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Blog DMA New York


Food for thought: "The Human Papillomavirus immunization and its public health efforts"

Luis G Abreu, MPH (candidate)*

Did you know that The Human Papillomavirus (HPV) is the most common sexually transmitted infection (STI) that also has more than 150 different types of virus strains? People who acquired the HPV will often state that they did not feel or notice their symptoms. An individual also can develop symptoms years after sexual intercourse with someone who is infected, which makes it hard to know when he or she first became infected. The virus infects the skin and genital area, depending on the infection area, and can lead to cancers of the cervix, vagina, vulva, penis, anus, mouth and throat [4]. Infections like these can be prevented by the simple administration of the HPV vaccine. In despite of public health efforts from primary care providers, local and state health authorities, there is still skepticism from parents and caretakers about inoculating their children against this serious illness.

When the first HPV vaccine was launched, (cervarix), it offered the buildup of immunity against virus type 16 and 18, which are the most common in the proliferation of cervical, vulvar/vaginal cancer. Then the quadrivalent vaccine was launched commonly known as Gardasil. [3] The new product offered safeguard against the same viruses as its predecessor but now including virus strains 6 and 11which cause genital warts and now including males in its scope of practice. The latest update to the vaccine added five more virus strains, called Gardasil 9. It offers additional immunity against virus strains type, 31, 33, 45, 52, and 58, which produce precancerous, or dysplastic lesions.

HPV Infection, HPV Testing and HPV Vaccine (Human Papilloma Virus). Published October 23, 2017.

Despite of the range of protection against many virus strains, the HPV vaccine has not been accepted and welcomed by parents and caretakers. Surveys from the Center for Disease Control and Prevention show that in 2011 approximately half of females aged 13–17 years sampled had not yet received the recommended first HPV vaccine dose, and nearly two thirds had not received the ?3 doses required for series completion [6].
In a recent survey performed in 2016, the CDC showed that, during 2014–2015, coverage among adolescents aged 13–17 years, there was increased for each HPV vaccine dose among males, including ?1 HPV vaccine dose (from 41.7% to 49.8%), and increased modestly for ?1 HPV vaccine dose among females (from 60.0% to 62.8%) [5].

What has been the difference? And why are there more vaccinated children than before? This steady growing rate of HPV immunization is thanks to the nonstop labor of public health agencies that are trying to educate target population through the media and constant education and promotion from pediatricians and health care providers. Now, in order to be able to fully vaccinate preteens and adolescents, the CDC is now recommending the administration of two doses of the HPV vaccine, instead of three. With this new addendum, the rate of preteens and adolescents receiving the full series of the vaccine is projected to increase as they will receive it alongside with their T-dap and Meningococcal immunizations.

But what are the myths and ideals that have prevented parents and surrogates from vaccinating their children against this multi-strained virus? To begin with, immunizations have a simple but mild painfully way to be administered, which is most commonly intramuscular. Pain, redness, or swelling in the arm where the shot was given have been reported after the administration of the vaccine when compared to other vaccines. Some cases of fever, headache, or nausea have been reported as well [1].

There is also a gender gap on the recipients of the vaccine. Statewide and nationally, adolescent girls were inoculated at much higher rates than boys in 2015 [1]. Nationwide, 42% of girls and 28% of boys received all three shots, the CDC data show. Nationally, Hispanic girls (46%) and boys (35%) received all three doses, compared to African American girls (41%) and African American boys (26%), and white girls (40%) and white boys (25%), the CDC reports [1].

These scenarios, as well as the misperception that the vaccine contains doses mercury (which it does not) [2], make parents and caretakers skeptical and adverse on accepting the administration of the vaccine. Yet their main concern is that getting their children this vaccine will provoke promiscuity or will “wake up their sexual appetite” at a young age.
As drastic as it sounds, it is better to receive inoculation against this life-changing virus rather than being diagnosed and treated with radiation or chemotherapy, and having a shorter life expectancy. As a health care professional who worked in a Latino community for five years, I have witnessed the increase on the acceptance of the vaccine, thanks to nonstop efforts from local and state health care providers and authorities. Yet, it is imperative that parents become well-known of the risks that imply rejecting the HPV vaccine for their children and become familiar with the benefits of the vaccine. Public health practitioners strongly encourage parents to talk to their child’s pediatrician about how to approach their youngsters about “the talk”. Educating parents and caretakers should not only be perceived as a way to convince them on getting their children vaccinated against the HPV, but in a way to promote preventive health care, which in the long run, will only benefit their them both physiologically and intellectually

• Luis G Abreu, MPH (Candidate); A research staff associate for the Taub Institute for Research on Alzheimer's Disease and the Aging Brain at the Columbia University Medical Center. Bachelors in Health and Clinical Sciences from CUNY Lehman College.

1. Frequently Asked Questions about HPV Vaccine Safety. Centers for Disease Control and Prevention. Published October 21, 2016. Accessed January 26, 2017.
2. Gardasil (Human Papillomavirus Vaccine) Questions and Answers - Gardasil, June 8, 2006. Accessed January 26, 2017.
3. M. GARDASIL®9 (Human Papillomavirus 9-valent Vaccine, Recombinant). GARDASIL®9 (Human Papillomavirus 9-valent Vaccine, Accessed January 26, 2017.
4. McGill University. Hitch cohort - McGill University. Accessed January 26, 2017.
5. National Human Papillomavirus Vaccination Coverage among Adolescents Aged 13–17 Years — National Immunization Survey – Teen, United States, 2011. Centers for Disease Control and Prevention. Published September 12, 2014. Accessed January 26, 2017.
6. National, Regional, State, and Selected Local Area Vaccination Coverage among Adolescents Aged 13–17 Years — United States, 2014. Centers for Disease Control and Prevention. Published July 31, 2015. Accessed January 26, 2017.
7. HPV Infection, HPV Testing and HPV Vaccine (Human Papilloma Virus). Published October 23, 2017. Accessed April 4, 2018.