Why Kids Need the HPV Vaccine

Human Papilloma Virus – or HPV – is the most common sexually transmitted disease. More than 200 known strains of HPV exist worldwide, at least 14 of which are known to cause cancer. Other, lower risk strains can cause genital warts. Eighty percent of people will have had an HPV infection by the age of 50, with peak prevalence seen in people ages 15 to 25 (usually within 10 years of a person’s first sexual encounter).

While most HPV infections resolve on their own within 12 months, “there are almost 43,000 new HPV-associated cancers diagnosed every year in the United States,” said Nancy Engellenner, nurse practitioner with Boulder Women’s Care. “That equates to approximately one case every 20 minutes in the U.S.”

Fortunately, a very effective vaccine exists that protects both males and females against a variety of HPV strains, as Engellenner and her co-presenter, Paige Swales, certified nurse midwife at Foothills Community Midwives, explained in a recent free online lecture hosted by Boulder Community Health (BCH).

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VIDEO: Watch the online lecture on "Why kids need the HPV vaccine."
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HPV and Cancer

More than 200 virus strains comprise what we know of as HPV. Approximately 30 of those strains affect the genitals, and at least 14 cause cancers including cervical, penile, anal, vulvar and oropharyngeal cancer. (The oropharynx includes the back one-third of the tongue, tonsils, soft palate and the side and back walls of the throat.)

The most common HPV-related cancer for females is cervical cancer, while the most common one for males is oropharyngeal cancer. In general, more females (25,400) develop cancer from HPV than males (19,900).

• Of the females who develop an HPV-related cancer, nearly half will develop cervical cancer, the fourth most common type of cancer in women overall.
• Of the males who develop an HPV-related cancer, 81% will develop oropharyngeal cancer.

As stated above, cervical cancer is one of the common types of cancer in women. Virtually all cases of cervical cancer result from HPV.

The good news with cervical cancer, according to Swales, is that it is also one of the most preventable cancers given the available screenings such as pap and HPV tests, among others.

While a lot of people think of oropharyngeal cancer as being tobacco or alcohol-related, the majority of cases are actually caused by HPV. Routine primary care checkups and dental screenings are important when it comes to identifying oropharyngeal cancer because it can start out as something really small like a white spot on the roof of your mouth or on the back of your tongue and then quickly lead to a mass or extensive lesions.

HPV and Genital Warts

Lower-risk HPV strands can lead to genital warts. They affect both males and females and can appear in the vagina, on the vulva, on the penis and around the anus. Also known as condyloma, HPV-related warts can also be oropharyngeal.

In addition to being aesthetically displeasing, condyloma can be painful and uncomfortable, and it is extremely contagious – not only for transmission but also for yourself. According to Swales, “a person may start off with one wart, but because they’re so contagious, it might lead to two or four or 10, and they can get really, really extensive. So, we do encourage people – if they have any abnormal findings or start to notice things – to reach out to their health care provider.”

HPV Transmission, Prevention and Treatment

HPV is transmitted via sexual intercourse as well as skin-to-skin contact, so you can transmit it through close, intimate touch. Condoms are therefore not 100% effective at preventing HPV.

However, there are proactive steps you can take to help prevent HPV. Some of those include the same steps doctors advise patients to take in terms of their general health. “Take care of yourself, keep your stress down, eat right, don’t party too hardy, limit the number of partners you have and think about getting the HPV vaccine,” noted Engellenner.

“With the high prevalence of cervical cancer related to HPV, it’s really important for females to be sure they’re getting their routine screenings, including pap and/or HPV screenings,” added Swales.

“It’s important to do a lot of teaching and education, especially for young adolescents who may have newly become sexually active,” said Swales. “It’s important to show them what a healthy cervix looks like and teach them good habits and prevention mechanisms to help prevent things like HPV.”

The HPV Vaccine

Gardasil 9, the vaccine that is currently used in the United States, came onto the market in 2014.

“As health care providers, we definitely recommend Gardasil 9,” said Swales. “There are lots of different ways we track adverse reactions or events related to vaccine safety, and Gardasil has been proven to be safe.”

For the first four years that Gardasil 9 was on the market, it was only approved for ages 9 through 26. In 2018, approval was extended to the age of 45. The ideal vaccination age for both males and females is between the ages of 11 and 12.

“We want to have males and females get this vaccine prior to the onset of sexual activity, which is why we state the ideal vaccination age as between 11 and 12,” said Swales. “There are special circumstances where we would recommend getting the vaccine a little earlier. It’s really important to discuss the need or desire to get a vaccine with your child’s pediatrician or health care provider.”

Dosing depends on the age at which the vaccine is given:

• Under 15 years old requires two doses
  • Initial dose
  • 2^nd dose: 6-12 months later
• Over the age of 15 requires three doses
  • Initial dose
  • 2^nd dose after two months
  • 3^rd dose six months after the initial dose (four months after the second dose)

There is also some off-label use of the vaccine, meaning you can still get the vaccine even if you are older than age 45.

HPV vaccines are widely available through BCH's health care clinics. They are also generally covered by insurance.

Why the HPV Vaccine?

The number one reason to get the HPV vaccine is cancer prevention. Ninety-eight percent of people will have an antibody response to the strains included in the vaccine one month after the series of shots is completed.

The vaccine is almost 100% effective in reducing the HPV strands included in the vaccine. It is 86% effective at reducing cancer and 71% effective at reducing the incidence of genital warts.

Getting the vaccine can still be beneficial even if you are in the older end of the approved age range. If you have been sexually active, chances are that you have not been exposed to every strain covered by the vaccine, so it will still provide you some protection against those strains.

Most people do not have adverse reactions to the HPV vaccine. The most common side effect is a sore arm at the injection site.

You can learn more about the efficacy of Gardasil 9 at www.gardasil9.com.

The Final Word

“The thing to remember is this virus is very prevalent. A lot of people will get it in their lifetime,” concluded Engellenner. “You don’t need to feel badly that it happened. Do your best to prevent it like I said – sleep right, eat right, don’t party too hardy, limit the number of partners you have, use condoms and get the vaccine. But if you think you have something going on, don’t be ashamed to come in and get checked. We see it all day long, every day. We’re just here to help you and keep you as healthy as possible.”

Visit the Boulder Women’s Care website for more information or call (303) 872-9431 to schedule an appointment with Nancy Engllenner, NP. Visit the Foothills Community Midwives website or call (303) 622-5834 to schedule an appointment with Paige Swales, CNM.

Click here to view/download a PDF of slides shown during the recent BCH lecture “Why Kids Need the HPV Vaccine.” (Note: the slides do contain images of a graphic nature.)