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Bittersweet news about cervical cancer: Teen vaccination rates are low, but infections are declining

This article first appeared in the St. Louis Beacon: It isn’t often that a developing nation outstrips the United States in vaccination rates for a potentially deadly but preventable medical condition. But that’s happening in the case of vaccinations against certain types of HPV or human papillomavirus infections, which can cause cervical cancer. The data show that while the United States is making major progress against this disease, it still has a long way to go to match vaccination rates in many other countries.

The Centers for Disease Control and Prevention reports that some European nations and developing countries, such as Rwanda, boast HPV vaccination rates of 80 percent or more among teen girls. The rate for the same group in the United States is only about 33 percent.

The results were published in the June issue of The Journal of Infectious Diseases. The study noted that 79 million Americans, most of them young people, are infected with HPV, and that about 14 million people become newly infected each year.

In spite of the low U.S. vaccination rate against HPV, some experts see a rosy side to the data, noting that the prevalence of HPV infections that respond to the vaccine has dropped 56 percent among teen girls between the ages of 14 and 19 since the vaccine was introduced in 2006.

That drop “is surprising since the vaccination rate is relatively low,” says Dr. L. Steward Massad, a gynecologic oncologist at the Center for Advanced Medicine and a professor at the Washington University School of Medicine.

“Only about 1 in 3 girls in the targeted age range get all three shots” in the United States, he says. “That compares to 80 percent or better in Australia and several European countries where they are allowed to give vaccines in the school, but they allow parents to opt out.”

The difference in the participation rates in the United States and many other countries, he says, is due to the American policy of requiring that “you have to bring your child (to a doctor's office or clinic) in order to get vaccinated.”

In many other nations, he says, “you have to actively ask not to be vaccinated if you object. You have to take more vigorous steps to get out of vaccination than to get into it.”

But even if U.S. policy were changed, Massad isn’t sure public acceptance would immediately follow. The CDC study “will be one piece of information that parents use to bring their children in to get vaccinated, but it won’t persuade everybody,” he says. A lot of parents are concerned about side effects, he says. “Many of the side effects parents hear about, especially online, are not true, such as (claims that) it causes mental retardation. But there are allergic reactions.”

Another interpretation of the data, he says, is that the vaccination works best for girls who have never engaged in sex. Although 17 is the average age for a girl’s first sexual experience, he says roughly 5 percent of 13-year-old American girls are sexually active. That explains why the target age for the vaccine is between 11 and 12, he says.

“Remember it is a preventive vaccine. It doesn’t treat HPV once people have it. So girls should get vaccinated before they start having sex and that’s the greatest benefit of this vaccine.”

There also is a move to encourage boys to get the vaccine as well.

There is no way to know how well a specific region is doing in the fight against HPV because the CDC data aren’t broken down by regions.

“HPV is not a reportable infection, so nobody keeps track of it,” Massad says, but he thinks the CDC data suggest that “even though we are not doing terribly well (in vaccinating), we may be starting to win the fight against the virus that causes cervical cancer. With any luck, the vaccine will put me out of business. But we haven’t seen that yet.”

Robert Joiner has carved a niche in providing informed reporting about a range of medical issues. He won a Dennis A. Hunt Journalism Award for the Beacon’s "Worlds Apart" series on health-care disparities. His journalism experience includes working at the St. Louis American and the St. Louis Post-Dispatch, where he was a beat reporter, wire editor, editorial writer, columnist, and member of the Washington bureau.