“The single biggest problem in communication is the illusion that it has taken place.” - George Bernard Shaw
“If you have an important point to make, don’t try to be subtle or clever. Use a pile driver. Hit the point once. Then come back and hit it again. Then hit it a third time—a tremendous whack.”
- Winston Churchill
Human papilloma virus (HPV) can be detected in 99.7% of cervical cancers. According to the World Health Organization (WHO), in 2018 an estimated 570,000 women were diagnosed with cervical cancer worldwide, and about 311,000 women died from the disease. Most of these deaths occurred in countries where the average income was in the low to middle range. But it is estimated that this year in the U.S. 14,480 women will be diagnosed with invasive cervical cancer, and by the end of the year, 4,290 will have died from it.
There is a simple way, however, to prevent cervical cancer and these tragic deaths—the HPV vaccine. This vaccine not only prevents cancer of the cervix but also cancers at other body sites in women (vulva/vagina), in men (penis), and in both genders (anus, mouth, and throat). Nonetheless, some parents are not having their children vaccinated with this cancer preventative vaccine. So when an article appeared in the February 9, 2021 issue of Health Day News entitled, “More Parents Balking at Giving Kids Cancer-Fighting HPV Vaccine,” I thought it’s time for a Germ Gems post on this extraordinary vaccine and on the basis for the parental vaccine hesitancy.
What is HPV infection? There are more than 100 types of HPV, a DNA virus from the Papillomaviridae family. At least 14 HPV types cause cancer, but two types, 16 and 18, cause 70% of cervical cancers and pre-cancerous cervical lesions. Type 6 and 11 cause 90% of genital warts, and other HPV types are associated with additional clinical conditions.
All HPV types are transmitted by sexual activity. In fact, HPV is the most common sexually transmitted disease globally. At some point in one’s life, nearly every individual is or has been infected by HPV. There is, therefore, no room for stigmatizing anyone who is infected with HPV.
About 90% of HPV infections cause no symptoms and resolve spontaneously (go away on their own) within two years. But in some cases, HPV infection persists and results in venereal warts or precancerous lesions of the cervix, vulva/vagina, penis, anus, mouth, or throat. Risk factors for persistent infection include early age of first sexual intercourse, multiple sexual partners, smoking, and poor immune function.
Discovery of cause of cervical cancer led to vaccine. In the early 1970s, the prevailing hypothesis was that herpes simplex virus-2 caused cervical cancer. Going against this dogma, Professor Harald zur Hausen, a German virologist, postulated and later proved that HPV-DNA could exist in a non-productive state in tumors and was the cause of cervical cancer. He also discovered that HPV is a heterogenous family of viruses and that only some HPV types cause cancer. His discoveries led to characterization of the natural history of HPV infection, an understanding of how the virus causes cancer, and to the development of HPV vaccines. For his groundbreaking work, he was awarded the Nobel Prize for Physiology or Medicine in 2008, the same year that Francoise Barre-Sinoussi and Luc Montagnier received a Nobel Prize for their discovery in 1983 of HIV, another sexually transmitted viral pathogen.
HPV vaccinations. Several pharmaceutical companies manufacture a HPV vaccine. Regardless of the company or brand name, HPV vaccines are both safe and effective. In fact, the HPV vaccine now used in the United States protects against nine types of HPV, including types 16 and 18. For the vaccine to be most effective, however, the vaccine series should be given before children are ever exposed to the virus. To prevent the six HPV-related cancers mentioned above (cervix, vagina, penis, anus, mouth and throat), the Center for Disease Control and Prevention (CDC) recommends that allchildren receive the HPV vaccine containing types 16 and 18 by the ages 11-12 years (the vaccine series can be started at age 9 years).
HPV vaccines are administered as a two-dose series (with an initial shot and a booster at 6-12 months) for most persons who initiate vaccination at ages 9 through 14 years, and a three-dose series (with an initial shot, a booster at 1-2 months, and a second booster at 6 months) for persons who initiate vaccination at ages 15 through 45 years, and for immunocompromised persons. In addition to primary prevention of cervical cancer with HPV vaccine, the American Cancer Society recommends screening strategies for cervical cancer based on a woman’s age, screening history, and risk factors.
HPV vaccines prevent cancer. Many authorities on vaccines think that when the HPV vaccine was first released it wasn’t marketed properly, that is, the message for vaccination focused on the vaccine’s ability to prevent HPV infection rather than on its ability to prevent cancer. Also, it was not made clear that in addition to cervical cancer, HPV causes penile, anal and oral cancers. In other words, the HPV vaccine benefits males as well as females.
Responding to concerns about growing parental reluctance to have their children vaccinated against HPV, researchers at the University of Texas Health Science Center in Houston carried out a study aimed at understanding the trajectory of acute HPV vaccine hesitancy. The results of this study were published in the February issue of the journal Pediatrics, “HPV Vaccine Recommendations and Parental Intent.” Kalyani Sonaware, the lead author of this study, expressed its most important result: “The public message about the HPV vaccine should highlight that the vaccine protects against cancer. It is important to emphasize to parents that the vaccine offers protection against six cancers, because data indicates that many people are not aware of this fact.”
In most instances it is a parent who makes the decision about whether to get a HPV vaccination for their daughter or son. In the Texas study, the researchers also discovered that parental reluctance to HPV vaccinations is largely due to safety concerns. Therefore, parents need to know the basics about the HPV vaccine.
First and foremost, the vaccines are safe. The most common side effects of HPV vaccines are soreness, swelling, or redness at the injection site. Second, they work. Clinical trials and post-marketing surveillance have shown that HPV vaccines prevent HPV infections, and data from the CDC show that vaccination reduces the numbers of cervical precancers (lesions that can become cervical cancers). Nonetheless, many parental decisions about the HPV vaccine are influenced negatively by anti-vaxxers’ postings on social media.
Where can parents find trustworthy information about HPV vaccines? HPV cancers are global and so too is the pandemic of misinformation about the HPV vaccine posted on Facebook and other social media by anti-vaxxers. A recent article from New Zealand, “Gardasil [the Merck Sharpe & Dohme vaccine]: Myths, Misinformation and Lies about the HPV vaccine,” described this phenomenon. Moreover, in a recent study out of the University of Missouri, researchers reported that more than 45% of identified Facebook posts about the HPV vaccine had a negative tone.
It is obvious from my other Germ Gems posts that I have no tolerance for anti-vaxxers and the pandemic of vaccine misinformation they foster on social media. My June 4, 2019 post, “The Vexatious Anti-Vaxxers” dealt with their involvement in an alarming upsurge of measles cases in the United States. And on December 2, 2020, on the cusp of COVID-19 vaccine approvals, the post, “Anti-maskers and Anti-vaxxers: A New Coalition?” highlighted a dangerous collaboration of people hellbent on derailing public confidence in health measures aimed at stopping the spread of SARS-CoV-2. Now I write again with respect to the HPV vaccine. I cannot stress enough that this has been proven to be a safe vaccine that prevents cancers and should be given to all children.
Unlike the on-line social media sites that foster misinformation, trustworthy information about HPV vaccines can be found on the websites of the CDC and the WHO. Check them out! But in my opinion, one’s family physician or a child’s pediatrician is the best source for recommendations about vaccinations for children and adolescents. These doctors can be trusted to have your children’s best interests in mind when recommending any treatment or vaccination. After all, their job is to keep their patients alive and well, and they take an oath to “do no harm.”
The need to stem the tide of parental vaccine hesitancy. In a January 20, 2021 article in the New England Journal of Medicine “Vaccinating Children against Covid-19—The Lessons of Measles,” the authors stated, “[W]e need to think creatively and empathically about what motivates parents to accept vaccination for their offspring.” Parental vaccine hesitancy is likely to take on greater urgency as Pfizer, Moderna and AstraZeneca, along with its partner the University of Oxford in England, have all begun clinical trials testing their COVID-19 vaccines in children. It is therefore imperative that we gain a better understanding of the basis for parental vaccine hesitancy and take measures to prevent the rampant spread of misinformation about all vaccines on social media.
As Jeffery Kluger, senior writer at Time magazine wrote: “Vaccines save lives; fear endangers them. It’s a simple message parents need to keep hearing.” So, spread this message: “The HPV vaccine is safe. It prevents six cancers. Get your children vaccinated.” And give it a “tremendous whack.”
