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Rania Habib, MD, DDS (Host): The CDC estimates that 15 million Americans are infected with HPV in the U.S. each year, and up to 50 percent of those infected are aged 15 to 24. In 2016, the human papillomavirus vaccine was approved in the United States and protects against infection. What is HPV and is the vaccine worth it? This is Expert Insights with the Carle Foundation Hospital. I'm your host, Dr. Rania Habib. Joining me today is Dr. Dionne Smith, a Pediatrician at Carle Clinic in Urbana, and she is here to discuss HPV and the risks and benefits of vaccination in children.

Welcome Dr. Smith. We are really excited to have you on board for this very important topic.

Dionne Smith, MD: Thank you very much, I'm thrilled to be here and thrilled to be talking about a subject that I am passionate about.

Host: Now we know that HPV has been all over the news. What is human papillomavirus, also known as HPV?

Dionne Smith, MD: Well, much like any virus, it is one that can be considered highly contagious. However, unlike the common cold or flu, this one is spread typically through sexual contact or close skin to skin contact, during intimate activities. And so this is a virus that I usually tell my patients is not something that any child would probably come in contact with for many years.

However if they do, it's best to be protected at an early age from it. HPV stands for Human Papillomavirus and has a number of different strains, which can cause different pathologies. Two particular strains are noteworthy for causing warts in the genital area and also some oral warts as well.

And there are two additional strains that are notorious for causing cancer and are attributed to 70 percent of cervical cancers as well as penile, anal, and oropharyngeal cancers worldwide.

Host: Wow, that's an incredible statistic.

Dionne Smith, MD: Yes.

Host: Now, when a child is infected with HPV, what are some of those effects and especially the long term effects of infection with HPV?

Dionne Smith, MD: I wouldn't say that I have much experience, thankfully, with children being infected with HPV. Generally, these would be adolescents or young adults who are becoming sexually active. Almost all of us will be exposed to HPV in our lifetime. The symptoms of it can be zero. So many people will contract this virus and not have symptoms of it whatsoever.

That's particularly true in young men. But oftentimes they can produce physical symptoms such as a wart or growth. There can be pain as well in the penile or cervical region. And sometimes this infection is found incidentally. So if you, as a young woman, go in to see your gynecologist and have your routine PAP smear, there can be these abnormal cells that are discovered.

And when they test them for the virus and if the cells are positive for this virus, you have to undergo quite this extensive workup to serotype it and figure out what strain it is. And there's quite a bit that goes into it as far as treatment going forward.

Host: Now, let's move on to the HPV vaccination. You've given us some great information about the virus and the long term effects of the virus, but who is eligible for HPV vaccination?

Dionne Smith, MD: So young women and men typically we start vaccinating them around age 11, which is around the time of entry into middle school. However, children as young as nine can and do get the vaccine as well. Up until the age of about 45 is considered the window of time at which the vaccine makes sense.

We're trying to kind of target the population between age 11 and mid 20s or early 30s because this is the time when you're most likely to be exposed to the virus. I'm told that, now in my pediatric population, I see children, you know, up until the age typically of about 21, but I'm told that adults past the age of 45 may also talk to their provider about getting HPV vaccination. However, it may not make as much sense.

Host: Now you did say that there's the ideal age of vaccination is really early on and it's in childhood. What is the importance of this early vaccination?

Dionne Smith, MD: Children's immune systems tend to be better equipped to have an immune response to vaccines. So I have a lot of parents who sometimes are hesitant about even talking about this virus in their 11 year old. And as a mom myself, I totally get that. You're not wanting to picture your child engaging in such activities.

And they certainly are not expected to be at that age or likely are going to be. However, earlier vaccination provides a better level of protection. We see, and studies have shown that if initiated around or before the age of 12 to 13 years of age, the HPV vaccine can be up to 90 percent effective at protecting against the nine strains of HPV that the Gardasil vaccine protects against.

Each year that you initiate the vaccine past age 12 or 13, that effectiveness goes down little by little. And so if it's being initiated after the age of 18, the efficacy goes down to about 29%. So there's quite a big difference. And a lot of that just has to do with the robustness of kids immune systems.

Host: That is a really important factor that I think a lot of us probably didn't know, so thank you for sharing that.

Dionne Smith, MD: Absolutely.

Host: Now, Dr. Smith, a lot of parents might be extremely skeptical about additional vaccines, especially newer ones. What are common concerns that parents might have about the HPV vaccination, and could you highlight some of the risks?

Dionne Smith, MD: Absolutely. As far as safety of the vaccine, you know, this vaccine kind of became, it became widely distributed to the general population, I believe around early 2000s. So it's been around now for a couple of decades. So it's hard for me to look at it in the light of a quote unquote new vaccine.

We have enough data to show that it is safe, that we're not seeing clearly correlated long certainly not short term side effects associated with the vaccine. A lot of the hesitancy I get from parents is, well, has it been studied enough? And without hesitation, I can say, yes, been given long enough to where we are seeing decreased rates of HPV. The next phase of it we'll see, is it decreasing rates of cancer. And so far research is showing that we are seeing decreased rates of it. So the main fears I think that parents have are why are we talking about this now with my kid?

You know, they're already getting a couple shots for sixth grade. And what makes my job a little difficult too, is this is a vaccine that's not required for school, like your tetanus and your meningitis vaccines are entering into sixth grade. But I like to still talk about it as if it is just as important, because in my opinion, it is.

A lot of parents, you know, as with any vaccine, will have questions about ingredients, and so I'm usually transparent about that and let them know what's in it. And like many vaccines, there are proteins within the vaccine that are meant to mimic the virus so that as our immune system mounts a response to it, it recognizes that protein in the future as being foreign and we should attack it.

So, it's a great way to just prime our immune system for if we ever meet something like this in the future, we're going to neutralize it.

Host: And what about some of the risks?

Dionne Smith, MD: Like any vaccine, there can be minor local side effects. So, a lot of teens will tell me that it stings. But vaccine does seem to sting more than others. And they don't like that. And a lot of them, well for teenagers who get this initiated before their 15th birthday, there's only two vaccines that need to be spaced about six months apart. It used to be a three part series. So, that provides, I think, a little extra incentive too to initiate it a little earlier. Fewer pokes, which I think makes the teens happy. But yeah, with any injection site, there can be some local redness, maybe swelling and a little bit of pain. Nothing, though, that maybe some ibuprofen and a cold compress wouldn't help.

But as far as safety for any life threatening instances, if you look at the Vaccine Adverse Event Reporting System that is of free reign for a lot of people to just log potential reactions. So I would say to parents, I wouldn't use that as a tool to judging whether your child is going to have a more serious reaction to the vaccine.

Generally speaking, it is very well tolerated, and I, anecdotally, have yet to see anybody who's had any negative consequences, aside, perhaps, from maybe some dizziness afterwards. So sometimes we'll monitor them for a few minutes in the office after they get it. But lately, I have not had a need to do that and kids have been doing very well with it.

Host: That is fantastic to hear because parents are always hesitant about giving additional vaccines from the mandated ones and it's really good to hear that the side or the risk is minimal, the long term side effects are minimal, so it sounds like it's a pretty safe vaccine.

Dionne Smith, MD: Yeah and again, I speak of it like I would any other one that's been around for multiple decades. You know, I've seen with my own eyes, it's very safe, it's extremely effective. And I mentioned before, I'm a mom, my kids are still pretty young, but when they are entering into middle school, they will be getting this vaccine too. I believe very strongly in it.

Host: And again, our listeners are probably a little bit more reassured that a pediatrician believes in it so much that you'll be giving it to your children when they reach the age, so that's good to hear.

Dionne Smith, MD: Absolutely.

Host: Dr. Smith, what are some of the new advances and research into HPV?

Dionne Smith, MD: Interestingly, I looked at a study that had gone on, or at least was published about a week ago that mentioned that they are noticing some variants in genes in certain individuals that may make them more susceptible to high grade or recurrent HPV infection. So now we have individuals who may even with a single exposure may be more prone to getting HPV in a more serious strain of it and having that not be fully eradicated with treatment and need basically lifelong gynecological care, which is something I wouldn't wish on anybody. And I think I think further speaks to just how serious, how prevalent this disease is and how important it is to protect ourselves from it as early as possible.

Host: Absolutely. And that will be a very interesting area of research because if they are identifying certain genes that make them susceptible, perhaps we'll see medications that are directed towards those genes.

Dionne Smith, MD: I wouldn't be surprised. The way genetic research goes, it tends to be fairly quick, but it also wouldn't shock me if it took many, many years of further research to figure out other ways to protect ourselves from this. In the meantime, vaccination continues to be the best way to keep ourselves protected.

Host: Absolutely. Dr. Smith, you have shared some wonderful information with our audience in regards to exactly what HPV is, the vaccination. What is your final take home message to our audience today?

Dionne Smith, MD: My final take home message, I think, would be to just have and establish a really trusting relationship with your child's provider. Because we all, as physicians, took what's known as the Hippocratic Oath. And that oath amongst other verbiage, says first to do no harm. And so we are in the practice of preventing known illnesses that are known to be debilitating and cause disease, cause illness and in some cases, be fatal. My role as a pediatrician is really just to protect kids. And as a mom myself, I have this inherent, need to protect my own children. But I consider, my patients to be my own kids as well. And so I hope parents out there have a trusting enough relationship with their doctor to have these serious conversations about vaccines, their effectiveness, their safety and be able to ask these questions without judgment and develop a plan that's best for them and their families.

I would say not a lot of people know just how prevalent and how severe HPV can be, so it's important to educate ourselves on that. And since right now the best tool we have at protecting ourselves against it is vaccination, I consider it just as important as the other ones your child may get.

Host: Absolutely. Thank you so much for sharing that information. And hopefully through this conversation, patients will be more inclined to have this very important conversation with their pediatricians.

Dionne Smith, MD: Absolutely, I hope so too.

Host: Thank you so much for joining us today.

Dionne Smith, MD: Thank you very much for having me.

Host: That was Dr. Dionne Smith, a Pediatrician at Carle Clinic in Urbana.

For more information and to get connected with one of our providers, please visit carle.org. For a listing of Carle providers and to view Carle sponsored educational activities, head on over to our website at carleconnect.com. I'm your host, Dr. Rania Habib, wishing you well. That wraps up this episode of Expert Insights with the Carle Foundation Hospital.