Vaccinating 11- and 12-year-olds for the Human Papillomavirus (HPV) is a highly charged topic, especially when considering that the debate collides possible mandatory vaccination and teenage sexuality. While it may make perfect sense medically to vaccinate against an infection that could ultimately lead to cervical cancer, many parents see vaccinating as promoting promiscuity at an early age. They feel that making the vaccine mandatory infringes on their autonomy in raising their child, especially in regard to values about sexual behavior.
HPV: Different from HIV and HSV (herpes), HPV is the most common sexually transmitted infection. There are many different types, with some causing health problems including genital warts and cancers. HPV can be passed by having vaginal, anal or oral sex with an infected person, even if they are showing no signs or symptoms. Anyone who is sexually active can get HPV, and symptoms may not develop until years after having sex with someone who is infected.
More than 90 percent of cervical cancers are caused by HPV, which equates to an estimated 12,000 women being diagnosed each year, according to the American Cancer Society. A Centers for Disease Control and Prevention (CDC) study found that one in four women ages 14 to 59 is infected and that nearly all sexually active men and women will get HPV at some point in their lives.
HPV also causes cancers in men, including cancer of the tonsils, tongue, penis and anus. HPV-associated head and neck cancers are diagnosed in 12,638 men each year.
There are more than 40 types of HPV, but nine of them (types 6, 11, 16, 18, 31, 33, 45, 52 and 58) are known to cause the majority of HPV-related cancer and diseases. Gardasil 9, the HPV vaccine, is at least 99 percent effective against the most dangerous subtypes of HPV in young women. A competing vaccine, Cervarix, approved by the FDA in 2009, prevents against cervical cancers but not against genital warts; so it is useful for girls but not for boys.
Most people with HPV do not know they are infected and never develop symptoms or health problems from it. Women may find out they have HPV when they get an abnormal Pap test result (during cervical cancer screening). Others may only find out once they’ve developed more serious problems such as cancer.
Dr. Lori Williamson, an OB-GYN affiliated with Baylor Scott & White Fort Worth, has nearly 25 years of experience in the field. She says, “Unless there is a lesion, there are rarely symptoms. Occasionally there is post-coital bleeding, which can be a sign. Generally the infection is transmitted from an asymptomatic partner.”
Because the vaccine is most effective when given before any exposure, the recommended age of vaccination is set low to ensure that all girls are vaccinated before they engage in sex. “Girls 9-13 are the target group with availability of the vaccine up to age 26, especially if sexual activity has not yet occurred. In general we immunize the males the same way, although the studies are mostly in women,” Williamson says.
Area organizations and agencies are working to ensure children in Tarrant County are vaccinated against HPV. The Immunization Collaboration of Tarrant County (ICTC) is a collaboration of agencies and organizations, public and private, committed to providing the systematic eradication of childhood, vaccine-preventable diseases since 1991.
Alyssa Clader, Tarrant County Public Health nurse and ICTC social media chair, says, “ICTC offers the HPV vaccine at all 23 days of our back-to-school immunization events in August. We also take the vaccine into the Tarrant County ISD’s that allow us to and immunize sixth graders in combination with the MCV (Meningococcal Conjugate Vaccine) and Tdap (Tetanus, Diphtheria, Pertussis) vaccine, which are required for seventh grade. To help with completion of the series, last year ICTC held a contest. Any child who completed the HPV series at a Tarrant County Public Health Clinic was entered into a drawing to win one of three tablets. ICTC also provides educational material about HPV that we distribute at health fairs, clinics, schools, etc., across the county.”
At least 11 states, including Texas, are considering adding the HPV vaccine to the list of necessary school shots, starting with females entering the sixth grade. This would be the first required vaccine for a disease spread exclusively through sexual contact. Time and again, it has been shown that school-based mandates are effective in increasing rates of vaccinations, as seen in Hepatitis B vaccination rates. As of now, there will be the ability to opt out for those that think it’s too soon to be addressing sexually transmitted disease with their children.
Uncertainty about the duration of protection afforded by first generation HPV vaccines has been a common concern. Due to the recent development of the vaccines and the scientific uncertainty about the actual long-term side effects of the vaccine, wide acceptance by the general public has been an uphill battle.
Many parents say that this particular vaccine can be seen as a license to have sex. It is argued that proposing universal HPV vaccination, especially in adolescents, could encourage sexual relations by removing the deterrent effect of the fear of contracting a serious disease.
The greatest concerns arose with the possibility of making the vaccine mandatory with many feeling that it is an overextension of a school’s authority to force vaccination for a disease that cannot be caught in the classroom and is the result of preventable behavior.
Jimmy Hamilton is raising a 10-year-old daughter who attends a North Texas elementary school. He believes strongly that parents should ultimately have the decision as to what vaccination their child receives.
“I don’t feel like getting your child vaccinated for HPV is ‘giving them permission to be promiscuous.’ When you take your kid in to get vaccinations, they don’t ask what they are getting. They just know they are getting a shot and don’t like it. There’s little chance that a child is going to equate getting a shot to being given the go-ahead to be sexually active,” Hamilton says.
Tarrant County Public Health Medical Director, Catherine Colquitt, M.D., hopes to educate parents that may still have reservations or concerns about their child getting vaccinated. “I believe that most of the resistance from parents and guardians relates to the administration of a vaccine against a virus regarded as a sexually transmitted infection to this young population, but HPV vaccination incontrovertibly provides protection against many tragic and avoidable cancers with devastating consequences to those affected. Parents need reassurance that HPV vaccine is administered between ages 9 and 26 based on vaccine efficacy and for no other reason.”
Common Side Effects of HPV Vaccine
Pain, redness or swelling in the arm where the shot was given
Headache or feeling tired
Muscle or joint pain
Who Should NOT Get the Vaccine
Anyone who has ever had a life-threatening allergic reaction to any component of HPV vaccine, or to a previous dose of HPV vaccine, should not get the vaccine. Tell your doctor if the person getting vaccinated has any severe allergies, including an allergy to yeast.
HPV vaccine is not recommended for pregnant women. However, receiving HPV vaccine when pregnant is not a reason to consider terminating the pregnancy. Women who are breastfeeding may get the vaccine.
People who are mildly ill when a dose of HPV vaccine is planned can still be vaccinated. People with a moderate or severe illness should wait until they are better.