important to remember that people who have had a “normal” experience, neither extremely good nor extremely bad, are not likely to comment. Whether online in testimonials or in person at the ball game, those with grievances wish to air them, but complaints do not constitute scientific fact. Parents should check with the pediatrician for appropriate sources of information regarding vaccines and use the vaccine visit as a chance to get questions answered.
 
We don’t feel it is necessary.
 
79 million people in the US are currently infected with HPV, and 14 million new infections occur each year. If an adolescent will ever have sex in his or her lifetime, the risk of HPV infection is real, and it approaches 100%.
 
In those with HPV infection, there are approximately 27,000 new cases of HPV-associated cancer each year. That is roughly one every 20 minutes. HPV does not just cause cancer of the genitals, either: it is a leading cause of oral and throat cancers. HPV cancers at minimum generate need for medical procedures such as surgery or chemotherapy, but the cancers and treatments can also cause infertility or even death. The HPV vaccine could prevent almost all of these cancers. There is minimal risk and much to gain by getting vaccinated.

But I have a son. Do guys really need the HPV vaccine?
 
Yes. Throat cancers can affect males and females. 72% of these are linked to HPV. HPV also causes 63% of penile cancers and 91% of anal cancers. Protecting sons is just as critical as protecting daughters.
 
I have heard the vaccine is not that effective.
                 
The HPV vaccine is actually very effective. When studied, immunity rates approach 100% for covered strains of the HPV virus. Since the HPV vaccine was recommended 2006, there has been a dramatic decrease in the rates of vaccine-covered HPV infections in teenage girls. This means fewer teens will have complications associated with HPV infection as well.
 
I feel my child is too young for the vaccine.
 
The best way to prevent any HPV infection is to give the vaccine before exposure occurs, keeping in mind that the parent may not be notified when the adolescent becomes sexually active. (It is still appropriate to vaccinate teens who have already been sexually active as they may not have been exposed to all covered strains of HPV.) Also, while the vaccine is proven to be effective at all indicated ages, the immune system is very receptive to new information at ages 11 and 12, so the vaccine will produce the highest level of immunity then.
 
All adolescents should receive HPV vaccination: it is time to stop the excuses and protect our kids. If there are more questions, please refer to the list of resources below, or see your pediatrician for more information.
 
CDC: Frequently Asked Questions About HPV Vaccine Safety

CDC: Human Papilloma Virus (HPV)

CDC: Human Papilloma Virus (HPV) Questions and Answers

Dr. Whitney is a general pediatrician with The Children’s Medical Center, PA in Greenville, SC. Her interests include toddler feeding issues and helping children develop healthy habits. Other articles by Dr. Whitney include Hiding Veggies in Your Kids' Food: A Pediatrician's Perspective and Tips for Getting the Most Out of Your Pediatrician Visit