LOCAL

HPV vaccination rates lag

Coalition, partners work to boost awareness of vaccine's cancer prevention

Morgan Chilson
morgan.chilson@cjonline.com
Recent data from the National Immunization Study shows an increase in the number of girls that have received the HPV vaccination in Kansas.

Kansas consistently ranks near the bottom when it comes to the number of teenagers who have received the HPV, or human papillomavirus, vaccination. But in recent data, experts were encouraged to see the percentages improve.

Laura Connolly, chairwoman of the Immunize Kansas Coalition, said the state ranks fourth from the bottom on teens who have had the first dose of the two- or three-dose HPV vaccination in new data from the Centers for Disease Control and Prevention, but focused efforts of IKC and local health departments will hopefully continue to improve the numbers.The CDC recommends two HPV doses for children under age 15 and three doses for those 15 and older.

The state, though, went down slightly on numbers who have completed the second or third dose of the vaccination, dropping to third from the bottom in that category, she said.

"Obviously Kansas has some challenges with that," she said. "We fare a little bit better on the other adolescent immunizations."

The "million dollar question" is how to address parents' concerns about the safety of HPV vaccinations and how to ensure teenagers receive the vaccinations, she said.

"I think one of the things that we know is it kind of takes a village. It can’t be, and it’s not going to be, any one thing that moves the needle," she said. "It takes individual providers, it takes public education, schools, health systems, partners like the American Cancer Society. It takes all of these entities together to make that change."

The challenge with the HPV vaccine is that it is relatively new, introduced about 10 years ago, said Dan Leong, American Cancer Society spokesman. 

"When it first came out, I don’t think the vaccine was really marketed with a strong cancer prevention," he said, adding that when it was first introduced it was also a three-shot vaccine. People would get the first shot, then not follow up with the second or third.

Nationally, the number of teens getting the HPV shot has increased by a little over 5 percent each year. The IKC, recognizing how far Kansas lagged in vaccination rates, focused in 2015 on reaching out to parents and providers to change the trajectory. An HPV vaccine toolkit was released in 2016.

Understanding that the HPV vaccination prevents cancer is an important part of the message, Leong and Connolly said.

The work at IKC has included HPV vaccinations with the meningococcal and Tdap vaccines. The meningococcal vaccine protects against meningococcal bacteria, which can lead to meningitis. The Tdap vaccine protects against tetanus, diphtheria and pertussis.

Working on messaging with providers has been part of IKC's focus. If a provider says here are two vaccines you need, referring to meningococcal and Tdap, and then there is another one you might want to consider, that makes a difference in how parents choose to vaccinate, Connolly said.

The messaging also needs to make clear the link between HPV and cancer, particularly cervical cancer. About 90 percent of cervical cancer cases are caused by HPV, and in 2018, the CDC projected more than 4,100 women would die of the disease.

"From the American Cancer Society's perspective, if we had a vaccine that would prevent breast cancer or prostate cancer or lung cancer, people would be running in droves to get the vaccine," Leong said. "It’s the same with this. The American Cancer Society believes we can eliminate cervical cancer if we just focus on making sure that when kids are getting their Tdap and meningococcal vaccine, they would also get their HPV vaccine."

Concerns about vaccine safety are one reason parents choose not to vaccinate for HPV, but another issue also comes into play. Because HPV is transmitted through sexual intercourse, some parents hesitate because they believe getting the vaccine will encourage their children to be sexually active. In research at Johns Hopkins University, parents listed a lack of perceived necessity for the HPV immunization as one of their top reasons.

The Johns Hopkins research also found that many believed the vaccine to be less necessary for boys.

"I think it’s out there kind of in the collective conscious that to get this immunization then is a license to have sex, and it makes having sex OK among teens," Connolly said.

Leong said some national studies have looked at whether getting the HPV vaccination increases promiscuity, and none has found a connection.

"I think that’s really been the main issue I’ve heard in Kansas is more of the safety issue," he said. "It’s just so much a sign of our times with the internet, and there’s so much on the internet that may be credible and certain things that are not. That’s what’s so great about having the American Cancer Society working with the Immunize Kansas Coalition, family physicians and pediatric and health plans that are really working hard to get the accurate message that this vaccine is safe, it’s effective."

Leong and Connelly encouraged parents to talk to their medical providers about their concerns and to ask questions. The CDC monitors adverse reactions to all vaccines, and there have been no deaths or any types of sentinel events associated with the HPV vaccine, Leong said.

On the IKC website, parents and caregivers can find information about evidence-based studies and credible sources.

"The American Cancer Society has adopted the Mission: HPV Cancer Free campaign," Leong said. "We really hope that being such a credible organization with cancer, we can break the stigmas associated with HPV virus and really focus on cancer prevention."

HPV VACCINATION

• HPV, human papillomavirus, is the most common sexually transmitted disease.

• About 80 percent of people will be infected with HPV in their lifetimes.

• HPV can cause cancer, and cervical cancer is almost exclusively caused by HPV.

• In 2018, more than 4,000 women are expected to die from cervical cancer.

• In Kansas, about 62.4 percent of girls aged 13 to 17 have received a first dose of the multi-dose HPV vaccination.

• Of boys in the same age group, about 41.7 percent have received the first dose of HPV.

Source: Immunize Kansas Coalition and the Centers for Disease Control and Prevention