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Bill Klaproth (Host): Human papilloma viruses are the most common sexually transmitted infections. Known as HPV, this term refers to a group of more than 200 viruses. Among those about a dozen can cause certain types of cancer. Now the good news is, that we have HPV vaccines to protect against infection. So, here to talk more about HPV and the vaccine is Dr. Michelle Bowden, Assistant Professor at the University of Tennessee Health Science Center.

This is the Peds Pod by Le Bonheur Children's Hospital. I'm Bill Klaproth. Dr. Bowden, thank you so much for your time. Always great to talk with you. So, let me ask you this. Why are HPV vaccines so important?

Michelle Bowden, MD (Guest): Yeah, that's a great question. So, as a pediatrician and somebody who really cares about the health of our children, not just for today, but for the future, I believe the HPV vaccines are so important because they're actually one of the few vaccines that we have available that can prevent cancer. So, when we look at the scope of impact of HPV on the worldwide burden, what we know is that HPV continues to cause cancer in both men and women around the world. And if we can prevent that, it's the old saying that there's an ounce of prevention, right? It's so much better than all the treatment that we can possibly give in the future.

Host: Well, preventing cancer, as we know is huge. Are there other types of cancer or disease that the HPV vaccine will help prevent?

Dr. Bowden: Yeah. I think what most people are familiar with in terms of HPV vaccine is the idea that it prevents cervical cancer. But what we know is that HPV actually causes many different types of cancer, including anogenital cancer. It can cause cancer of vulvar space, of the penal space and actually is a rising cause of throat and neck cancer. And so by getting an HPV vaccination, you can prevent cancer in all of those places.

Host: Well, this really is an important vaccine, as by the different cancers that you just mentioned. So how young, how soon should someone think about getting the HPV vaccine?

Dr. Bowden: Well, the HPV vaccine has historically been recommended at ages 11 and 12. And we do that because that's an age where kids are typically getting their vaccinations around seventh grade anyway. And so when your child goes to their TDap booster or their first meningitis vaccine, they can also get their HPV vaccine. But it's actually approved down to age nine. So as young as age nine, we can start this vaccination series and provide our children with an immunity against HPV for their lifetimes, which is such a gift that we can give our children.

Host: Yeah, you are not kidding about that. So why do boys need to get the vaccine as well?

Dr. Bowden: I think that's a question that I get in my clinic a lot. And so we like to highlight the fact that this is a vaccine that's really relevant for both boys and girls. As I mentioned, it can prevent cancers of the genital area in boys as well as in girls. But what's really interesting is that we're seeing this rising number of throat and neck cancers, and the majority of those cases are actually occurring in men. And so by vaccinating our boys, we really probably are helping in many of those cases prevent not only the potential genital cancer, but the head neck cancer, that's much more prevalent in the male population.

Host: Wow. That is really interesting. So, just so we're all on the same page on this, we get the human papilloma virus through sexual activity. And that includes oral sex too. Is that right?

Dr. Bowden: Exactly. So HPV can be transmitted through any kind of sexual activity, whether that be vaginal sex or any other type of sexual activity, including oral sex. And so, the reason that we're giving this vaccine at kids, for kids who are 9, 10, 11, and 12, though, it's not because we think that they're going to be sexually active at those ages.

We give it at those ages because just as we want to baby-proof our houses before our babies potentially could get hurt by something like an electrical outlet in our house, we want to take care of that before it happens. We want to protect our kids way before that happens, which is why we recommend an HPV vaccine at 9, 10, 11, and 12, before we expect our kids to be sexually active.

Host: So that's why it's good to get the HPV vaccine as a pre-teen and not later in someone's teen years.

Dr. Bowden: Yeah. For a couple of reasons, one of the reasons is again, because we want to make sure that we are preventing the exposure before it ever happens. The second reason though is because we know that kids are actually really great at making antibodies, which is what the vaccine is supposed to do to give our body something to recognize so that when we see it again in the future, it can fight it off.

And when we give vaccines to kids, that's why we give so many vaccines to little kids, is because their bodies actually make really great responses to those in their early childhood years. It's even better than it would be if we gave it to them as an adult.

Host: Okay. So you said our bodies are amazing at creating antibodies. So is that how the HPV vaccine works? How does it work?

Dr. Bowden: Yeah. Great question. So like many other vaccines, part of what the HPV vaccine does is it exposes the body, to not the entire virus, but to parts of the virus. And specifically, actually that I've seen that we have right now exposes the body to nine different variations of the HPV virus.

And so, by showing the body, those parts of the virus, that body can then respond to and makes a great antibody response, and then it able to protect the body from future exposures that may occur naturally through sexual activity. So, it's not possible to get a human papilloma virus through the vaccine. But because a portion of the virus that's being exposed to the body, the body can still mount a strong response that protects the person for the rest of their lives.

Host: Wow. So you just said for the rest of their lives. So after these, is it a course of shots starting, preferably in the, in the pre-teen years, is it a course of shots? Is that how it works?

Dr. Bowden: That's right. So the recommendation right now is for anybody 15 or under that they get two shots about six months apart. That would be what would be sufficient to protect that person. As far as the studies that we have right now, we believe that protects them for life.

Now, as you get older, you may require more than two doses. So that's another reason why it's a great idea to go ahead and get your kids immunized is because you actually save them a shot by giving them, giving it to them at a younger age.

Host: So, since we're speaking of the vaccine and of course there's a lot of debate about another certain, vaccine out there right now. Oh my goodness. Is the HPV vaccine safe and of course, parents are going to want to know, are there side effects that come along with it?

Dr. Bowden: The HPV vaccine is absolutely safe and very effective. What we know is that the HPV vaccine has actually been one of the most studied vaccines prior to COVID, but it has been historically one of the more studied vaccines. The side effects that have come with it have been very, very minimal.

What most people report are really common side effects are things like my arm is a little sore, which would be pretty typical of most vaccines. There could be some redness or swelling at the injection site. A few people, about 10 to 15% of people will have a little fever within about a week or two of getting the vaccine. Some people do report things like having a little dizziness or muscle soreness or feeling tired for a few days.

But this actually, is a pretty uncommon reaction, for most people. And it happens, as we all know, whether you get a vaccine or not just sometimes that's how our days go. Occasionally, I will have patients that get a little lightheaded or even pass out with the vaccine. And that's not really about I think component as much as it is about the process of getting a vaccine. But overall, what we know is this is a really, really safe vaccine that helps protect our kids for a long time.

Host: Absolutely. So let me ask you this. A woman might be asking then, hey, okay, I've got the vaccine. Do I still need to get a PAP test? What about that?

Dr. Bowden: Great question. Well, what we know is that right now, the vaccine that we have available protects against nine different strains of HPV. Unfortunately, there are a hundred different strains of HPV that exist. So it is possible that you could get a strain of HPV that's not covered within this particular vaccine.

The good news is the vaccine protects against about 90% of the cancer causing strains of HPV. So it's very effective at preventing it, but for that last 10%, there are still recommendations in adults who are over 21 to continue to have PAP tests. We are seeing a dramatic reduction in cervical cancer rates over time. So, that's great news for people who are vaccinated, but just in case, we still recommend that adults over 21, females over 21, continue to get their PAP tests.

Host: Okay. And just trying to cover every angle here. Let me ask you this then, as far as the HPV vaccine and fertility, it doesn't affect a woman's fertility at all. Is that correct?

Dr. Bowden: Yeah, we have no evidence to suggest that this vaccine would affect fertility at any point. And, luckily we're at a point now where this vaccine has been around long enough that we've been able to study it over many years. In which case we expect that we would have seen effects on fertility and that's just not ever been a part of the conversation because we're not seeing it in people who've been vaccinated against HPV. There's no effect on future fertility.

Host: Okay. And then since, like I mentioned earlier, there's a lot of hot debate about vaccines. Has the pandemic affected HPV vaccination rates or HPV vaccination in general?

Dr. Bowden: This is one of the things that has made me really passionate about talking about HPV vaccination in the last year is that we know we lost a lot of well-child visits over the course of the pandemic because clinics were shut down. We were doing Telehealth visits. People were afraid to go out and be exposed to the virus. And so then we know we've lost a lot of opportunities to vaccinate kids, especially against HPV and other routine immunizations. We estimate that there may have been as many as a million HPV vaccinations that could have been missed in the last 18 months, which feels like kind of a scary number.

And certainly what we look at in the future is that would directly impact the rate of cervical cancer and head and neck cancer that we see in the future. And so we're really as pediatricians, committed to vaccinating our children, wherever they are in the series and at whatever they are age are now. We're welcoming our patients back into our offices, asking them to get vaccinated so that they can be protected in the future, despite having lived through this really trialing time with COVID in the last 18 months.

Host: Absolutely.Wow. That does seem kind of like a scary number. A million shots potentially have been lost because of the pandemic. Hopefully we'll make those up.

Dr. Bowden: That's our goal. And that's what we, as your pediatricians are here for is to help make up those missed opportunities, get our kids vaccinated so that they can live long and healthy lives when the pandemic is over, because we really believe this is a long road that we're protecting our kids from, in the future so that they live long and healthy lives.

Host: Anytime you can prevent something like cancer, it's definitely worthwhile. So this is really, really important. Yeah. And a great topic. And I'm glad we're talking about this. Dr. Bowden, thank you so much for your time. This has really been informative. Thanks again.

Dr. Bowden: Thank you so much. I enjoyed it.

Host: And once again, that's Dr. Michelle Bowden. And to learn more, please visit LeBonheur.org/podcast. And be sure to subscribe to the Peds Pod on Apple podcasts, Google podcasts, or wherever you listen to your podcasts. You can also check out LeBonheur.org/podcast to view our full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children's Hospital. Thanks for listening.