PHILADELPHIA
— EVERY year in the United States thousands of men and women die from
cancers that can be prevented with a simple vaccine. Sadly, uptake of
this cancer-preventing vaccine is abysmal. One reason: Doctors don’t want to talk about sex. The good news is, they don’t have to.
In
the past decade, the Centers for Disease Control and Prevention, in
concert with the American Academy of Pediatrics, has recommended three
vaccines for adolescents. One to prevent meningococcus, which causes
bloodstream infections and meningitis; another, given in a three-in-one shot called Tdap, to prevent tetanus, diphtheria and pertussis (whooping cough); and a third to prevent human papillomavirus (HPV), which causes several types of cancer.
In July, the C.D.C. announced the most recent results of its teenage immunization
survey. Around 80 percent of adolescents now receive the meningococcal
and Tdap vaccines. The HPV vaccine, however, is a different story. Only
57 percent of girls had started the three-dose series; 38 percent had
finished it. In boys, for whom the vaccine was recommended a few years
ago, 35 percent had started and 14 percent had finished the series.
“It’s
frustrating to report almost the same HPV vaccination coverage levels
among girls for another year,” said Dr. Anne Schuchat, director of the
National Center for Immunization and Respiratory Diseases at the C.D.C.,
in a statement.
Why
are adolescents and their parents embracing meningococcal and Tdap
vaccines but not the HPV vaccine? One possible explanation is a clash
between perception and reality, People just don’t understand how serious
an infection HPV can be. In a typical year in the United States about
150 people die from meningococcus, four from tetanus, none from
diphtheria, 20 from pertussis, and roughly 4,000 from cancers caused by
HPV. People are more than 20 times more likely to die from HPV than from
the other four diseases combined.
About
79 million people in the United States have been infected with HPV, and
14 million new infections occur every year. As a consequence, 18,000
women and 8,000 men suffer preventable cancers of the cervix, anus,
penis and throat; it’s the most common, and except for H.I.V., the most fatal sexually transmitted disease.
Another
common misperception is that the HPV vaccine is ineffective and
immunity is short-lived. But the truth is that the HPV vaccine is
virtually 100 percent effective at preventing the precancerous lesions
caused by the types of HPV contained in the vaccine, which would most
likely prevent most cervical cancers. Regarding how long immunity will
last, the HPV vaccine is made in the same manner as the hepatitis B vaccine, for which immunity lasts at least 30 years. Immunity provided by the HPV vaccine is likely to be no different.
Further,
some high-profile — and highly irresponsible — claims have been made
that the vaccine is unsafe. The HPV vaccine has now been studied in more
than a million women to determine whether it causes any serious side
effects. It doesn’t. There is no scientific support for the suggestion
by the onetime presidential hopeful Michele Bachmann that the HPV
vaccine could cause “mental retardation,” or for Katie Couric’s giving voice to the notion that it may have caused illnesses and death.
Finally,
some fear that the HPV vaccine may increase sexual promiscuity. A study
of 1,243 young women and girls between the ages of 15 and 24 alleviated
this concern. Those who received the HPV vaccine were not more likely
to engage in risky sexual behavior. Nor did it make sense that they
would. The HPV vaccine doesn’t prevent other sexually transmitted
diseases, like chlamydia, gonorrhea, herpes and syphilis.
Indeed, the HPV vaccine doesn’t even prevent all types of HPV, just the
majority of those most likely to cause cancer. This argument would be
analogous to the claim that people who received a tetanus vaccine could run across a bed of rusty nails with impunity.
When
the C.D.C.’s Dr. Schuchat stood in front of the media in July and
analyzed the woeful rates of HPV vaccination, she didn’t mention any of
these misperceptions. Rather, she offered something else. Adolescents
weren’t getting the HPV vaccine because doctors weren’t recommending it
strongly enough. In fact, one of the top reasons parents gave for not
vaccinating was the lack of a recommendation from their health care
providers. A likely reason: Doctors are uncomfortable talking about sex
with 11-year-olds. So, what to do? How do we separate “the sex talk”
from the first dose of HPV vaccine?
Amy
B. Middleman, chief of adolescent medicine at the University of
Oklahoma College of Medicine offers one solution in the coming NOVA
television special “Vaccines — Calling the Shots”: Don’t talk about sex.
“The sex part,” says Dr. Middleman, “the way in which you get the
target disease, is irrelevant. We don’t talk about diphtheria, and how
you can get diphtheria, before we give the Tdap vaccine.” In other
words, it’s not about sex. It’s about cancer.
The
fact remains that millions of adolescents aren’t getting a vaccine to
prevent a known cause of cancer. It takes about 20 years for an HPV
infection to progress to cancer. That’s when the bill is due. Given
current rates of immunization, somewhere around 2,000 adults every year
whose parents had chosen not to give them the HPV vaccine will probably
die from a preventable cancer. It’s unconscionable. And doctors will
have only themselves to blame.
Paul A. Offit
is a professor of pediatrics in the division of infectious diseases,
and director of the Vaccine Education Center, at the Children’s Hospital
of Philadelphia.
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