Questions & Answers on HPV (Human Papilloma Virus) vaccine
Dr. Edward Layne and Dr. Stephanie K. Dilsuk
(Commentary to follow by Dr. Dr. John D. Cochran, Pathologist and Dr. Earl G. Long, Infectious Diseases consultant)
Conclusion: the “Human Papilloma Virus” commonly referred to as “HPV” is the most common cause of cervical cancer in the United States and probably in the world. The HPV virus is also associated with other serious problems in sexually active individuals, including other forms of head and neck cancer and of genital cancer.
Patients with weak or compromised immune systems are especially susceptible to infection by the HPV virus. The Centers for Disease Control and Prevention (CDC) currently recommends that children and young adults between ages 11 and 26 receive the HPV vaccine.
The decision to give or not to give the HPV vaccine to your child or young adult is a very personal one. Parents react to this decision in different ways. Some parents say “yes” as a knee-jerk reaction to vaccinations and some parents say “no” because they do not believe in any vaccinations.
The facts are that children are having sex at an earlier age and the risks and consequences of infection with the HPV virus are very real. We suggest that you research this vaccine thoroughly before making a decision about giving this vaccine to your child. A recent study in the journal Pediatrics looked at parents who opted out of allowing their children to get the vaccine. 17 % of the parents stated that their reason for opting out was that the vaccine was either unnecessary or unwanted.
This article details a typical conversation between a concerned parent and her childrens’ doctor. The names have been changed to protect the parties. This article is followed by some brief questions and answers about this vaccine.
Chapter 1. A Conversation on HPV
“Good morning Mrs. Williams, the doctor will see your daughter in a moment. Can you please ask Alexis to watch the TV and play with the other children in the waiting room for a few minutes? I would like to speak with you in private in my office?”
Mrs. Madeline Williams returned the friendly nurse’s smile. “Of course, “And please call me Madeline.” She replied as she entered the nurse’s office.
Madeline, our records indicate that Alexis has not yet had her first dose of the HPV vaccine. Would you like us to administer the vaccine today?”
Madeline looked over at her 11 year old daughter to make sure Alexis was out of earshot before asking the nurse what the vaccine was meant to guard against. She had heard her girlfriends and co-workers talking about this vaccine and she had seen the ads on television but she needed much more information.
“I need to know more about this vaccine before I would consider giving it to my daughter”. Madeline replied.
Conflicting thoughts raced through Madeline’s mind as she listened to the nurse explain that the vaccination was meant to guard against Human Papilloma Virus or “HPV”, one of the most common sexually transmitted infections in the United States. Madeline was angry about the invasion of her daughter’s privacy and she was also puzzled. Why was this subject of HPV being raised about her innocent 11 year old daughter? Did the nurse know something about her daughter that she didn’t know?
Chapter 2. A Conversation on HPV
In the last chapter, Madeline takes her 11-year-old daughter to the pediatrician and is stunned when the nurse asked her whether she would like to have the HPV vaccine administered to her 11-year-old girl on this visit.
“Thank you for asking Nurse, but this entire subject of giving HPV vaccine to my children is something that I think I would rather discuss in person with the doctor!” Madeline said politely and got up to leave the office.
The shock was obvious on Madeline’s face. As far as she knew, her daughter was not sexually active and she had no need for an HPV vaccine at such a tender age. As Madeline saw it, her little girl was years away from needing such a vaccine. How could she say “yes” to such a request?
Madeline made a mental note to inform the Pediatrician that her staff was out of line for raising the subject of sexually transmitted diseases with her young daughter. She took her little girl by the hand and marched her into the examination room when her name was called. She immediately informed the pediatrician that her staff was offering children inappropriate shots.
“Did you know that your staff is offering minors vaccinations against STDs? Your nurse offered to give my little girl Alexis the vaccination against the HPV virus. Why would she be offering this vaccination to such a young child? I thought my daughter was only supposed to get the meningitis and tetanus shots today?”
Madeline was more than surprised when the Pediatrician informed her that the US Centers for Disease Control and Prevention (CDC) recommended that all children, teenagers and young adults in the US should receive the vaccine.
“I understand your concern, Mrs. Williams, but the CDC has recommended that children 11 years and older get the HPV vaccine. We give it up to children and young adults up to age 26. It’s not a mandatory shot, but it is highly recommended”, the pediatrician patiently explained.
“She said children, Mom. That means Jimmy needs to get it too,” piped-up 11-year-old Alexis.
“No, no Alexis! It’s a shot for girls!” Madeline said, trying to silence her daughter. Madeline was certain that she did not want her daughter to be hearing this conversation. The Pediatrician was silent, but Madeline did not like the nod he gave to Alexis and the look of assent on his face.
Alexis, please step back out into the waiting room with the other children for a few minutes. I need to chat with the doctor in private. Ms. Williams held her daughter’s hand and guided down the corridor and back into the waiting area. She returned and faced the doctor squarely.
“Now you were saying something about giving this HPV shot to my children?”
Chapter 3. A Conversation on HPV
In previous chapters of this story, Madeline takes her 11-year-old daughter to the Pediatrician for a routine visit, and is asked to make the gut wrenching decision about giving HPV vaccine to her little girl Alexis. While she is considering decision, the Pediatrician also suggested that her son (Alexis’ 11-year-old twin brother) should also get the vaccine as well.
The pediatrician turned to Madeline after her daughter had left the exam room. “Actually, Alexis was right. The HPV vaccine is recommended for boys as well.” “If I remember correctly, Alexis and Jimmy are twins so we can give them the vaccine at the same time if you wish.”
Ms. Williams looked completely baffled. “Wait a minute, now I’m really confused!” Your nurse just told me that this HPV vaccine was for cervical cancer or something like that. My little boy doesn’t have a cervix! Why does he need the HPV vaccine?”
“You are correct Ms. Williams. The HPV virus does play a major role in causing cervical cancer and the HPV vaccine is given to young girls to prevent them from developing cancer of the cervix. But the HPV virus can also cause a number of other serious problems in addition to the cancer of the cervix, including:
Cancer of the penis in men
Cancers of vagina
Cancer of anus (rectal area)
Cancer of mouth, the base of the tongue, the tonsils and the back of the throat”.
“That sounds like an awful virus!” Ms. Williams exclaimed.
“It certainly is, Ma’am”, the Pediatrician continued. “The virus can also cause a rare condition in which cancer-like warts can grow in the back of the throat later in life. This is why we administer the HPV vaccine “Guardasil” to both boys and girls” the pediatrician explained. If you have any other questions I would be happy to answer them.
Well, all right! Ms. Williams said grudgingly. I have read that HPV stands for ‘Human Papilloma Virus’, but is this virus really as common and as they say it is?
“Roughly 79,000,000 Americans are thought to be currently infected with HPV and about 12 to 14,000,000 new people get infected every year.” The pediatrician replied. “HPV is so common that nearly all sexually active people will get at least one type of the virus at some stage in their lives.”
“You said it was a sexually transmitted infection. Can it be spread in any other ways?” Ms. Williams asked the pediatrician, still looking puzzled.
HPV can be passed on through sex but it can also be passed on during oral contact in some rare instances. A pregnant woman with genital HPV can pass it on to her baby during delivery. We have a good idea of how it is spread through sex but very few studies have examined how people get for HPV otherwise.
Oral sex is commonly cited example another route that can be used to spread the virus. Some studies even suggest that the virus can be passed on through open mouth kisses. However additional research is needed to fully understand how people get and pass on HPV infections.”
“But Doctor”, Mrs. Williams protested, “I am positive that my little girl has not been having sex with anyone! And if infection by the HPV virus is so common, how do we know that we don’t all have it in our systems?”
Chapter 4. A Conversation on HPV
Madeline has taken her 11-year-old twins (Alexis and her brother Jimmy) to the Pediatrician for a routine visit, and is advised that both children should receive the HPV vaccine. Madeline is shocked and is trying to understand the Pediatrician’s reasoning
“That’s a great question.” The Pediatrician replied. “An important fact to keep in mind is that it is possible to have HPV without knowing it, so many people can have the virus and pass it to their partners without them or their partner being aware of it.”
“Are HPV and HIV similar? And are you suggesting that my husband and I could have this virus in our bodies?”
“I was not making any judgment about you and your husband, Mrs. Williams. HPV is very different from HIV and it causes different problems. HPV lives on the skin while HIV lives in the blood. In addition, HIV leads to AIDS while HPV does not lead to AIDS but can lead to oral and genital warts and different types of cancer. It is important to know though that people living with HIV are more likely to get and develop problems from HPV due to their weak immune system.”
“Is it possible to prevent HPV even if children don’t get this vaccine?”
There are many ways to reduce the risk of HPV. We make the same recommendations to people who have gotten the vaccine, the vaccine is not foolproof but it is a great prevention tool. People can lower their risk of health problems from HPV by the following ways:
Women aged 21 – 65 should continue to get routine pap smears and follow-ups on any abnormal results.
Avoid tobacco and limit alcohol to help reduce the risk of cancers of the mouth and throat.
Use Condoms to reduce the risk of getting or transmitting genital warts.
“Can you explain to me how HPV causes cancer?”
It a complex process, but in brief, the HPV can damage your DNA and cause the normal cells of the skin to change into abnormal cells. These changes occur within your cells and most of the time you will not be able to see or feel them. Your body tries to combat the infection with your built in defense system (your “immune system”) but in many cases your body is unable to fight off the virus. If your body is unable to fight off the virus, HPV can cause changes in your cells’ DNA that leads to the lesions that we detect as “cancer.”
“From what you are telling me in this conversation it seems like this HPV vaccine should be given mainly to adults. Why is this vaccine recommended for children at such a young age? And why do you have to give my daughter three separate injections of the vaccine?”
Chapter 5. A Conversation on HPV
Madeline has taken her 11-year-old twins (Alexis and her brother Jimmy) to the Pediatrician for a routine visit, and is advised that both children should receive the HPV vaccine. Madeline is shocked to learn the facts about the HPV virus, including the fact that HPV virus can cause different forms of cancer in both males and females. In this Chapter, the Pediatrician continues to lay out the facts on HPV and Madeline is faced with the painful decision of whether to give the HPV vaccine to her two children
“Those are all great questions, Mrs. Williams. Studies on this vaccine have indicated that the HPV vaccine gives the best protection when 3 doses of the vaccine are given to pre-teens over a 6 month period as early as possible before any sexual activity begins. Studies have also shown that the immune response to the vaccine is better when it is given at age 11 or 12 than when given to older individuals.”
But doctor, I read somewhere that there are many different strains of the HPV virus and that this vaccine only protects against a few strains.
You are right about that Madeline, but people who get this HPV vaccine seem to get some lower level of protection against some of the other types of HPV viruses. Of course our goal is to vaccinate as people as possible before they become infected with any strains of the virus so that they can be protected against all strains of the virus.
“Why then are you only giving the HPV vaccine to people up to age 26?”
“The HPV vaccine has not been shown to be effective in preventing HPV in people over 26. In addition, the vaccine is not licensed to treat or eliminate the existing infection in persons who are already infected with the virus. As I noted earlier in our conversation, the HPV virus is very common and many sexually active adults and adults that have been sexually active at one point in their lives are already infected with one or more strains of the HPV virus.
Most of these unvaccinated adults do not have any signs of infection by the HPV virus. Giving the HPV vaccine to these adults will not prevent them from developing signs of HPV infection later in life, but we think that the vaccine will protect the young people that have received the vaccine from developing the signs and complications of HPV infection if they happen to become infected later in life.
“You mentioned Oral HPV, can you help me understand what that is?”
Essentially, the same strains of HPV which infect the male and female genital organs can infect the throat and mouth. This is called oral HPV. People who develop oral HPV can develop cancers of the head and neck area or warts in the mouth and throat later in their lives. In many cases, the infection goes away before it can cause any health problems, but there have been cases where it becomes a serious health issue many, many years later.
“How common is this oral HPV?”
“Recent studies have shown that roughly 7% of the US population has oral HPV.”
“That all sounds very scary doc! How can a person know if they have oral HPV?
Chapter 6. Conclusion of ‘A Conversation on HPV’
Madeline took her 11-year-old twins (Alexis and her brother Jimmy) to the Pediatrician for a routine visit, and was advised that both children should receive the HPV vaccine. Madeline was shocked to learn the scary facts about the HPV virus and the reasoning behind the Pediatrician’s recommendations. She makes a gut-wrenching decision about her daughter and is agonizing about what to do about her son.
As I mentioned earlier, Mrs. Williams, many people were infected with oral HPV have no signs or symptoms of oral HPV, but symptoms and signs of the Oral HPV can include the following:
Enlarged lymph nodes
Pain with swallowing
Constant sore throat
Unexplained weight loss
“Are there any risks to giving my child this vaccine?”
“The HPV vaccine has not been shown to have any serious side effects, but a vaccine can be considered a medication and any medication has the potential to cause problems. Those problems can include allergic reactions, pain at the injection site, redness, swelling, fever, itching and a few people faint when getting shots of any kind.
The experience so far with this HPV vaccine has shown that these problems are all temporary and manageable. If you have any reservations, it is to right to read more about this vaccine and educate yourself and your family before making a decision to give it to your children.”
“Doctor, can this HPV vaccine give my child an HPV infection?”
“The HPV vaccine is made from the outer protein coat of certain strains of the HPV virus and as far as we have been able to determine, this preparation cannot cause the HPV infection.”
“Will this vaccine stimulate my children’s sex hormones in any way?”
“As far as we know, The HPV vaccine does not affect hormone levels of your child and there is no evidence that the vaccine causes children to have unnatural sexual urges”.
“But if I give this HPV vaccine to my kids and they think that they are protected from some of these bad diseases will this encourage them to be sexually active earlier?”
“It’s a matter of talking to your children, Ms. Williams. All parents need to talk to their children and make sure that they are well informed about the possibility of pregnancy and sexually transmitted infections, sometimes called STI’s or STD’s. If you instill good morals in your children when they are young, then you have done your part and the rest is up to them.”
“That’s the truth! One last question doctor: If a female gets this HPV vaccination to protect her against Cervical Cancer, will she still need to undergo regular pap smears?”
“Yes. Females who receive this HPV vaccination to protect against Cervical Cancer will still need to undergo regular pap smears starting at age 21 as an extra precaution. Individuals should also remember that this HPV vaccine offers no protection against other sexually transmitted infections. All vaccinated patients are encouraged to practice safe sex by using condoms.”
“Thank you doctor, you’ve given me a lot of information.” Mrs. Williams replied. I think I will discuss this with my husband before I bring my son in, but in the meantime, I feel comfortable that we can start Alexis’s HPV vaccinations today.”
Conclusion: the HPV virus is the most common cause of cervical cancer in the United States and probably in the world. The HPV virus is also associated with other serious problems in sexually active individuals, including other forms of cancer of the head and neck and cancers of the genital area. Patients with weak or compromised immune systems are especially susceptible to infection by this virus. The Centers for Disease Control and Prevention (CDC) currently recommends that children and young adults between ages 11 and 26 receive the HPV vaccine.