Dr. Daniel Shust
Guest Columnist: Dr. Daniel Shust, 2015 Doctor of Medicine Graduate from The Commonwealth Medical College (TCMC)
Daniel Shust, MD., is originally from Greenfield Township. He received his Bachelor of Science (BS) in Biopsychology from Penn State in 2005, a Master of Biomedical Sciences (MBS) from The Commonwealth Medical College (TCMC) in 2010 and a Doctor of Medicine (MD) from TCMC in 2015. Currently, Dr. Shust is a resident in The Wright Center’s Regional Family Medicine Residency Program, based in Wilkes Barre, PA.
One of the greatest frustrations in modern medicine occurs when a safe, tried and proven treatment exists to prevent deadly disease but it is not possible to administer it to the potentially vulnerable victims. Unnecessarily, overtime the disease spreads exponentially. Malaria in sub-Saharan Africa where one million die from the disease each year and tuberculosis in Haiti where the highest rates in the Western Hemisphere exists, are two examples. More recently, parents in California have made national news because they refused to vaccinate their children from measles. Since the measles vaccine was introduced in 1963, a 99 percent reduction has been attained. However, as of last month, 79 confirmed cases of measles in California due to parent refusal to vaccinate their children due to unsubstantiated fear of harm to their children.
The vast majority of parents belonging to the “anti-vaccine movement” justify their actions with completely unfounded and unsupported fears of autism and other illnesses from the vaccine. However, their decisions affect the health of not only their children, but others as well. The outbreak has quickly spread to Arizona, Utah, Washington, Colorado, Oregon, and Nebraska.
Another such disease that can be prevented with vaccination is the Human Papillomavirus, (HPV). Some strains of HPV lead the cancer. A 100% percent disease prevention rate is associated with those vaccinated before the age of first potential exposure.
According to Paul Offit, MD, professor of pediatrics, division of infectious diseases director of the Vaccine Education Center at the Children’s Hospital of Philadelphia (CHOP), every year in the United States, thousands of men and women die of cancers that can be prevented with a simple vaccine administered during adolescence to prevent HPV. He states, “It is critical that doctors and parents keep in mind; the disease is NOT ABOUT SEX…IT IS ABOUT CANCER!”
The Centers for Disease Control (CDC) has listed the prevention of HPV as a one of its “Top 5 Health Initiatives.” The pressure will be on health care providers to take time educate and dispel myths in order for parents to make informed decisions for the health of their children. In fact, local pediatrician Anders Nelson, who spends significant time educating parents and children about the importance of vaccination, requires parents to sign a “Refused HPV Vaccine” form and boasts a 99% compliance rate.
2013 the CDC reported 13.9% of males and 37.6% of females’ ages 13-19 are completing vaccination for Human Papillomavirus (HPV). Despite such low vaccination rates, a 50% reduction in HPV among 14 -19 year old females is note. Moreover, studies demonstrate a 100% success rate to eradicate HPV in children vaccinated between the ages of 9 and 11 years old. With this in mind, health professionals ask a frustrating and burning question: “Why do parents hesitate to vaccinate their children from a potentially deadly virus when a safe and effective cure exists?”
Reasons cited by parents for not vaccinating are challenging to health providers. Some of the most common responses include misunderstanding of HPV and its impact, unfamiliarity with vaccine recommendations, distrust of vaccine safety, religious and moral issues with mode of disease transmission, and social pressures. It will be the purpose of this column to dispel myths and address these concerns among parents.
HPV is the most common sexually transmitted disease (STD) in the United States. It is estimated that nearly all sexually active Americans will at some point become infected with the virus. HPV is spread by direct skin to skin contact. Although the infection maybe asymptomatic, it is still possible to spread the virus. Condoms are not 100% effective to prevent HPV because infected skin may be present outside of the barrier.
Studies have demonstrated that at any given time, 52.8% of males will be infected. American females’ infection rates vary primarily with age. Although the prevalence of the disease among all females age 19-59 is 26.8%, females age 20-24 have a prevalence of 44.8%.
HPV is a family of viruses that primarily produce warts, but a limited number are responsible for cancers. There are a total 120 different subtypes of the virus capable of producing warts on skin or mucus membranes. Specific strains of the virus show preference for sites of infection, and different disease progressions. For example, most types are responsible for common warts on the hands and feet, however, there are strains with a preference for producing genital/anal disease. Moreover, the HPV causing the most of significant concern are those strains responsible for certain cancers. Some HPV strains will directly interrupt a cells repair cycle, resulting in vulnerability to be transformed into a cancerous cell. HPV types 16 and 18 are high risk for cancer and account for 70% of all 490,000 cases cervical cancer with 3,900 deaths. In addition, these two types cause penile, anal and head/neck cancers.
Prevention is paramount because once infected there is no treatment for HPV infections. Only the associated lesions, including genital warts, recurrent respiratory papillomatosis (RRP), pre-cancers, and cancers are treated. Treatment options professionals utilize are biopsy, cauterization, cryotherapy, and can be mildly to severely disfiguring. Biopsy results are used to determine the HPV strain and treatment. High risk subtypes lead to increased medical observation, and have the potential for more invasive treatments which can impair fertility and cause facial disfigurement.
The two vaccines available for use are Gardasil and Cervarix. Both vaccines protect against HPV 16 and 18, which account for 70% of all cervical cancers. Gardasil additionally protects against other high and low risk virus types.
The Gardasil vaccine was initially developed in the mid 1980’s at various institutions in the US and abroad. HPV proteins were added to a previous vaccine base that was proved safe and effective. After 20 years of testing and scrutiny by the FDA, Gardasil was deemed safe and released to the public in 2006.
Since distribution of the Gardasil vaccine, 67 million were administered with less than .037% adverse events. The reported vaccine reactions are injection site discomfort, dizziness, and fainting. Furthermore, research has concluded that there is no association with neurological conditions such as Guillain-Barre’ and Autism.
Gardasil and Cervarix are licensed for use for males and females ages 9 through 26 years. The vaccines are administered in a series of three on a 0, 2, and 6-month schedule. Studies have shown vaccination earlier in the recommended age spectrum has more advantageous results. For example, children administered the vaccine between the ages of 9-11 display 100% prevention of disease. Sexually activity is not a contraindication to receiving the vaccine, but the vaccine is not recommended to those currently pregnant.
Despite the safety and efficacy of the vaccines, one reason reported by parents for not vaccinating their children is the concern that vaccination will increase sexual activity in adolescents. Although disconcerting for parents, a study conducted two years before the introduction of Gardasil by the U.S. Department of Health and Human Services reported that the number of sexually active teens has increased to 30% in ages 15 to 17 and more than 63% in ages 18 to 19. Furthermore, these numbers continued to increase regardless of public programs in sexual education and abstinence.
Since released in 2006, Gardasil has made a direct impact on HPV prevalence in adolescents. Even with vaccination rates of 37.6%, HPV prevalence among adolescent females age 14-19 is 50% less than previously recorded. The decline in affected teens is predicted to lead to decreased future HPV related cancers. These vaccinations are safe, effective, powerful tools at our disposal to protect our children from the detrimental effects of a preventable disease. If you would like more information on Gardasil or Cervarix consult your local Family Physician, Pediatrician, or Obstetrician-gynecologists (OB/GYN).
Remember the advice of CHOP pediatrician, Dr. Paul Offit regarding the HPV vaccination for adolescents, “it is critical that doctors and parents keep in mind; the disease is NOT ABOUT SEX…IT IS ABOUT CANCER!”
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This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com
