The HPV vaccine protects against cancer, but less than half of Texas kids get the shot
As Texas kids and teenagers return to the classroom, the majority - about 85% , according to federal data - have received vaccines protecting them against tetanus, diphtheria and pertussis, as required by state law.
But far fewer kids in Tarrant County have received the vaccine that protects against the human papillomavirus, a virus that infects most people at some point in their lifetimes and that can cause cancers in both men and women. In Texas, just 48.4% of kids between the ages of 13 and 17 were up to date on their HPV vaccine, according to data from 2019, the most recent year for which data is available.
As kids resume the school year amid the ongoing COVID-19 pandemic, pediatricians and oncologists urge families who haven’t protected their child against HPV to talk to their kid’s pediatrician about getting the vaccine, which requires two doses if you start vaccination before you turn 15.
“We don’t always know what causes cancers, but in this case, we do know that cervical cancer or dysplasia or vulvar cancers are caused by HPV, which is something that all people are exposed to at some point in their life,” said Dr. Lois Ramondetta, a professor of gynecologic oncology at MD Anderson Cancer Center in Houston. “And the great thing is that we have a vaccine that can prevent it.”
The HPV vaccine is a “huge breakthrough,” Ramondetta said, because it is one of only two vaccines that can prevent certain cancers, including those that affect Black and Hispanic women at a disproportional rate.
But for a number of reasons, uptake of the vaccine remains low in the U.S., and especially in Texas, which in 2016 ranked 47th out of all 50 U.S. states and Washington, D.C. in terms of HPV vaccine uptake, according to the University of Texas Health System Office of Health Affairs. Nationwide, about 54% of all teenagers were up to date on their HPV vaccinations in 2019, according to federal data, with considerable variation based on where kids live.
Most people will be infected with HPV at some point in their lifetimes, according to the CDC. For the majority of people exposed, HPV will clear their bodies naturally within two years. But in some cases, HPV can cause genital warts or a range of different cancers.
It’s a common misconception that HPV causes only cervical cancer in women, said Dr. Jason Terk, a pediatrician in Keller with Cook Children’s. Although HPV does cause more than 90% of cervical cancers, it can also cause penile, vulvar, vaginal, anal, and throat cancers.
Cancers of the head and neck are especially difficult to treat, Terk said.
“It requires pretty invasive surgery, and some people never regain some of the functions that they had before the radiation therapy that’s required,” said Terk, who is also the chair of the Texas Public Health Coalition.
Ramondetta and Terk said they both recommend children receive their first HPV vaccine at the age of 9 or 10, so that kids can get their second dose when they are 11 and are also due for other routine childhood vaccinations, like the tetanus, diphtheria and pertussis, or Tdap, vaccine.
There are several reasons why the HPV vaccine is recommended for children starting as young as nine or 10 years old. First, kids’ immune systems are more resilient, Ramondetta said, so as with other vaccines, the sooner their immune system gets introduced to a vaccine the better it learns how to fight the virus in question when infected.
That’s why if a child gets their first HPV vaccine before the age of 15, they’ll only need two doses to complete the series. But for older teens and adults who start vaccination after they turn 15, three doses are currently needed to complete the vaccination.
The HPV vaccine is also recommended for children because, as a two-dose vaccine, it’s best distributed to people when they are receiving regular, preventive care, Ramondetta said. The U.S. childhood vaccination program is largely considered a success in public health, thanks in part to school requirements and a federal program that makes the recommended childhood vaccines free regardless of insurance status.
When the HPV vaccine was first made available in 2006, its rollout was accompanied by wave of controversy, particularly in Texas, fed in part by concerns that a vaccine that protects against a sexually transmitted infection shouldn’t be given to children. HPV is spread primarily through sexual contact, and is the most common sexually transmitted infection in the U.S. But Terk and Ramondetta said the vaccine should be thought of first and foremost as a vaccine that protects the vaccinated from cancer, and the needless suffering that accompanies a preventable cancer diagnosis.
“It’s horrible to diagnose someone with cancer,” Ramondetta said. “It is devastating to diagnose somebody with a cancer that we know could have been prevented by screening and vaccination.”
Across the globe, Australia has made so much progress against cervical cancer through vaccinations and screenings that the country is on track to eliminate the disease as a public health problem within the next 20 years, according to a modeling study published in 2018.
In the U.S., Black and Hispanic women have the highest rates of cervical cancer as well as cervical cancer deaths, according to the U.S. Cancer Statistics Working Group. And in Texas, Black women have a higher mortality rate from cervical cancer than women of any other racial or ethnic group, according to the Texas Cancer Registry. Researchers fear that the disruptions caused by the COVID-19 pandemic have only worsened these disparities. Screenings for breast and cervical cancer dropped among all women in April 2020, but especially among Black and Hispanic women, according to new research.
In addition to drops in cancer screenings, the pandemic has likely contributed to declines in routine childhood vaccinations, including the HPV vaccine, meaning the vaccine’s stagnant uptake rate in Texas could have actually gotten worse in the last year.
Both physicians stressed that an unequivocal and affirmative recommendation from a child’s doctor or other health care provider to get the HPV vaccine is one of the most important steps toward improving vaccination rates. Like the COVID-19 vaccine and other vaccinations, surveys and research have shown that the individual a parent trusts most for vaccination information is their personal doctor or their child’s pediatrician.
“The number one determinant of whether a child is going to get the HPV vaccination or any other vaccination is whether the parent heard an unequivocal affirmative recommendation for it from their doctor,” Terk said.
Terk said a doctor’s recommendation was most essential to improving vaccination rates, but added: “It would be very nice if our political leadership got behind what is an extremely important vaccination.”
More information
If your child hasn’t been vaccinated against HPV, you should talk to your child’s pediatrician about the vaccine. The vaccine is available for free if your child is uninsured or underinsured through the Texas Vaccines for Children Program. Kids can get the first dose of the HPV vaccine as early as 9 or 10. If they begin vaccination before they turn 15, kids need only two doses. Between the ages of 15 and 26, people require three doses to complete vaccination.
