By Beth Allen, Nurse Practitioner Senior with ADPH-Family Health Services
According to the Centers for Disease Control and Prevention (CDC), approximately 20 million Americans are currently infected with HPV and 6 million become infected each year. The Human Papillomavirus or HPV is the main cause of cervical cancer in women. In the United States, approximately 12,000 women get cervical cancer every year, and 4,000 are expected to die from it.
HPV is also associated with less common cancers such as vulvar and vaginal in women and anal and oropharyngeal in both men and women. HPV can also cause genital warts. In the US, around 12,000 HPV associated cancers occur in men. Cancers of the mouth and throat are the most common of these. Overall, the incidence of anal and oropharyngeal cancers have increased over the past year; therefore, females are only part of the total equation.
The HPV vaccine can prevent most cases of cervical cancer if given before exposure to the virus. The American Society for Colposcopy and Cervical Pathology (ASCCP), experts in cervical cancer testing and prevention, incorporate HPV testing as the proven indicator to oncogenic testing in these HPV cancers. The ASCCP conclude that at the present time studies are ongoing as to the effect of HPV vaccination on large populations and the vaccine holds promise of reducing these cancers worldwide.
There are two types of HPV vaccine presently available. The quadrivalent vaccine, Gardisil (Merck), targets HPV types 6 and 11 which cause genital warts, and types 16 and 18 which cause the majority of cervical, vaginal, anal, vulvar cancers and precancerous or dysplastic lesions. The bivalent vaccine, Cervarix (GlaxoSmithKline) targets only HPV types 16 and 18. The protection afforded by the HPV vaccine is projected to be long-lasting and can be given to both boys and girls. Gardisil is the only vaccine approved for boys.
The CDC Advisory Committee on Immunization Practices (ACIP) guidelines recommend that the HPV vaccine be given to both girls and boys 11 to 12 years of age. It may be given starting at 9 through 26 years of age. Patients in these age groups with HPV exposure are still recommended for the series, because the vaccine can offer protection against infection with HPV types not already acquired. Additionally, ACIP recommends vaccination after exposure to HPV, even though benefit is less. Furthermore, in a HPV bivalent study with HPV exposure from one to six years, with HPV vaccination showed a cumulative reduction in moderate and high risk infection. This is evidence that HPV vaccination within six years of exposure results in preventing cancer precursors. The vaccination is given as a three dose intramuscular administered series. The ACIP three dose schedule consist of: dose one, second dose is one to two months after the first dose, and the third dose is six months after the first dose. Additional booster doses are not recommended at this time. It takes all three doses to get the best protection.
The Alabama Department of Public Health encourages pairing the first dose of the HPV vaccine with the required 6th grade vaccinations given at age 11 to 12. These vaccinations are covered by many insurance providers including Blue Cross/Blue Shield, Medicaid, and Allkids. The vaccine is available at all county health departments at little or no cost to children ages 9 to 18. The Vaccines for Children (VFC) program offers these vaccines at no charge to children who are eligible. The ADPH’s campaign “Third Time’s the Charm” is currently underway. This campaign promotes the importance of receiving all three vaccines. It includes promotional materials such as postcards, handouts, posters, and ads in parenting magazines. A birthday card is sent with reminders of vaccines, including HPV vaccine, on 11th and 12th birthdays. Reminder systems nationwide are recommended by the National Cancer Institute’s (NCI) annual report. The Alabama Department of Public Health’s campaign can be accessed at ADPH.org/cancercontrol and facebook.com/ALCompCancerCoalition.
The HPV vaccine has been found to be safe and free of serious side effects through worldwide studies. When given before exposure to the virus, the quadrivalent HPV vaccine is expected to prevent more than 90% of genital and approximately 60% to 70% of cervical cancers. The National Cancer Institute’s (NCI) annual report in 2012, a collaborative report involving the American Cancer Society (ACS), the Centers for disease Control and prevention (CDC), and the North American Association of Central Cancer Registries (NAACCR), published percentages of HPV uptake in the Morbidity and Mortality Weekly Report (MMWR). The HPV uptake nationally is 53% in girls ages 13-17 receiving one dose and 34.8% uptake receiving all three doses. Alabama’s statistics are 49.5% uptake with one dose and 31.2% uptake for all three doses. The movement is to get both boys and girls vaccinated. It is important to recognize that patients trust their health care provider’s advice. As health care professionals, we have an opportunity to change an outcome and make a positive impact in decreasing cervical and other HPV cancers, and the time is now.