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New campaign aims to increase HPV vaccination rates among Minnesota’s teens

The Minnesota Department of Health announced Wednesday that it has received a $600,000 grant from the Centers for Disease Control and Prevention (CDC) “to increase coverage rates for the human papillomavirus (HPV) vaccine among adolescents in the state.” The money will be used to launch a public awareness campaign aimed at the families of adolescents and to educate health-care providers about the need to discuss the vaccine with adolescents and their parents.

The HPV vaccine, which first became available in 2006, protects against 70 percent of cervical cancer in women and several other types of cancer that affect both women and men. It’s given in a series of three injections, starting at the age of 11 or 12 — a time when young people are also receiving vaccines to prevent whooping cough and meningitis.

The HPV vaccine has been shown effective in preventing cancer, yet few teens in Minnesota — or nationwide — are fully vaccinated. A 2012 survey found that 59 percent of young women in Minnesota had received the initial dose of the vaccine and only 33.1 percent had received all three doses. (The nationwide rate is 33.4 percent.)

The survey also found that the number of young men in Minnesota who had received the initial dose of the vaccine was even lower: 20.8 percent. The vaccine was not recommended for boys, however, until 2011.

The goal of Minnesota’s new public awareness campaign is to reach an 80 percent level of coverage (all three doses) for girls ages 13 to 15, by 2020. (A specific goal for boys is not part of the campaign because the CDC set its “Healthy People 2020” goals in 2010, before the vaccine was recommended for boys.)

MinnPost talked about the campaign and the HPV vaccine Wednesday with Kristen Ehresmann, the state Health Department’s director of infectious disease. The following is an edited transcript of that interview.

MinnPost: Why is it important that adolescents and young adults receive this vaccine?

Kristen Ehresmann: The key reason is that we have a vaccine that can help us prevent cancer. So we want to make sure that we’re taking advantage of this.

If we look at the cancer burden in the United States, there are 26,000 cases of cancer that are caused [each year] by the human papillomavirus. The vaccine can help address 22,000 of those cancers. The types of cancer that are covered are cervical cancer, which is obviously the most well known, but also vulvar cancer, vaginal cancer, oropharyngeal cancer [a type of throat cancer], anal cancer and penile cancer. So it’s a wide range of cancers that can be addressed by using this vaccine. That is really what our motivation is in making sure that youth are taking advantage of this.

MP: The vaccine is now recommended for boys as well as girls, but that message has been much slower to reach the public.

KE: You’re right. The focus has been on women to a large extent. But this is a vaccine that is currently recommended for both boys and girls at their adolescent visit [to their physician]. The cancers [covered by this vaccine] clearly affect men as well as women, although cervical cancer has been the primary cancer that people have focused on.

MP: Why haven’t more young people received this vaccine?

KE: Our goal for a vaccine is usually 90 percent coverage. So, yes, we’re not seeing the uptake we would typically see with other vaccines. There are a couple of reasons for that. First, this vaccine was very much linked to sexual activity when it was first licensed. It helps prevent infections caused by the human papillomavirus, and how are those infections acquired or transmitted? Through sexual transmission. So there was a real outcry among parents.

Also, after the vaccine was licensed, there were some initial efforts to mandate the vaccine. The combination of the mode of transmission for HPV infection as well as that mandate didn’t sit well with parents.

Parents were thinking, here’s a vaccine that’s been tied to sexual activity, and now I’m hearing that the age [for receiving it] is 11 to 12 years. That also didn’t sit well with some of them.

But part of the reason it’s being recommended at those ages is that you have a better immune response then. Parents think we’re recommending it because there’s an expectation that the kids will be sexually active at those ages. That is absolutely, of course, not the case. But that has been a challenge that we have been working hard to overcome. We want kids protected, and we want them protected in the best way possible. And that means making sure that they are vaccinated at these young ages, when they need to be seeing their health-care provider and when they will have the best immune response to the vaccine.

Even with the poor uptake we’ve had, we’ve seen a 56 percent reduction [nationwide] in infections caused by HPV. So it’s a very effective vaccine. We want to make sure that that message is getting out.

MP: Parents are also concerned about the vaccine’s safety, of course, and there have been a lot of myths and misinformation on that point. How do you address those concerns?

KE: First of all, before a vaccine is licensed by the FDA, it must meet stringent safety criteria. But we’ve also had seven-plus years of using the vaccine in the general public, and there have been specific studies that have looked at the HPV vaccine and safety, both in the United States and in Europe and worldwide. There haven’t been links to any adverse events or any concerns in that regard. What we’ve identified as issues related to the vaccine is pain at the injection site, some stinging. We clearly hear more about that with this vaccine than with other vaccines. We have also seen more fainting. I think that probably has less to do with the vaccine itself than with the age of the recipients.

Another concern was that if this vaccine is used, does that mean that the youth who receive it will be predisposed to being more sexually active. A study was done to look at that. It found that being vaccinated with HPV was not a marker for increased sexual activity.

MP: You’ll also be targeting physicians with this new public awareness effort, correct?

KE:  Yes, we will be doing provider education and outreach to the health-care community. When they’ve done studies and looked at how providers present information on different vaccines, they’ve found that with the HPV vaccine in particular, providers tend to have a much more hesitant approach. They’re not recommending it [to families] with the same strength as they do with other vaccines. And that really affects how parents view the vaccine. It’s important for physicians to realize that they’re doing this.

MP: Why aren’t providers recommending it as strongly as other vaccines?

KE: One of the initial issues was a concern about the vaccine’s safety. Our message to providers is that the safety profile is excellent. Also, the protection provided by this vaccine is a home run. It’s nearly 100 percent. After eight years, there’s no evidence of waning immunity, so we expect very long-term protection.

MP: Why was Minnesota one of only seven states chosen for this CDC grant?

KE: It wasn’t because Minnesota had vaccine rates that were abysmal. We got the grant based on our proposal — what we intended to do to reach out to parents, to teens, to providers. It was the strength of our proposal. This isn’t a pilot project, but [our results] will be [shared with other states] and used for best practices.

More information about the human papillomavirus and the HPV vaccine can be found on the CDC website.

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