The vaccine for human papillomavirus, or HPV, works best when given to children in late childhood and early adolescence — before they’re sexually active — according to some experts. While public health officials recommend the vaccine to prevent cancer, it’s up to the states to determine which vaccinations are required for students.
Lawmakers in two states have recently proposed legislation on the roles schools should play in HPV vaccination.
In California, the Cancer Prevention Act was introduced in February with the goal of adding HPV vaccine to the list of vaccines that both private and public school students must receive before entering the eighth grade, at around 13 or 14 years old. According to the proposed legislation, medical exemptions would be allowed.
Hearings on the bill will begin this month. If signed into law, it could go into effect next year and make California the fourth state to mandate the vaccination, behind Rhode Island, Hawaii and Virginia, along with Washington, D.C., which already requires middle schoolers to be vaccinated against HPV.
In Iowa, however, multiple bills have been introduced to eliminate a requirement that has been in place since 2007 that schools inform seventh and eighth graders about the HPV vaccine. One of the bills advanced out of an Iowa House subcommittee a few weeks ago and would make HPV vaccine education optional. However, general instruction about sexually transmitted diseases, including HPV, would remain a requirement, the Gazette reported.
Another bill, which was proposed by Republican Gov. Kim Reynolds, aims to restrict education around gender identity and sexual orientation for younger students, but it also includes a provision that would strike down the requirement that schools teach about HPV and the HPV vaccine. Iowa lawmakers heard from constituents about the bill last week and the legislation is heading to “a full Senate committee and possibly to the Senate floor for debate,” according to local news outlet KCRG.
To learn more about HPV, the HPV vaccine and why receiving the vaccine at an earlier age is more beneficial, Yahoo News spoke with Dr. Abigail Zamorano, assistant professor of gynecologic oncology with the McGovern Medical School at UTHealth Houston.
What is HPV? Who is affected?
HPV is the most common sexually transmitted infection in the United States, affecting about 80% of men and women at some point in their lives, Zamorano explained. The Centers for Disease Control and Prevention estimates that about 13 million Americans, including teens, become infected each year.
“Most people don’t know that they’re ever affected by it because it’s one of those viruses that we get and then our body fights off,” Zamorano said. “Most people are asymptomatic from this infection and for that reason, we don’t typically think about it like a sexually transmitted infection, even though that is how it’s classically passed from one person to the other,” she added.
According to the CDC, HPV most commonly spreads during anal or vaginal sex. However, it can also spread without intercourse through close skin-to-skin contact during sex. A person who is infected can pass HPV to another even if they exhibit no signs or symptoms. A person can also get the virus even after engaging in sex with only one person.
Zamorano said that while most people clear the virus on their own, many people — for reasons not yet well understood — do not. That’s when HPV can become a problem, she said.
“In some people ... it can linger and their bodies don’t fight it off, and it’s with this lingering infection that [HPV] can cause cellular changes that can then lead to precancer or cancer.”
What types of cancer can HPV cause?
“HPV is responsible for almost all cervical cancers, over 95% [of them],” Zamorano said, adding that it can also cause vaginal and vulvar cancer in women. But the virus can also lead to other types of cancers that can affect men, including penile, anal and throat cancer.
Even though there are over 100 different types of HPV, only about a dozen of them are high-risk strains. Two of them — HPV16 and HPV18 — are responsible for most HPV-related cancers.
Doctors normally monitor HPV through Pap smear tests, which can detect abnormal cervical cells or lesions. When the cell changes that are observed in the cervix are only mildly abnormal, they aren’t considered a problem. Most of the time, Zamorano said, these low-grade lesions clear up on their own. However, more serious changes, or high-grade lesions, can contain precancerous cells. If left untreated, they can turn to cancer over time.
The CDC advises women who receive a cervical cancer diagnosis to see a gynecologic oncologist who can then discuss the different types of treatments that are available. Some of these can include surgery to remove cancer tissue, radiation and chemotherapy.
Is the HPV vaccine safe and effective?
In 2006 the Food and Drug Administration approved the first HPV vaccine.
“The vaccine is one of those really amazing contributions of science in the last couple of decades,” Zamorano said. “As soon as it was introduced and started to be used, we really started to see a decline in cervical precancers ... and we’ve now also started to see declines in cervical cancers that can be really attributed to this vaccination strategy and to vaccinations of especially, you know, younger adolescents,” she said.
Infections with HPV types that cause most HPV cancers and genital warts among teen girls have decreased by 88% since the HPV vaccine became available, according to CDC data.
The most current HPV vaccine given to people in the U.S. is called Gardasil 9. The shot, Zamorano said, is “very effective” and helps protect against nine different types of HPV. The most common side effects of the shot are mild and can include pain, redness or swelling at the injection site, as well as dizziness, nausea and headache.
Early vaccination is the most effective
The CDC recommends that everyone through age 26 get the HPV vaccine. Vaccination after that isn’t as effective “because more people in this age range were exposed to HPV already,” the agency notes. Immunizing a person before they come into contact with the virus is what works best, the CDC says.
Children ages 11 to 12 years old should get two doses given six to 12 months apart, according to the CDC. However, children as young as 9 can receive the shot.
Those who get the vaccine when they are 15 or older should receive three doses given over six months.
But Zamorano said there are many reasons why doctors recommend vaccination to start as soon as children qualify for the shot. Besides achieving immunity against the virus before sexual activity begins, she said, there’s compelling evidence that vaccinating in late childhood and early adolescence may lead to more robust protection against the virus.
“There’s some data that shows that people who are vaccinated earlier in life have a more robust response to the virus than perhaps people who are vaccinated later. We’re still figuring all of this out, but there is pretty compelling [evidence] to say that earlier vaccination might be a really good thing.”
While the CDC recommends that the vaccine series start at 11 years of age, the American Academy of Pediatrics (AAP) actually recommends that the HPV vaccine series begin between the ages of 9 and 12. In a recommendation statement, the organization said this is “an age that the provider deems optimal for acceptance and completion of the vaccination series.” There is also no known downside to starting the series earlier, the AAP said.
Getting vaccinated against HPV earlier could improve immunization rates in adolescents, a retrospective study published this week found.
In the study, children who started the HPV vaccine series at age 9 or 10 were compared with those who began at ages 11 to 12. The research showed that those who initiated the vaccine series earlier were more likely to complete all the doses by age 13 (74% vs. 31.3%) and age 15 (91.7% vs 82.7%).
While adolescent HPV vaccination coverage in the U.S. has improved in recent years, it remains well below that of other adolescent vaccines.
The National HPV Vaccination Roundtable, a coalition of about 70 organizations whose mission is to improve HPV vaccination rates in the U.S., notes that “adolescent (13-17 years) HPV vaccine coverage, as assessed in 2020, has continued to increase in the United States (75% having received at least 1 HPV vaccine dose, compared to 72% in 2019; 59% up-to-date, compared to 54% in 2019), but still trails coverage of Tdap vaccine (90%) and quadrivalent meningococcal conjugate vaccine (89%).”
Zamorano told Yahoo News that she believes schools providing information on HPV and HPV vaccines, or requiring the shot, is a good public health measure.
“We have a real opportunity to completely eradicate cervical cancer. But it’s only going to happen if enough people in the population get vaccinated that we can drive down HPV to the point where it’s not causing problems,” Zamorano said.
For parents who are unsure about vaccinating their children, the UTHealth physician advises that they should talk to their doctors and think of the HPV vaccine as a cancer prevention tool.
“I think that the biggest message — especially since we think that there’s so much more value in this vaccine when given to a younger population — is really trying to separate out this from being a vaccine against a sexually transmitted disease, because that does have a lot of stigma,” Zamorano said.
“I definitely understand, like, as a parent myself, I understand ... you want to do the best thing for your child and ... you don’t want to think about the fact that, in however many years, they’re going to be sexually active. But ... think about this much more as a cancer prevention vaccine, like, you don’t want your child to have oral or penile or cervical or vulvar cancer in the future. So you’re doing everything that you can to help protect them when it’s the best time to do so,” she added.