The ‘Need-To-Know’ on the HPV Vaccine
By Space Coast Medicine // April 16, 2013
Experts Highly Recommend HPV Vaccination
BREVARD COUNTY • MELBOURNE, FLORIDA—The development of the human papillomavirus (HPV) vaccine provides an opportunity to prevent the majority of HPV infections that cause genital warts and cervical cancer. Although the vaccine is largely recognized as a medical breakthrough, its acceptance by the public has, for several reasons, been slow. Contributing factors include underestimation of HPV risk, the challenge of completing a three-shot regimen, concerns about cost, and parental barriers to acceptance. Although there has also been some public concern about vaccine safety in general, HPV vaccines have excellent safety records.
We at Space Coast Medicine and Active Living magazine and SpaceCoastDaily.com are delighted to welcome an expert in the field, gynecology oncology nurse practitioner Alice Spinelli, to address some of the frequently asked questions about HPV infections and the vaccine,
SCM&AL: What is HPV and how common is it?
Ms. Spinelli: HPV or Human Papillomavirus is a group of common viruses that in the most benign type can cause common warts, genital warts as well as some cancers. There are more than 100 types of HPV and approximately 35 different types of genital HPV. It is the most common sexually transmitted infection. Approximately 80% of sexually active people will get an HPV infection sometime in their lives, and it is estimated that over 20 million people in the United States are currently infected with HPV. Since it is so common, there is nothing to be ashamed of. Almost everyone has been exposed though not everyone will develop an infection or manifestation of the virus.
SCM&AL: What diseases are associated with HPV?
Ms. Spinelli: Cervical cancer is the only human cancer that is attributable to infection with a virus. HPV DNA is present in 99% of cervical cancer and its precursors, and HPV types 16 and 18 are found in 70% of invasive cervix cancer. This is why the HPV vaccines target these 2 types. The vaccine, Gardasil®, also covers HPV 6 and 11, the types responsible for genital warts or condyloma. Vulvar, vaginal, anal cancers and their precursors, penile cancer, oropharyngeal cancers (especially tonsil and tongue cancers) are also associated with HPV infections. The incidence of vulvar, anal and oropharyngeal cancers has increased, the latter two especially among men.
SCM&AL: How do I know if I have HPV?
Ms Spinelli: The most common manifestation is genital warts, which can affect both males and females. Otherwise there are no symptoms of HPV infection. Routine pap tests can detect the presence of HPV and related cervical abnormalities. Pap tests have decreased the risk of dying from cervix cancer by 90%. It is the only test that can actually help prevent a cancer. As the HPV vaccines do not cover all types of HPV, it is still important for women who’ve been vaccinated to have routine pap screening. There is currently no HPV test recommended for men.
SCM&AL: How can I best protect myself or my children from HPV related diseases?
Ms Spinelli: Avoid exposure by limiting the number of sex partners. Avoid initiation of genital sexual activity at a young age (</ = 15 years old). Smoking and immunosuppression are risk factors and can decrease the ability to clear an infection, but are not required to develop an HPV infection or related disease. Condoms offer some protection, but do not cover all areas involved in sexual contact. What’s the best protection? Get the HPV Vaccine!
SCM&AL: What is the HPV Vaccine and how is it given?
Ms. Spinelli: Gardasil ® is currently recommended by the CDC (Center for Disease Control) for boys/men and girls/women age 9-26 years old. However it is ideally recommended for boys and girls 9-10 years old, prior to sexual debut and at an age when the immune system is most robust. The vaccine is given in 3 injections: initial dose with a second dose 2 months later, third dose 3-6 months after the initial dose. The best protection is achieved when all 3 shots are given. It is not yet known if booster shots will be required.
SCM&AL: Is the HPV vaccine safe and effective?
Ms. Spinelli: Yes and yes! The vaccine was first recommended for girls in 2006 by the CDC and later for boys in 2011. It has been studied for many years on thousands of people around the world and there have been no significant adverse reactions. The side effects can include: redness and swelling at the injection site, fever, nausea and headache.
The HPV vaccine is highly effective with 99% efficacy against preventing cervical disease associated with the types included in the vaccine. This protection decreases to 44% if previously exposed, validating the rationale and importance of vaccinating children. The vaccine has also proven to be effective against condyloma in men.
SCM&AL: What organizations endorse the vaccine?
Ms. Spinelli: The HPV vaccine is recommended by the CDC, the FDA, the ACIP (Advisory Committee on Immunization Practice), ACS (the American Cancer Society) ACOG (the American College of Obstetricians and Gynecologists), AAP (American Academy of Pediatrics), NPWH (Nurse Practitioner’s in Women’s Health) and other professional organizations.
SCM&AL: Does insurance cover the vaccine?
Ms. Spinelli: Yes. As part of the Vaccine for Children’s program, the HPV vaccine is available to all children of appropriate age in Florida. Private insurance and Medicaid also cover the cost of the vaccine and insurance coverage will be required in the Affordable Care Act.
SCM&AL: Are children receiving the vaccine as recommended?
Ms. Spinelli: Unfortunately no. The HPV vaccine is under-utilized in the United States. While Healthy People 2020 targets a goal of 80%, only 35% of girls and only 2% of boys have completed all 3 injections. In Australia and the UK 70% have been vaccinated.
SCM&AL: What are the barriers to acceptance of the vaccine by parents?
Ms. Spinelli: Studies indicate parents who do not accept the vaccine report safety concerns and fear the vaccine would promote early sexual activity. The acceptance rate improved from 45% to 75% after reading educational materials. A study following 1400 girls found no evidence that those who were vaccinated beginning around age 11 went on to engage in more sexual activity than girls who were not vaccinated.
Inadequate provider recommendations are also a concern. One study from the NIH (National Cancer Institute) found only 53% of primary care physicians followed the CDC’s HPV vaccine recommendations. Success of the vaccine is dependent on acceptance by clinicians, patients, and parents. Clearly, HPV vaccine education is essential!!!
ABOUT THE EXPERT
Alice Spinelli is a nurse practitioner with Health First Medical Group, working with gynecologic oncologist Dr. John Bomalaski. She earned a BS in Nursing at Florida State University, NP Certification from the University of Virginia and a MS in Nursing at the University of North Carolina at Charlotte. A previous president in 2002-2004 of the Society of Gynecologic Nurse Oncologists (SGNO), she also served on the SGNO board of directors from 1992-2005. Among Ms. Spinelli’s many professional achievements she has authored several articles on gynecologic cancers for public and professional publications including peer review journals, chapters on cervix cancer for nursing texts and participated in Merck’s oncology expert input panel on the development of the HPV Vaccine, Gardisil.