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October 20, 2017 - 12:00 AM

Imagine the comfort of knowing your child is safe from getting certain kinds of cancer.
Today, that’s possible with the HPV vaccine, which prevents cancers of the genital areas and head and neck of men and women — conditions that can all lead to premature death.
The vaccine combats nine strains of the human papillomavirus (HPV) that have been found to cause such cancers. HPV routinely infects 14 million young Americans each year. So yes, it’s everywhere. For most, the virus clears up by itself. But for an estimated 31,000 Americans each year, they contract cancer from the virus. Two-thirds are women, who contract primarily cervical cancer. For males, the cancer attacks the anus, penis or back of the throat.
The virus is spread primarily through sexual activity.
The best way to prevent these cancers is to “vaccinate your child way before they even understand the concept of sex,” said Dr. Jay Lieberman, a pediatrician who specializes in infectious diseases and serves as regional medical director for Merck Pharmaceuticals.
Lieberman was the guest speaker Thursday night for a group of health care professionals who deal with vaccinations in public schools, health clinics, hospitals and private practices in Chanute, Humboldt and Iola.
The Rural Health Initiative, an offshoot of Thrive Allen County, sponsored the meeting.
 
THE HPV vaccine was first introduced in 2006, approximately 20 years after it was discovered that the virus is the main cause of cervical cancer in women. Since then it’s been found to cause other cancers including those for men.
Despite its efficacy, it has been slow to be adopted as a routine vaccine.
Kansas is in the lowest quartile in the nation for seeing its youth are protected from these cancers.
In reviewing the statistics for this region, Lieberman noted, “there’s a lot of work to be done. There are a lot of kids who are not protected.”
The urgency of preventing these cancers cannot be overstressed, Lieberman said, and should be part and parcel of a child’s vaccination regimen along with protection against diphtheria, pertussis, and tetanus (DTaP), polio, measles, mumps and rubella, influenza, and meningococcal. The recommended age for the two-shot series is 11-12, but can begin as young as 9. For those who wait until age 15, three shots are needed.
An engaging speaker, Lieberman is the father of four, including twin daughters who recently turned 9.
“What age 9 means to me is that they were eligible to receive their HPV vaccine. And so my wife, who’s a pharmacist, and I sat down to discuss whether our daughters should get the vaccine now. This discussion took 11 or 12 seconds and we decided of course we should vaccinate them now. We made this decision without consulting our daughters. This was our decision.”
In the lead-up to telling their daughters of the vaccination, however, Lieberman craftily left lying on the kitchen table information about HPV.
As Lieberman expected, the girls inspected the material — “My daughters are very nosy” — that included pictures of healthy teenagers juxtaposed next to adults whose heads were bald.
The girls asked if the latter pictures depicted the teens in their older years, and if so why were they bald.
Lieberman explained the people had contracted cancer just as their Auntie Lisa had done, and like her, lost their hair due to the treatments.
“When I explained that these people contracted cancer from a virus, they wanted to know what this was all about.
“So I was able to tell them the good news of a vaccine that can prevent infection with this virus and the better news that they were going to get this vaccine on a visit to the pediatrician.
“So what was their response? ‘Cool!’”
The kids easily connected “cancer, bad; vaccine, good,” he said.
 
LIEBERMAN had several theories as to why the vaccine has had a lackluster response by health professionals and parents in the United States as compared to other regions, such as Europe and Australia, whose children are almost all inoculated against the HPV virus.
He postulates that pediatricians typically don’t follow their patients past age 18 and so don’t see their patients ravaged by the disease as young adults.
“Pertussis, they see. Whooping cough, they see. But these patients who should have been vaccinated as youths and contract cancer years later, are long gone.”
In the U.S., about 63 percent of teenage girls age 13-17 have completed one shot out of the two-shot regime, and 43 percent are up to date.
What’s the impact of these numbers?
If this rate continues, today’s girls will develop 53,000 cases of cervical cancer that could have been prevented.
“Let that number sink in for a second,” he said. “And then realize HPV is not just cervical cancer, but other cancers in girls and boys.”
“It’s not just numbers, or colors on a chart,” Lieberman said as he held up the charts showing the immunization rates across southeast Kansas, “but you have girls and boys here who are not protected and 10-15 years from now, some of them will get cancer.”
“They are going to be diagnosed with cancer, and they are going to learn that their cancer was caused by HPV infection and then realize there was a vaccination that could have prevented this that they did not get. And their response is going to be ‘what the heck happened. Why? Mom, Dad, what happened?’”
“You want to talk about guilt.”
 
SO WHAT are the barriers preventing wider use of the vaccine?
“Social media,” said Kathi Yokum, a nurse practitioner who works at Humboldt’s Ashley Clinic. “People will post rumors about the effects of the vaccine that simply are not true.”
Such rumors come out of a good place in that they reflect a parent’s fear for their child’s safety, Lieberman said. That they are not based on fact is worrisome.
“So let’s talk about the reactions of the vaccine,” he said.
1. The shot hurts.
2. Sometimes children, especially those over 16, faint. The recommendation is for health professionals to watch all kids for 15 minutes after the vaccine is administrated. “The syncopate (fainting) is a result of the shot. It has nothing to do with what’s in the syringe.” The younger the child, the less likely they are to faint, Lieberman said. “A 16-year-old is much more likely to faint than an 11-year-old,” due to a more sensitive vasovagal reaction.
The vaccine used to prevent HPV is Gardisal and more than 200 million doses have been administered globally. In these past 11 years, no “safety signals” have emerged concerning the vaccine. “But in the era of social media, it takes one parent to write their child started walking backward after receiving the vaccine and you can Google that and find another parent saying their child did the same thing and all of the sudden it’s a case series and you’re convinced the vaccine did it. That’s not science.”
For parents who are afraid the vaccine will hurt their child, the message must be not giving the vaccine will hurt their child, he said, and encouraged the health professionals to learn the response: “By not vaccinating your son or daughter, you are increasing their risk to cancer.”
 
BECAUSE HPV is sexually transmitted, some parents say their children are out of the woods from contracting the disease and resent what they perceive as pressure to vaccinate their children.
“I get it,” Lieberman said. “As the father of 9-year-old twins there’s no part of my brain that wants to think of them one day having sex. But, this is not about sex, but about cancer prevention. And by giving the shots at age 9 or 11, it distances the discussion from sex.”
In the conversation with his daughters, the issue of sex never came up.
As for parents who contend the vaccine promotes sexual promiscuity, Lieberman’s reply is: “We are not opening the door to sex; we are closing the door to cancer.”
Of course, Lieberman was preaching to the choir Thursday night.
Getting families, schools and communities to sense the urgency and act is another matter.
Perhaps no greater challenge exists than in Humboldt, where only 40 percent of middle school students are up to date on their vaccines, according to Wendy Froggatte, school nurse.
Froggatte said a “small but powerful” contingency exists in Humboldt that is against immunizations in general.
Though state law mandates students who attend public schools be immunized it’s up to individual school districts to enforce it. It’s been about 15 years since Iola schools made compliance necessary, according to Jacki Chase, school nurse for District 257. If they fail, they are not allowed to attend school.
“I worry for my children,” said Yokum, whose children attend Humboldt schools.
The goal is to make vaccinations for “meninges and HPV as routine as that for TDaP,” Lieberman said. “Our job is to protect the children from the diseases for which they are at risk.”

 

PHOTO: Dr. Jay Lieberman addresses area health professionals Thursday about the importance of the HPV vaccine. In back are Amy Davis of the Ashley Clinic in Chanute and Kathi Yokum of Ashley’s Humboldt clinic. REGISTER/SUSAN LYNN

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