Routine, recommended vaccines in the US currently offer some level of protection against 17 infectious diseases. One of these vaccines targets preteen boys and girls between 11 and 12 years of age—the human papillomavirus (HPV) vaccine. According to the 2017 Centers for Disease Control and Prevention (CDC) National Immunization Survey (NIS)-Teen, this vaccine is not widely used. Only 66% of boys and 67% of girls had received at least the first vaccine dose by age 15. Even fewer completed the full vaccine series of 2 to 3 doses—just 53% of girls and 48% of boys.
In 2010, a 10-year national goal was set to increase the rate of HPV vaccination in pre-teens by age 15 to 80% by 2020. The goal is part of Healthy People 2020, a nationwide program of wellness goals set by the US Department of Health and Human Services (HHS). In 2012, only 28% of girls and 7% of boys had completed the HPV vaccine series by age 15. Since 2012, the rate of teen HPV immunization has increased about 5% each year, but there is still a long way to go to reach the target of 80% by 2020.
HPV is a group of more than 150 types of viruses. About 40 of these viruses are sexually transmitted and can infect the genital and oropharyngeal (throat, tonsils, base of tongue) areas of men and women. Approximately, 8 out of every 10 Americans will have an HPV infection, often acquiring it early in their sexual experience. Almost 80 million Americans are already infected with HPV. About 14 million new cases are reported every year.
Most people who become infected with HPV will have no symptoms and will clear the infection naturally. However, the virus may remain in the body for years. In some people, certain types of the HPV infection will lead to cancer. In the US, about 43,500 new cases of cancer are caused by HPV every year—24,000 cases in women, and 19,000 cases in men. Most of these cases are caused by just one or two types of the virus: HPV16 or HPV18.
In women, cervical cancer is the most common HPV-associated cancer, causing almost 13,000 new cases and 4,000 deaths each year in the US. Almost all cervical cancer is caused by HPV. In men, oropharyngeal cancer is the most common HPV-associated cancer.
The number of HPV-associated oropharyngeal cancer cases has more than tripled since 1988, making it the most common HPV-associated cancer in the US. For example, in 2015, there were a total of 18,917 new HPV-associated oropharyngeal cancer cases in both men and women, compared to 11,788 new cervical cancer cases in women. HPV also causes other cancers in men and women, including cancers of the vagina, penis, and anus.
The US Food and Drug Administration (FDA) initially approved three HPV vaccines: Gardasil in 2006, Cervarix in 2009, and Gardasil 9 in 2014. All three vaccines prevent infections with HPV16 and HPV18, which cause about 70% of cervical cancers and an even higher percentage of other HPV-associated cancers. Because Gardasil 9 also prevents infection with the same four HPV types plus five additional types of the virus, Gardasil 9 has been the only HPV vaccine available in the US since May 2017. This vaccine also prevents infection with the two types of HPV that cause most genital warts (not a cancer).
The HPV vaccine works by helping the body to produce antibodies against the infection, without actually causing the infection. The vaccine contains virus-like particles that mimic the HPV virus. After receiving the vaccine, the body learns to fight the real virus.
But the HPV vaccine only works if it is administered to the person before they are exposed to the 9 types of HPV infections targeted by the vaccine. It will not cure an existing HPV infection or HPV-caused diseases, nor will it lower the risk of getting cancer from an HPV infection acquired before vaccination. Thus, the vaccine is most effective if given to preteens before they become sexually active.
According to the latest NIS-Teen, the most common reason preteens had not started the HPV vaccine series by age 15 was a mistaken belief that the vaccine was not necessary.
First, parents may not be aware that the HPV vaccine is a cancer-preventing vaccine. Many are also unaware of how prevalent HPV infection is in the US in both women and men. In fact, the latest NIS-Teen showed that 10% of the parents of girls and 19% of the parents of boys had not been told by their preteen’s healthcare provider about the HPV vaccine or the link between HPV infection and certain cancers. Because the vaccine was approved for girls a few years before boys, changes in practice and awareness of HPV-associated cancers in boys may be lagging behind.
Also, the timing of the vaccine has been questioned by parents. The CDC recommends starting the vaccine at age 11 to 12 (or as early as age 9 in certain circumstances). However, parents may believe that, if their child is not sexually active, they do not need the vaccine. But, according to the Immunization Action Coalition, vaccination starting at age 11 or 12 will provide the best protection possible long before the start of any kind of sexual activity. It is standard practice to vaccinate people before they are exposed to an infection, as with measles and the other recommended childhood vaccines. Similarly, we want to vaccinate children before they get exposed to HPV. Numerous studies have shown that getting the HPV vaccine does not make preteens more likely to be sexually active or to start having sex at a younger age.
Studies of HPV vaccine also indicate that younger adolescents respond better to the vaccine than older adolescents and young adults. Healthy children vaccinated at this age will need only 2 doses of vaccine rather than 3 doses if vaccinated at an older age.
Furthermore, by the time a child is 11 or 12 years old, they may no longer visit a pediatrician or another doctor for well visits. Thus, they may miss the vaccines intended for preteens.
Although HPV vaccination rates are rising, there are still too many unvaccinated boys and girls that are vulnerable to devastating HPV-associated cancers later in life. Vaccination could prevent most of these cancers. If you or your child are between 9 and 45 years of age, consider the recommendations below, which are intended to promote effective vaccination of both male and female preteens and adults against HPV and HPV-associated cancers.
If you or your child are between 9 and 45 years of age, consider these recommendations to promote effective vaccination of both male and female preteens and adults against HPV and HPV-associated cancers.
Learn about the HPV vaccine. Before your next visit to a healthcare provider, go to the CDC website to learn more about the HPV vaccine. Be sure not to miss:
• HPV Vaccine for Preteens and Teens
• Questions and Answers about HPV and the Vaccine
• Video and audio resources about the HPV vaccine
• HPV Vaccine Information Statement
• HPV Vaccination: What Everyone Should Know
Talk to your healthcare provider. Don’t wait for your doctor or your preteen’s doctor to bring up the HPV vaccine. Ask questions about the vaccine, its importance, and the recommended vaccination schedule. If you still have questions, talk to your pharmacist.
Vaccinate before becoming sexually active. HPV vaccination prevents a variety of cancers that affect both boys and girls, but it will not work unless it is on board before HPV infection occurs. Thus, it’s important to get boys and girls vaccinated before they become sexually active. There is no reason to delay vaccination until teens reach puberty or start having sex. The recommended age of vaccination is 11 to 12, although it can be started as early as age 9 and as late as age 45. If you or your teen are already sexually active, still get vaccinated. You might not have been exposed to all of the HPV types that are covered by the HPV vaccine.
Complete the full series. Once you receive the first dose of the HPV vaccine, be sure to complete the series with a second and/or third dose. If the first dose is administered before age 15, only a second dose is needed 6-12 months after the first dose. If the first dose is administered at ages 15 through 45 years, three doses are needed, with a minimum of 4 weeks between the first and second dose, a minimum of 12 weeks between the second and third dose, and a minimum of 5 months between the first and third dose. Three doses are also recommended for people age 9 through 45 years who have a weak immune system.
Consult your doctor. The CDC does not recommend routine revaccination with Gardasil 9 for people who have already completed a 3-dose series with Gardasil. However, data indicates that revaccination with Gardasil 9 after a 3-dose series of Gardasil is safe. So, consult with your doctor to decide if the benefit of immunity against 5 additional strains of HPV that could cause up to 12% of all HPV-related cancers is justified.
Continue cervical cancer screening. Current HPV vaccines do NOT protect against all HPV infections that cause cervical cancer. Vaccinated women should continue to undergo cervical cancer screening.
