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IMMUNIZATIONS

The Effect of Vaccinations

on the Prevalence of

HPV By Abigail Cain, MD, MPH

While it is well known by medical professionals that the human The Healthy People 2020 target is for an 80% vaccination rate to
papillomavirus (HPV) causes nearly all cervical cancers (associated ensure maximum community immunity. This vaccination series re-
with cancers of the vagina, vulva, penis, anus and oropharynx), the quires three doses of vaccine to provide protection against the virus.
general populace is largely unaware of this. Patients, often unknow- In Bexar County, only 48% of targeted patients are completely up
ingly, rely upon physicians for the awareness and education that to date on their HPV vaccinations, with males being particularly low
leads to more patients receiving vaccinations. with only 25% of them receiving the required 3 doses of vaccine.
The virus is prevalent in Texas, with 2510 cases of HPV-related When the rates of HPV vaccination were compared between
cancer recorded between 2012 and 2016, including 830 cases of those who had received recommendations from a provider vs. those
oropharyngeal cancer and 890 cases of cervical cancer. During this who had not, it was found that those that had been recommended
period in Bexar County, the incidence of cervical cancer was 10.6 to receive the vaccine were much more likely to be vaccinated. It is
in 100,000 people, with 28% of those succumbing to (dying from) evident that in order to continue to decrease the rate of HPV in-
the disease. fections and of HPV related diseases, physicians need to educate
HPV vaccination, which has the potential to prevent most HPV patients (both male and female) as well as the community about the
related cancers, has been available for female adolescences, ages 9- importance of the HPV vaccine. Through broad-based community
26 years, since 2006, and has been available for male adolescents educational programs, as well as one-on-one patient centered care,
since 2011. Following the introduction of the vaccine, there has we as physicians can raise awareness and reduce the stigma sur-
been a significant decrease in HPV type infections. rounding HPV, causing more individuals to become vaccinated.
• Female Infections - Between 2013 and 2016, there was a decline
in HPV related infections from 11.5% to 1.8% for ages 14-19 years, References:
and from 18.5% to 5.3% among females aged 20-24 years old. • McClung NM, Lewis RM, Gargano JW, Querec T, Unger ER,
• Herd Effect - There have also been declines observed among Markowitz LE. Declines in vaccine-type human papillomavirus
unvaccinated women suggesting a herd effect. prevalence in females across racial/ethnic groups: data from a
• Male Vaccination Rates - Vaccination rates for males have gen- national survey. J Adolesc Health In press 2019.
erally been found to be lower than in females. However, concur- • Oliver SE, Unger ER, Lewis R, et al. Prevalence of human pa-
rent HPV vaccination in males significantly lowers the rates of pillomavirus among females after vaccine introduction – National
HPV infection in the female population as well. Health and Nutrition Examination Survey, United States, 2003–
2014. J Infect Dis 2017;216:594–603
The physician's role is critical in increasing the rates of HPV vac-
• J. Barrera, S. Greene, E. Petyak, S. Kenneson, E. McGill, H. How-
cination. A recent study evaluating the patient’s decision to be vac-
ell, D. Billing, S. Taylor, A. Ewing & J. Cull (2019): Reported ra-
cinated, versus not being vaccinated, concluded that patients often
tionales for HPV vaccinations vs Non-vaccination among
were vaccinated at the urging of their physician. The study pointed
undergraduate and medical students in South Carolina, Journal
out the following:
of American College Health. DOI 10.1080/07448481.2019.
• Physician Influence - of those who received the vaccination,
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40% said that physician recommendation influenced their decision.
• Non-vaccinated patients - 36% stated they had never thought
Abigail Cain, MD, MPH is a resident at UT Health San Antonio and
about receiving the vaccine.
is a member of the Bexar County Medical Society.
• No Need for The Vaccination - 31% felt they did not need
the vaccine.
20 San Antonio Medicine • November 2019