PLATTSBURGH — New York legislators want to add human papillomavirus (HPV) to the list of required immunizations for school children.
The proposal has its advocates and detractors on both sides, according to a Joe Mahoney in a CNHI State report in Monday's Press-Republican.
The Clinton County Health Department dispenses Gardasil 9, a Merck vaccine that offers protection from nine of the most common HPVs.
“Human papillomavirus is a virus that is spread by skin-to-skin contact,” Karen Plotas-McGrath, public health educator, said.
“Some of them cause things like cancers. Some of them cause things like non cancers but things like warts.”
HPV is a group of more than 200 related viruses, some of which are spread through vaginal, anal, or oral sex, according to www.cancer.gov.
The disease is transmitted through vaginal intercourse, anal and oral sex and is easily passed between sexual partners.
Though condoms and dental dams can reduce chances of HPV transmission, it does not completely prevent it.
Nearly all sexually active people are infected with HPV almost immediately once they become sexually active. Around half of these infections are with a high-risk HPV type, which causes cancers.
VACCINATION IS PREVENTION
HPV 16 and 18 are the most common viruses.
“Those two, according to the National Institute of Health, 70 percent of the cervical cancers are caused by the HPV type 16 and 18," Plotas-McGrath said.
"That is in the Gardasil 9. Then, 20 percent of some of the other cervical cancers caused by 31, 33, 45, 52, and 58, which are also in the Gardasil 9. Two other human papillomaviruses that are in the Gardasil 9, the 6 and the 11, which don't cause cancers but causes warts to the genitalia, the anus, mouth and throat."
Health officials are hoping that the vaccination will really reduce the number of cervical cancers if kids get vaccinated.
“What we tend to see is that people start the vaccine and don't always finish it, especially the third shot,” Plotas-McGrath said.
“They've done studies, and they have found children who are younger than age 15, if they start their vaccination, (recommendation is 11 or 12 but as early as age 9), the benefit to that is like with any vaccine. You give them the vaccine because you don't want them to get it. If you wait until they've got it, then you can't protect them from that particular HPV if they've already been exposed to it obviously.
“Children, their immune system is so good, to give them the vaccine when they're younger, they're actually finding that they only need two shots rather than three to protect them.”
UNDER THE MICROSCOPE
The recommendation is that children receive the vaccination, preferably under the age of 15, and through the age of 26.
“They do say that some individuals can benefit from the vaccination up to the age of 45,” she said.
“That's something that your medical professional would have to say, 'Yeah, I want you to get this vaccine.' It's not considered part of the typical recommendations.”
HPV is screened through cervical testing.
Typically, women get an annual gynecology exam whereas men don't get their urethra scraped to have cells analyzed.
“It's a little bit harder for men because women get a cervical Pap smear annually once they're sexually active,” Plotas-McGrath said.
“That's the only way really. We're kind of behind the eight ball unless we're talking about vaccination. It's really our best bet. I've seen hopeful signs that is already starting to make a dent in cervical cancers.”
Men or women may not have a whole lot of symptoms with HPV.
“Cervical screening, one of the things they are looking for in the testing is for any kind of cancers, any abnormalities in the cells,” she said.
Men get penile, anal and oropharyngeal cancers.
“And women can get some of those also,” Plotas-McGrath said.
“Men need it to because they are the ones helping to spread it around. They are also suffering for it. We've some people in the acting field that have died from throat cancers and stuff, probably, those might very well be some type of HPV they had, and they're dying from it. What's the screening for it?”
In the United States, there are 4,000 deaths a year are attributed to some type of HPV.
“That's why we're trying to say let's get more people vaccinated, especially younger children, because if we protect them better, and they only need two shots on top of it, we're going to get a lot more people to complete their vaccines and have more kids protected before they ever come into contact with the disease,” Plotas-McGrath said.
High-risk HPVs cause 3 percent of all cancers in women and 2 percenr of all cancers in men, according to the Centers for Disease Control.
There are about 44,000 new cases of cancer in parts of the body where HPV is often found, and HPV is estimated to cause about 34,000 cancers each year.
“It's kind of scary,” she said.
“A lot of these type of cervical cancers can be prevented by this vaccination. If we can get the younger people vaccinated before they come into contact to prevent them from getting it would be great.”
The problem with HPV is the length of time between exposure and detection of the cancer.
“The big thing with HPV in the beginning was oh, well men don't need this or boys don't need this,” Plotas-McGrath said.
“There's not immaculate infection. When we look at our college-age students or students that are sexually active, I mean, they know that is an easy way to spread it because you are having skin-to-skin contact.
Health professionals are seeing cases of chlamydia and other STIs, so there is risk for HPV.
“If we have kids that aren't vaccinated, they are at risk and they may not even realize it,” Plotas-McGrath said.
“We've got to protect them. If we can vaccinate kids up to the age of 26 and 7/8 because I would push it right to the limit if I could to get them vaccinated. But the younger the better though.”
Exemptions for any kind of mandated vaccine is getting increasingly difficult.
“As far as vaccinations go, you're putting a bunch of susceptible little kids in close proximity,” Plotas-McGrath said.
“For HPV that chance is a little lower than some of these other illnesses, but you're looking at a public place where people are not vaccinated for certain things, it can be really dangerous.
Before any vaccination, including HPV, adults are given a Vaccine Information Sheet (VIF) that lists adverse side effects.
“It allows people to either call or report any kind of problem they have from a vaccine,” Plotas-McGrath said.
“That is constantly reviewed. It is constantly assessed for any kind of problem. Problem with the batches? Problem with whatever side effect that people might be coming up with. That is constantly monitored after all these years.”
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CANCERS CAUSED BY HPV INFECTION
Long-lasting infections with high-risk HPVs can cause cancer in parts of the body where HPV infects cells, such as in the cervix, oropharynx (the part of the throat at the back of the mouth, including the soft palate, the base of the tongue, and the tonsils), anus, rectum, penis, vagina, and vulva.
HPV infects the squamous cells that line the inner surfaces of these organs. For this reason, most HPV-related cancers are a type of cancer called squamous cell carcinoma. Some cervical cancers come from HPV infection of gland cells in the cervix and are called adenocarcinomas.
HPV Related Cancers
Cervical cancer: Virtually all cervical cancers are caused by HPV. Routine screening can prevent most cervical cancers by allowing health care providers to find and remove precancerous cells before they develop into cancer. As a result, cervical cancer incidence rates in the United States are decreasing. Learn more about trends and statistics for cervical cancer.
Oropharyngeal cancers: Most oropharyngeal cancers (70 percent) in the United States are caused by HPV. The number of new cases is increasing each year, and oropharyngeal cancers are now the most common HPV-related cancer in the United States. Learn more about trends in diagnosis and survival rates of oral cavity and pharynx cancer.
Anal cancer: Over 90 percent of anal cancers are caused by HPV. The number of new cases and deaths from anal cancer are increasing each year.
Penile cancer: Most penile cancers (over 60 percent) are caused by HPV.
Vaginal cancer: Most vaginal cancers (75 percent) are caused by HPV.
Vulvar cancer: Most vulvar cancers (70 percent) are caused by HPV.