Empowering Parents and Health Care Providers to Protect Children from HPV

Posted in GUMC Stories

Jan. 23, 2015–As a post-doctoral fellow at Harvard University School of Public Health and the Dana Farber Cancer Center, Sherrie Wallington, PhD , had her first experience educating parents about the human papillomavirus (HPV), a sexually transmitted infection that causes 70 percent of cervical cancers as well as other cancers.

“The parents were very frustrated, angry and some even hostile about this new recommended childhood vaccination. They weren’t accepting. I heard comments like, ‘well, this doesn’t matter because our kids don’t have sex before marriage,’ and ‘I don’t know why we should listen to this because my son doesn’t have a cervix,’” Wallington said. “So it immediately showed me that there was such a huge knowledge gap around HPV.”

Since then, Wallington has worked to close that gap. As assistant professor of oncology at Georgetown Lombardi Comprehensive Cancer Center, she has been a driving force advocating for HPV vaccination in the District, especially in the most medically underserved communities.

Wallington’s work is critically important as the incidence of cervical cancer in D.C. remains higher than the national average, especially among African American and Hispanic women. “It disappoints me to say that D.C. has one of the highest rates of cervical cancer,” Wallington said.

Nearly ten years have passed since the FDA approved the first vaccine to prevent infection by HPV, which was developed partially at Georgetown. Since then, the percentage of adolescents nationwide who have received the vaccine has lagged significantly behind that of other vaccines. To increase vaccination rates in D.C., Wallington has focused her outreach efforts on three groups of gatekeepers who have a major influence on whether or not young people receive the vaccine – health care providers, parents and adolescents.

Promoting the HPV Vaccine Among Health Care Providers

The likelihood that young people will get vaccinated is strongly linked to the encouragement that they receive from their physicians. Health care providers should also describe the vaccine as a cancer prevention tool and view every patient interaction as an opportunity to discuss or administer the vaccine.

“The number one predictor, and this is across the U.S., of HPV vaccine uptake is physician recommendation. But what we’re finding is that a lot of physicians are not recommending it and if they are, not providing a strong HPV vaccine recommendation,” Wallington said. “And so now, a lot of the research is focusing on helping physicians understand that they have to look at this like they look at other childhood recommended vaccines and don’t think of it as something different, but to offer it almost like a menu or bundle of vaccines needed; for example, here are the vaccines that your son or daughter needs today.”

In trainings with physicians and medical assistants, Wallington shares an HPV and HPV vaccine stakeholder tool kit with facts, statistics and additional information they need to help them talk to parents about the vaccine. One place she frequently holds trainings related to the HPV vaccine is the Health Outreach for Youth and Adults (HOYA) Clinic, a Georgetown student-driven free clinic at D.C. General Family Shelter. In June 2013, with funding from the Paul Carey Foundation, the Schlegel Lab and the Georgetown Lombardi’s Health Disparities Initiative, the clinic launched a multi-pronged effort to educate and administer the vaccine.

“It was the idea of the medical students to offer HPV vaccination at the HOYA Clinic,” Wallington said. “We also felt that offering HPV vaccination created an important opportunity to educate parents and teens about HPV and the vaccine, so we scheduled a one-hour HPV workshop at the D.C. Family Homeless Shelter every other Tuesday just before the clinic opens for clinical hours.”

Students can sign up to serve as workshop facilitators after attending an orientation training led by Wallington. At the end of the workshop, patients can receive the vaccine free of charge. One volunteer serves as an HPV navigator who calls and writes letters to patients to remind them about the follow-up vaccines and help them cope with any obstacles that may prevent them from returning to the clinic for the subsequent shots.

Persuading Parents to Vaccinate Their Daughters and Sons

Many parents continue to express concerns about having their children vaccinated to prevent a sexually transmitted infection. “There are still a lot of parents that believe, if I give my son or daughter this vaccine, it’s giving them the green light to want to engage in sexual activity,” Wallington said. “And so what I tell parents is some research shows that when adolescents are educated about HPV, it makes them really want to delay sexual activity and that vaccination today is possibly closing the door to an HPV-associated cancer in the future.”

The HPV vaccine was approved for use in children starting at age 9 because CDC surveys show that young people are engaging in sexual activity at earlier and earlier ages. “One of the reasons is that there’s optimal vaccine efficacy if the vaccine series is completed before the onset of sexual activity,” Wallington said. “Also, science has taught us that antibody responses are highest at ages 9 to 15,” making it an especially effective time frame for vaccination.

“This is difficult to digest but definitely we have to talk about it because I can assure you, as a researcher who does interventions with adolescents, teen girls and teen boys, they’re definitely talking about it and some of the places that they’re going for information on the internet, there’s such inaccurate data and they’re taking it as the gospel and it’s causing serious, serious harms to our young people,” Wallington continued.

While the HPV vaccine has been approved for use in both females and males, it was initially only approved for use in females and Wallington has found in focus groups that a lot of parents still don’t know that males can get vaccinated. “We didn’t approve the vaccine for males and females at the same time so now we’re having to do a lot of catch-up around education and training of males,” she said. “Once parents understood that this was not just a virus that females could get, you saw more and more men asking about the vaccine for themselves and parents interested in the vaccine for their sons. There is now more of an awareness by the general public that HPV can manifest in not only cervical cancers, but also some cancers of the vulva, vagina, penis, anus and oropharynx.”

Increasing rates of cancers that are caused by HPV besides cervical cancer have pushed parents to take vaccination more seriously. “Now we’re starting to see, more and more, where these cancers were once rare cancers, such as anal, penile, the rates of these cancers are going up, up, up,” Wallington said. “When we talk about HPV, now we have to think about HPV beyond cervical cancer.”

Georgetown University is the owner of intellectual property on which HPV vaccines were developed. Dr. Richard Schlegel is a co-inventor of technology on which HPV vaccines were developed. Georgetown and Schlegel receive financial benefit from commercial sales of the vaccine.

Kat Zambon
GUMC Communications