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Help Families Understand HPV's Real Risks


Kristin Oliver, MD, MHS, FAAP
August 28, 2017

I met recently with a colleague who runs a busy private practice. It happened to be a slow summer afternoon, an unusual pause in a bustling season of physicals, school forms and Coxsackie infections.

My colleague mentioned they also were getting a flurry of calls that week from parents requesting the meningitis vaccine for their children. I wondered whether this was a delayed effect of last year’s state mandate for students entering seventh and 12th grades to be vaccinated against meningococcal disease.

Tragically, however, it was the death of a young adolescent who passed away at summer camp from what turned out to be meningococcal disease driving this rush of requests. Every parent’s worst nightmare, all over the local news.

Fortunately, death from meningococcal disease in the United States is very rare, with the Centers for Disease Control and Prevention (CDC) reporting 51 deaths among all age groups in 2015. It is also fortunate that we have something to offer parents to help protect their preteens, teens, and young adults against the common meningococcal serogroups: meningococcal vaccines that have been proven safe and effective.

This is the recurring story of vaccine preventable diseases.

- See more at: https://www.aap.org/en-us/aap-voices/Pages/We-Can%27t-Let-Our-Guard-Down-Against-Vaccine-Preventable-Diseases.aspx#sthash.196pj2e8.dpuf

In the mid-1980’s, the vaccine for HIB was released and thirty years later we no longer see this disease. Because of the effectiveness of this vaccine my younger partners only know of HIB meningitis through textbooks (and some of my anecdotes).

This is the recurring story of vaccine preventable diseases.

- See more at: https://www.aap.org/en-us/aap-voices/Pages/We-Can%27t-Let-Our-Guard-Down-Against-Vaccine-Preventable-Diseases.aspx#sthash.196pj2e8.dpuf

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Some injuries
Pediatricians have been working hard to get their patients vaccinated against HPV, and now roughly 60 percent of U.S. teens (65 percent of girls and 56 percent of boys) have received their first dose of HPV vaccine."

That conversation with my colleague got me thinking about the human papilloma virus (HPV) vaccine, also safe and effective against a disease's most common strains. Deaths from cervical cancer caused by HPV, which number more than 4,000 per year, far exceed meningococcal deaths--and this does not include deaths from HPV-related oropharyngeal, anal, penile, vaginal, and vulvar cancers.

Pediatricians have been working hard to get their patients vaccinated against HPV, and now roughly 60 percent of U.S. teens (65 percent of girls and 56 percent of boys) have received their first dose of HPV vaccine. Surveys have shown most parents want the HPV vaccine for their adolescents. Nevertheless, they aren't jamming our phone lines with requests, and newly released CDC data show that only 43 percent of teens are up to date on all the recommended doses of HPV vaccine.  We still have a lot of work ahead to get teens fully vaccinated.


"​Parents still may be more likely to seek our protection from more immediate disease threats, but we can take the opportunity to protect their children from the more common HPV-related cancers."

So, what can we do?

Educate our patients, families, friends and colleagues about HPV-related risks.

Risk perception has been defined as reality plus emotional factors. Risks that are perceived as involuntary, and those threatening children, raise the emotional ante. This may be why parents act quickly to vaccinate their children when faced with a case of meningitis. But while HPV infection can be acquired in adolescence, later stage manifestations often don't develop until adulthood.  As a result, perceived risk is minimized.

As pediatricians, we need to help educate our patients, families and colleagues on the real risks of HPV-associated cancers. The American Cancer Society has developed a video series, "HPV Survivor Stories," that features patients who battled head and neck, and cervical cancers. I use these short video clips in presentations to residents and colleagues and am working on playing them in waiting rooms.

​Give a strong, clear, recommendation for the HPV vaccine at every 11- and 12-year-old visit.
I say something like this: "Great, Michael is 11 years old now, so we can go ahead and do his tetanus/diphtheria/whooping cough vaccine, his HPV vaccine, and his meningitis vaccine today." This announcement lets parents know that all three adolescent vaccines are needed, and are equally important. Research shows this type of communication results in higher uptake of vaccines. 

Use other evidence-based strategies in our practices to increase HPV immunization rates.
Standing orders also have been shown to increase HPV immunization rates. Using standing orders for adolescents helped Denver Health Medical Center achieve HPV vaccination series completion rates of more than 60 percent, as described in a recent Pediatrics article. That's 30 percentage points higher than the national average.

The American Academy of Pediatrics has tools, including the HPV Champion Toolkit, "Making a Change in Your Office," to help implement these strategies into practice (and ways to get continuing education credit for it, too!).

Parents still may be more likely to seek our protection from more immediate disease threats, but we can take the opportunity to protect their children from the more common HPV-related cancers. The more often we do, the sooner death from cervical and oropharyngeal cancer can become a rare event, too.

The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics. ​​​


​​​Ab​out the ​​Author

Kristin Oliver, MD, MHS, FAAP, a member of the American Academy of Pediatrics, serves on the AAP's HPV expert physician panel and the American Cancer Society's National HPV Vaccination Roundtable. She is a pediatrician and preventive medicine specialist at the Icahn School of Medicine at Mount Sinai in New York. 



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