COMMENTARY

HPV Vaccine: It's About Cancer Prevention -- Not Sex

Paul A. Offit, MD

Disclosures

September 12, 2014

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Hi. I am Paul Offit, and I am speaking to you from the Vaccine Education Center at the Children's Hospital of Philadelphia. Today I want to talk about immunization of teenagers. In July 2014, the Centers for Disease Control and Prevention released the National Immunization Survey - Teen,[1] which showed just how well we are doing.

There are three vaccines recommended for teenagers. One is the Tdap vaccine (tetanus, diphtheria, and acellular pertussis); the second is the meningococcal vaccine, which contains the meningococcal serum groups ACY and W135; and the third is the HPV (human papilloma virus) vaccine.

With the Tdap and meningococcal vaccines, we are doing pretty well. Immunization rates are roughly in the 80% to 85% range, but for the HPV vaccine, the immunization rate is woeful. For girls completing the three-dose series, the immunization rate is around 38%; for boys it is 14%. The question is, why? Why are we better at giving Tdap and meningococcal vaccines than we are at giving the HPV vaccine? It certainly is not because Tdap and meningococcal diseases are more important than HPV-related cancers. If you take all four of those diseases -- tetanus, diphtheria, pertussis, and meningococcal diseases combined -- the number of deaths is 20-fold less than the number of deaths related to HPV every year. It certainly cannot be an issue of safety. The HPV vaccine is probably the best studied vaccine post-licensure in the United States. More than one million people have been followed to learn whether the HPV vaccine causes any important adverse effects, and it does not. The only real adverse effect is postinjection syncope or fainting.

The third issue that is raised for this vaccine is, how long does the immunogenicity last? How long are people immune to HPV infection following vaccination? We certainly know that immunogenicity after this vaccine lasts at least eight years because the vaccine was first licensed in 2006, so we have eight years of data. For at least eight years, one has an anamnestic response, and we certainly know that for the hepatitis B vaccine, which is made in a manner that is virtually identical to the HPV vaccine, immunity from hepatitis B lasts at least 30 years, so I believe we can say with confidence that HPV immunity will probably be lifelong.

Talk About Cancer, Not Sex

I believe the primary reason we are not very good about giving this vaccine is that we feel compelled to talk about the nature in which it is transmitted; we feel compelled to have the sex talk at the time we give the first dose of HPV vaccine. In an upcoming NOVA television special, "Vaccines -- Calling the Shots," Amy Middleman, Chief of Adolescent Medicine at University of Oklahoma College of Medicine in Oklahoma City, says this quite well: "Why do we feel compelled to talk about transmission of HPV when we do not talk about transmission for any other vaccine, including hepatitis B, which also can be transmitted via sexual contact?"

There are many reasons why people are not getting the HPV vaccine. One reason is cost and another is insurance reimbursement, but one of the biggest reasons is that physicians are hesitant to talk to 11- and 13-year-olds about vaccines when they feel compelled at the same time to talk about the sexual nature of the virus's transmission.

I believe we should think of this vaccine as what it is -- a cancer-preventing vaccine. Let's talk about cancer rather than sex. Thank you.

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