Promoting a vaccine that prevents some cancers is a new focus in Georgia

Cancers caused by human papillomavirus (HPV) can be entirely eliminated with a vaccine given to kids, but the uptake in Georgia is slightly below the national average.  (Dreamstime/TNS)

Credit: TNS

Credit: TNS

Cancers caused by human papillomavirus (HPV) can be entirely eliminated with a vaccine given to kids, but the uptake in Georgia is slightly below the national average. (Dreamstime/TNS)

Cancers caused by human papillomavirus (HPV) can be entirely eliminated via a vaccine given to kids, but in Georgia and some other states, not enough young people are taking the shot.

Australia and the UK are on track to vaccinate nearly all schoolchildren, even as the U.S. is falling short. Georgia is working to catch up and is closely watching an effort in California, which has announced it hopes to vaccinate 80% of children by 2026. In Georgia, a team led by experts at Emory and St. Jude’s Research wants to match this.

According to the Centers for Disease Control and Prevention, HPV is the most common sexually transmitted infection. It can be spread through touching as well as sex, and can cause problems such as genital warts and several cancers.

“As a recent study in Scotland made clear, girls who were vaccinated before age 12 and 13 had zero cervical cancer,” Robert Bednarczyk, an epidemiologist at Emory University and member of the HPV Vaccination Roundtable of the Southeast, told the Atlanta Journal-Constitution. “The fact that the vaccine prevents six types of cancer that tens of thousands of Americans get each year should be our message.”

According to the CDC, the vast majority of cancers caused by HPV are cervical cancer in women, and throat cancer in men. The good news is vaccinations prevent at least 90% of these cancers. The more mixed news is that vaccination rates dipped during the pandemic, and experts in Georgia and California say they are still playing catch up.

“We were on such a good trajectory in the U.S. and in California, and then came COVID,” Catherine Flores Martin, executive director for the California Immunization Coalition (CIC), told The Atlanta Journal-Constitution. “We lost ground, but we are working with parents and providers to build confidence in vaccines again.”

Though 63% of children in the U.S. are fully vaccinated against HPV, California and Georgia both are lagging the national average, with about 61% of adolescents ages 13-17 in each state vaccinated.

During the pandemic, HPV vaccination rates in the U.S. slid 13.6%, according to the CDC, compared to a 5.7% fall for measles vaccinations.

While measles vaccination rates in Georgia have returned to pre-pandemic labels, the state’s HPV vaccination rate remains 18% lower than before the pandemic, CDC data show.

As cervical cancer rates in younger, vaccinated women have fallen, rates have increased among middle-age women who may not have had the chance to be vaccinated. Moreover, about 70% to 90% of head and neck cancers in the U.S. are now linked to HPV. Survival rates are high if the cancer is found early. HPV testing alone detects more abnormalities than Pap tests alone, especially in young women — that’s why the American Cancer Society recommends co-testing with a Pap test and an HPV test every five years, or a Pap test every three years.

About 37,000 annual cancer cases in the U.S. are attributable to human papillomavirus, 34,400 of which may have been prevented through vaccination. Preventing and treating HPV-associated diseases costs the U.S. at least $9 billion annually, according to the CDC.

Flores Martin says California’s strategy is to normalize vaccine uptake “so parents see it as a standard vaccine, like those against measles, tetanus, flu.”

Last year, California passed legislation to inform parents that HPV vaccination can prevent cancers, and that the state strongly recommends children be immunized by the 8th grade, or age 13-14. Letters to that effect will be sent out this spring.

“It might just seem like a letter, but we see it as another opportunity to get information to parents who might have been unaware or on the fence about it,” Flores Martin said.

The approach was seen as a compromise. Although U.S. states like Rhode Island or countries like Portugal were able to achieve HPV vaccination rates of over 80% by requiring it for school matriculation, Flores Martin said the political climate in the U.S. right now made a mandate unlikely, even in California. Moreover, Texas’ subsequent reversal of its 2011 HPV vaccine mandate has led California to favor an approach that emphasizes parent-doctor cooperation in HPV vaccination planning.

A parental consent process like the one adopted in California has been a success in Australia, said Karen Canfell, a researcher at the The Daffodil Centre, a partnership between the Cancer Council New South Wales and The University of Sydney.

“It’s a parental-consent process in Australia,” Canfell told the AJC. “And from the beginning, there has been clear messaging to parents of young girls and boys that this has been a lifesaving vaccine.”

Australia adopted a WHO recommendation that one dose of the vaccine in children would provide lasting protection, after initially giving children two doses.

“Australia wants to increase coverage rates to meet and exceed 90% coverage, and the one-dose regime will be an enabler of that,” she said.

Walter Orenstein, formerly Director of the United States Immunization Program and currently of Emory Vaccine Center, said the U.S. needs to do a better job in explaining to parents the seriousness of HPV. One way to accomplish this, he said, could be to compensate physicians for family vaccine counseling.

“Even if physicians do not give the vaccine that day, this will give them an incentive to invest the time in talking to families,” Orenstein told the AJC. “If nothing else, we should do research to see whether or not this would enhance vaccine uptake.”

Efforts to increase outreach should also include adults, who also can benefit from HPV vaccinations until at least age 45, said Joshua O’Neal, Director of Sexual Health, Medical and Preventive Services at the Fulton County Board of Health.

And he says Georgia needs to overcome a taboo around talking about HPV.

“HPV is the leading cause of throat cancer among men, but we don’t talk about it enough,” O’Neal told the AJC. “We talk about cervical cancer, but I hardly ever hear people talk about how they are connected.”

Questions on HPV

Who should get the HPV vaccine? CDC recommends HPV vaccination for:

  • All preteens (including boys and girls) at age 11 or 12 years (or can start at age 9 years).
  • Everyone through age 26 years, if not vaccinated already.
  • Vaccination is not recommended for everyone older than age 26 years. However, some adults age 27 through 45 years who are not already vaccinated may decide to get the HPV vaccine after speaking with their healthcare provider about their risk for new HPV infections

How do I know if I have HPV?

Most people with HPV do not know they have the infection or have developed cancer. The American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines recommend HPV testing for women aged 30 to 65 years as part of a cervical cancer screening. The HPV test is used in conjunction with a Pap test every 5 years. Some women over 65 might require more frequent testing. The tests may also be beneficial to gay men. HPV tests are not recommended to adolescents, or women under the age of 30 years.

Source: Centers for Disease Control and Prevention and ASCCP