Prudish doctors inhibit vaccines for sexually transmitted infections
WHEN people hear about vaccine deniers — antivaxxers, to some — they most often think about parents who are refusing to vaccinate their children. But there’s another type of vaccine refusal, and it’s important that we not ignore that. Doctors sometimes promote the use of some vaccines with less enthusiasm than others. Sometimes, they don’t talk about them at all
This occurs most often with the human papillomavirus (HPV) vaccine. The low immunisation rates with this vaccine, and the behaviours of the physicians who might be contributing to that, have consequences.
HPV is a sexually transmitted infection that is very common — so much so that almost all sexually active people will get at least one of more than 40 types at some point in their lives.
The US Centers for Disease Control and Prevention (CDC) estimates that almost 80-million Americans are infected with HPV, and that about 14-million people will become newly infected this year. Most people don’t suffer any real negative health consequences, but about 1% of those infected will have genital warts at any given moment, and about 17,500 women and 9,300 men will be affected by cancers that HPV causes each year. These include cervical, oropharyngeal, anal, vaginal and penile cancers.
This is preventable. The CDC recommends that all boys and girls begin receiving the first of three vaccinations when they are 11 or 12 years old because it is important they be immune well before they become sexually active, when the vaccine may be less effective.
And to be clear, regardless of what some presidential candidates say, the vaccine is safe.
The scary e-mails and internet horror stories can easily be explained away.
Immunisation rates for HPV in the US fall far short of other vaccine rates. Last year, less than 42% of those aged 13 to 17 received at least one dose of the HPV vaccine. Fewer receive all three shots.
Even this rate of vaccination has made a difference, though. A study published two years ago in The Journal of Infectious Diseases examined the prevalence of HPV infections in girls and women before and after the vaccine was introduced. Among those aged 14 to 19, the prevalence of HPV went from 11.5% before 2006 to 5.1% after. This could not be accounted for by changes in demographics or sexual activity.
The remarkable reduction occurs even though only about a third of girls aged 13 to 17 received all three doses of the vaccine in 2010.
CDC director Tom Frieden estimated then that if we could increase the vaccination rate to 80%, far lower than we see with most other vaccines, we could prevent 50,000 cases of cervical cancer in women. He argued that every year we did not achieve this goal would result in an additional 4,400 women getting cervical cancer at some point.
Policy is partly to blame here. Although US states pretty much mandate all childhood vaccines as necessary for entry into school, fewer focus on diseases affecting adolescents. However, all states and the District of Columbia (DC) require immunity to chickenpox; 47 states and DC require vaccination against hepatitis B; and 29 states and DC require it for meningococcus.
Only two states, Rhode Island and Virginia, and DC require vaccination against HPV.
Myths about the safety of the vaccine persist despite overwhelming evidence to the contrary.
Doctors bear responsibility here as well. A recent study by Melissa Gilkey, a behavioural scientist at Harvard Medical School, surveyed paediatricians and family physicians, and found that more than a quarter of doctors did not endorse the vaccine strongly. About a quarter did not make timely recommendations for girls, and almost 40% did not make timely recommendations for boys. Only half recommended same-day vaccinations, and almost 60% recommended the vaccine more often to patients they thought were at higher risk of HPV infection, such as those more likely to be sexually active.
Regardless of what some presidential candidates say, the vaccine is safe. The scary stories can easily be explained
published last year in the journal Vaccine found that doctors underestimated how important vaccines were to parents, and overestimated parental concerns about how many shots their children were getting. Other research shows that the most common reason for adolescents not to receive the HPV vaccine is not parental refusal; it is a lack of physician recommendation.
Even if there are parental concerns, it is up to the physician to address them. Research by one of the nation’s pre-eminent experts in HPV vaccine behavioural research, Greg Zimet, from the Indiana University School of Medicine, has also found physician communication to be a significant predictor of HPV coverage.
However, he says, the number of behavioural studies of the HPV vaccine is far greater than for any other vaccine. There’s something about this vaccine that causes people to behave differently when discussing, considering and administering it.
The elephant in the room is, of course, sex. There is a pervasive belief that when parents, or even doctors, give the vaccine, they may be condoning sexual activity in young adolescents. This is not true. Many engage in sexual activity with or without the vaccine. Moreover, research is abundant in this domain. A 2012 study published in JAMA Pediatrics found that girls perceived no less need for safer sexual behaviours after receiving the vaccine. A study of more than 260,000 girls last year found that those who received the HPV vaccine were no more likely to get pregnant or to contract a nonHPV-related sexually transmitted infection than girls who were unvaccinated. NYTimes