The vaccine schedule is the same schedule for boys and for girls. The path to today’s human papilloma virus (HPV) vaccine has not been entirely straightforward for parents as recommendations have changed over time. Know this: the clear and simple message is that HPV vaccine is safe and effective for boys and girls. We know it works best when given earlier in the tween/teen years and we know the immunity it produces in our bodies is durable and lasting. HPV vaccines is an anti-cancer vaccine that works best when given to boys and girls at age 11. For me it’s a no-brainer to recommend this vaccine enthusiastically before children head off to 6th grade.
Earnestly, it’s not a “new” vaccine as pediatricians began giving the vaccine back in 2007 and it’s been given well over 50 million times. In the U.S. we starting giving the vaccine to girls first yet because human papilloma virus can infect boys and girls, men and women, HPV vaccine is also recommended for boys age 11 and older. Uptake by boys has been fast and steady since recommendations included them. Three different HPV vaccines are now available: a 2-HPV strain (protects against the viral strains that cause 70% of cervical cancer) or a 4-HPV strain vaccine (same 2 strains plus two more that protect against HPV strains causing warts) and now a 9-strain vaccine (expansion of strains causing warts), upping the number of different viruses that the vaccine protects teens against. The new options improve protection against HPV viruses that cause genital warts and also HPV viruses that can cause cancers of the cervix, mouth, throat, vagina and rarely, the penis.
HPV Vaccine Protecting Teens
Although we haven’t reached vaccination rates of countries like Australia (they vaccinate at school which certainly makes the vaccine convenient) our rates of completed HPV vaccine series are up (see graph below). In Australia where the majority of teens have been immunized they have seen remarkable progress:
- A 77% reduction in HPV types responsible for almost 75% of cervical cancer
- An almost 50% reduction in the incidence of high-grade cervical abnormalities in Victorian girls under 18 years of age
- A 90% reduction in genital warts in heterosexual men and women under 21 years of age.
Boys and girls getting the vaccine protect themselves but they also help protect future partners.
Why Does Avoiding HPV Matter?
There are hundreds of human papilloma viruses out there. Some cause typical warts on your hands. However more than 40 types of HPV are transmitted through sexual contact (condoms unfortunately don’t prevent the spread). And although most HPV infections come into our bodies and go without a trace occasionally they cause warts and sometimes they cause changes in tissue that leads to cancer. The majority of adults get HPV at some point in their lifetime.
Dr. Rachel Katzenellenbogen, Adolescent Medicine physician who studies HPV at Seattle Children’s, reinforced in this Q&A that studies looking at antibody responses (the body’s response to the vaccine) find the response is best for girls and boys ages 9 to 11. Since the antibody response is better the younger you are, I don’t see any significant benefit in waiting.
When talking about this vaccine, it is important to know that it is safe and effective in protecting people from developing several types of cancer and genital warts. Not everyone gets cancer, but most people get HPV. If you remove HPV from the equation, you remove that risk of cervical cancer, other anogenital cancers, and some head and neck cancers.
75 percent of us have evidence of a current or prior HPV infection. It’s an extraordinarily common infection. There’s no need to wait until we believe someone will be exposed. ~ Dr. Rachel Katzenellenbogen
Tips For Teens Getting Their 11 Year-Old Shots:
Tips For Teens Getting Their 11 Year-Old Shots:- Bring a cellphone, smartphone, tablet, or enticing magazine along with you to the clinic.
- Know that the HPV vaccine can really sting when it goes in. Most all teens report this back to me! This is in part because of the high-salt concentration in the solution. Although telling your teen, “This shot is really going to hurt” won’t help and will likely increase anxiety, providing support and acknowledgement for the discomfort during and after the shot is very helpful. My advice: don’t lie and say it won’t hurt. Also, if shots make you as a parent nervous, it’s okay to have the teen get the shot with the RN or MA alone. Some teens prefer it. If your teens wants you with them during the shot, help distract your teens during the shot (use a smartphone, tell a story or joke, ask them about prom or something!). If your teen is anxious or nervous, it’s especially important to have them wait the recommended 10-15 minutes after getting the shot to prevent them from getting woozy or from even fainting. Teens often feel woozy or even faint after shots during adolescence — this is from the experience of getting shots while being a teen, not the ingredients in the shots themselves.
- Many parents are concerned about shots for sexually-transmitted infections. Do your best to ask your teen’s doctor or nurse about fears or worries you have. You’re certainly not alone in being queasy about your teen potentially having sex some day. We do know that by getting them the HPV vaccine you’re increasing safety and we also have data that finds this won’t make them more interested in sexual activity.
- Fear of Needles? If you teen has a fear of needles check out this blog post. Also, don’t hesitate to talk to your child’s clinician about the fear and get them on-board to help.
- Finish the Series: Make that first poke worth it! The best way to protect your teen (or yourself) from HPV infections and the consequences of infection is to finish all 3 shots in the series. Don’t forget to return to the nurse or medical assistant for the 2-month and 6-month booster! Many girls and boys start the series and don’t finish, thus leaving them exposed and vulnerable to HPV when they are sexually active. It’s not always convenient or top of mind to return. I suggest you book your next HPV shot appointment each time you get a dose. Here’s data from the CDC on how we’re doing finishing the series in teens.
Anne Marie says
HPV is an unneeded and very expensive vaccine $900 that provides protection against a virus that rarely if ever causes a problem and has a huge opportunity cost. Most people don’t realize that it has never been studied long term and since most cervical cancer happens to women in their 50’s we aren’t even sure if it works (or if other strains will become more prevalent). This is a HUGE waste of money as almost no cases of cervical abnormality even need to be treated and we no longer even recommend pap smears for young women as we end up treating things that resolve on their own.. Trust your body.
Far more kids will die from suicide (#1 killer for young adults) for example and we neither screen nor give young adults resilience training to prevent depression.
Finally what are the ethics of a physician as a blogger/”journalist” – there is an inherent conflict of interest when you are blogging and “reporting” “s. Some physician-journalists may promote themselves, their colleagues, or their hospital without realizing that such reporting is biased,”
Wendy Sue Swanson, MD, MBE says
Hi Anne Marie,
Lots to respond to in your comment. I’ll do my best here to start and look forward to your responses.
1) I agree HPV vaccine is expensive. I’ve trusted ACIP/AAP/CDC to do the math on this as a part of their algorithms in creating and approving the final recommendation in order to put this into the universal vaccine schedule. Cost is a relevant part of the recommendation decision. Meningitis (serotype B) just received a different (category B) recommendation in part because of cost and the balance of disease burden, etc as I understand it. Do you feel the cost component of HPV vaccine wasn’t properly incorporated into the decision to put this on the schedule in 2007? I’d be happy to ask more questions around this later this month as I’ll be meeting with folks from CDC and also with the Dir of the Vaccines For Children program at HHS in Washington, D.C. Help me form some smart questions, please.
2) The vaccine hasn’t had “long-term” study in the regard for long-standing immunity simply because of how long we’ve been using it (that’s how I’m reading your comment) because we’ve been using it just since 2007 universally (for girls). The early data on durability is good (at 8 years) — and it will continue to be monitored as time unfolds. A sincere question: is it your hope or preference that HPV vaccine is studied for decades with durability as a primary or even secondary index and then given thereafter? In some ways we have a similar lesson with how we used and implemented varicella vaccine. Universal immunization began and then a booster (at age 4-6) was added to ensure longer-lasting or lifetime immunity. But with time we will know more — those never exposed to wild-type varicella may depend upon additional boosters as older adults.
3) Concur about the horrific standards for screening for depression and “resilience training” in teens and in young adulthood. With standard work, more and more of us are implementing screening tools (PHQ-9, standard questions at adolescent well child check-ups) with the help of our EHRs to ensure it happens every time. Do you have a link you like on resilience training and recommendations of what pediatricians should be teaching? Ways to implement that and provide time in adolescent visits to accomplish it? Would enjoy more info.
4) Your question around reporting, blogging, promotion, and the ethics of sharing information online is a just one. And certainly one I think about a lot. No question that authoring content online is a responsibility I believe in earnest is something we must do as modern physicians. No question in my mind that I’m also learning how to do this best, working to spread ideas, and get information to patients and families in arm’s reach. When I do so in partnership with organizations for whom I work (Seattle Children’s, KING5 News, The Everett Clinic, AAP, etc) there is secondary promotion. But the benefit in partnership exceeds the risks in my mind. I get to partner with like-minded, mission-driven orgs to spread ideas, shape patient-physician communication with modern tools, and leverage expert opinion. I’d be interested to hear more about your concerns and ideas to improve my work and decrease the perceived bias.