Human Papillomavirus (HPV) is a very common virus. Nearly 80 million people—about one in four—are currently infected in the United States. Although HPV is one of the most common sexually transmitted infections and is a linked cause of cervical cancer, the infection is often silent. Patients may never know they have the infection but often have serious consequences. Educating the population about the importance of the HPV vaccination is necessary to bring down the number of infections.
Hear from Dr. Pahud on the benefits of the HPV vaccination for eligible patients and impact it will have on the community.
Improving the Health of our Community Through the HPV Vaccination
Featured Speaker:
Learn more about Dr. Barbara Pahud
Barbara A. Pahud, MD, MPH
Dr. Barbara Pahud is a pediatric infectious disease specialist in Kansas City, Missouri and is affiliated with Children's Mercy Kansas City. She received her medical degree from Universidad La Salle School of Medicine. Dr. Pahud completed her residency at Infants and Children’s Hospital of Brooklyn, Maimonides Medical Center and her fellowship at Stanford-LPCH Vaccine Program, Stanford University Medical Center and University of California. Dr. Pahud is certified in pediatrics.Learn more about Dr. Barbara Pahud
Transcription:
Improving the Health of our Community Through the HPV Vaccination
Dr. Michael Smith (Host): Today our topic is “Improving the Health of our Community Through the HPV Vaccination”. My guest is Dr. Barbara Pahud. She is a pediatric infectious disease specialist in Kansas City, Missouri, and is affiliated with Children’s Mercy Kansas City. Dr. Pahud, welcome to the show.
Dr. Barbara Pahud (Guest): Thank you for having me.
Dr. Smith: So, how common is HPV infection?
Dr. Pahud: Unfortunately, it is actually very common. Most people have been infected with the HPV virus and they just don’t know that they have had it because most people get the virus, and they’re able to handle it on their own and it leads to no problems. But, there are a certain number of people that may be infected with it, and go on to develop cancer. This is why it is such an important topic because, even though most people don’t have any problems with it, since it’s affecting the vast majority of the population, that results in a very large number of cancers.
Dr. Smith: Because it’s kind of a silent infection in so many people, do you think it’s under-reported or under-diagnosed?
Dr. Pahud: Yes, absolutely, because we’re not always checking to see we have HPV if you’re symptomatic. So, basically, if you feel well, there’s no reason to go and test you for it. That’s not something that we’re doing right now. One of the reasons why we don’t want to do that is: imagine you are one of those persons that have HPV, and that your body is not going to result in cancer with the HPV virus. If I test you, and I tell you that you have it, you may get very concerned, and go on and do some sort of surgical procedures or treatments that you don’t need. So, we don’t want to over-test, if we know that it might result in problems. But, we want to keep a close eye on these infections by doing things like Pap smears, so that if you are one of those persons that’s infected, and develop lesions that can lead to cancer, that we catch you right on time.
Dr. Smith: So, how often does HPV infection lead to, say, something like cervical cancer?
Dr. Pahud: Unfortunately, it is pretty common. The rates have been decreasing in the past hundred years, and thanks to the introduction of the Papanicolaou, the Pap smear that we do, early detection has helped to decrease the number of cancers. But, it is one of the most common cancers in women. It’s the number one cause of uterine and cervical cancer and, unfortunately, it’s also affecting a lot of men. It’s the number one cause of cancer of the mouth and throat in men and by the year 2020 the number of cancers in the mouth and throat in men is going to be higher than the number of cervical and uterine cancers in women. That’s how important this is.
Dr. Smith: Wow. And so, what, besides the cancers--the oral cancers in men and the cervical cancers – are there other consequences of the infection that that we don’t know as much about?
Dr. Pahud: Yes. So, for example, if a woman has HPV and she has warts, which – you will not die of warts, it’s just a sexually transmitted infection – but let’s say that you have a wart, and you have not been treated, and you have a baby, that baby will be exposed to the HPV virus when it’s going through the birth canal. That baby may have warts in their nose, throat and airways, which leads to horrible consequences, as you can imagine. So, that’s just one of many other examples of other things that HPV can do, that we are not very aware of.
Dr. Smith: So, let’s move the discussion, then, into the HPV vaccination. So, what, ultimately, do you see as the benefits of getting more people vaccinated?
Dr. Pahud: Well, before talking about the benefits, I would like to tell you a little bit about the vaccine because this is actually my favorite vaccine of them all. Imagine that you order something from Amazon and you get all the goodies inside of the box, but all that you see is the box, right? If you grab it and move it around, you’ll know that it’s full of something but if you just see the box sitting there, it’s just a box. Well, imagine now that that box full of Amazon stuff is the virus. The outside of the virus is the box, and all that stuff that produces cancer and warts is the stuff that’s inside the box, okay? Now, the vaccine is just the box, without anything inside of it. So, it’s a brilliant vaccine, because it looks exactly like the virus, but it has no way of causing disease, because all the contents--all the DNA that caused the problems--is out, it’s not there. So, the body sees the box and attacks it in the exact same way that it would to a normal virus but, in this case, it produces an even better immune response than if you were infected with a regular virus. And, the reason for that is, when you have the normal virus, and it infects you, all those things inside of the box come out, and defend the virus from you. This vaccine has nothing inside, so the body can attack it, defend it, and produce a very good immune response, so that when you actually see the real virus, it will not cause an infection.
Dr. Smith: And so, Dr. Pahud, when you use that analogy that you just went over with me, what kind of response do you get from your patients, especially maybe a young girl’s parents who are concerned about more vaccinations? When you use that story, what do people say to you?
Dr. Pahud: Well, the reality is, when I have face-to-face contact with patients and families, most of the time, they will vaccinate. Unfortunately, with HPV, there’s a lot of misinformation and misconceptions and rumors and problems through social media. But, once I’m able to sit down with somebody and explain to them the dangers of HPV, and how real they are, and how safe the vaccine is, most people are absolutely okay with vaccinating, and every time I give talks about this, people usually come to me and say, “I did not know this. My doctor had not told me this. I’m going to go get the vaccine.” Now, a lot of doctors are recommending the HPV vaccine, don’t get me wrong, but we are not seeing as much recommendation for this vaccine as we do with infant vaccines, for example.
Dr. Smith: So, speaking of getting more people vaccinated, what’s the plan? What are you going to do? What’s Children’s Mercy going to do to increase the number of vaccinations? Is there a plan at work here?
Dr. Pahud: Yes, fortunately, here at Children’s Mercy, we’ve been looking at our own numbers and we are doing pretty well compared to the state. Kansas, unfortunately, is the lowest state, with the lowest rates of HPV vaccination in the entire country, which is very sad. We don’t know but that maybe is due to the fact that it is such a rural state, and maybe physicians out in the community are not recommending the vaccine as vigorously as other physicians or if it’s the parents that are misinformed or not obtaining it. So, there’s been a lot of effort in the Kansas City to increase administration. The NCI Institutes, or National Cancer Institutes, have gotten together and put out a statement saying, “This is a cancer-preventing vaccine and we need to immunize.” We have collaborated with KU to make sure that people get information that is accurate about HPV vaccines. We are offering the vaccine, of course, to every child that comes in through our clinics. There’s also some work being done through the medical society where different colleagues from different institutions are trying to get together to put projects together to increase HPV vaccines in the state.
Dr. Smith: Dr. Pahud, when you go out and speak, are you talking more to the patient, or are you speaking more and more to the world, doctors, you’re talking about, in Kansas City?
Dr. Pahud: I have to be very honest with you, and I’m saddened to say this, but I speak mostly to healthcare providers—so, nurses, nurse practitioners, physicians, because in my experience, the biggest problem is we are not recommending this vaccine as much as we should. As soon as a physician understands the importance of this vaccine, they can recommend it to the parents and parents will trust them. We have data studies showing that parents trust their doctors but if the doctors don’t have the information, they are not giving an effective recommendation. So, I am focusing most of my efforts in educating the healthcare providers.
Dr. Smith: Got you. So, Dr. Pahud, I want to thank you for the work that you’re doing and also thank you for coming on the show today. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information, you can go to childrensmercy.org. That’s childrensmercy.org. I’m Dr. Mike Smith. Thanks for listening.
Improving the Health of our Community Through the HPV Vaccination
Dr. Michael Smith (Host): Today our topic is “Improving the Health of our Community Through the HPV Vaccination”. My guest is Dr. Barbara Pahud. She is a pediatric infectious disease specialist in Kansas City, Missouri, and is affiliated with Children’s Mercy Kansas City. Dr. Pahud, welcome to the show.
Dr. Barbara Pahud (Guest): Thank you for having me.
Dr. Smith: So, how common is HPV infection?
Dr. Pahud: Unfortunately, it is actually very common. Most people have been infected with the HPV virus and they just don’t know that they have had it because most people get the virus, and they’re able to handle it on their own and it leads to no problems. But, there are a certain number of people that may be infected with it, and go on to develop cancer. This is why it is such an important topic because, even though most people don’t have any problems with it, since it’s affecting the vast majority of the population, that results in a very large number of cancers.
Dr. Smith: Because it’s kind of a silent infection in so many people, do you think it’s under-reported or under-diagnosed?
Dr. Pahud: Yes, absolutely, because we’re not always checking to see we have HPV if you’re symptomatic. So, basically, if you feel well, there’s no reason to go and test you for it. That’s not something that we’re doing right now. One of the reasons why we don’t want to do that is: imagine you are one of those persons that have HPV, and that your body is not going to result in cancer with the HPV virus. If I test you, and I tell you that you have it, you may get very concerned, and go on and do some sort of surgical procedures or treatments that you don’t need. So, we don’t want to over-test, if we know that it might result in problems. But, we want to keep a close eye on these infections by doing things like Pap smears, so that if you are one of those persons that’s infected, and develop lesions that can lead to cancer, that we catch you right on time.
Dr. Smith: So, how often does HPV infection lead to, say, something like cervical cancer?
Dr. Pahud: Unfortunately, it is pretty common. The rates have been decreasing in the past hundred years, and thanks to the introduction of the Papanicolaou, the Pap smear that we do, early detection has helped to decrease the number of cancers. But, it is one of the most common cancers in women. It’s the number one cause of uterine and cervical cancer and, unfortunately, it’s also affecting a lot of men. It’s the number one cause of cancer of the mouth and throat in men and by the year 2020 the number of cancers in the mouth and throat in men is going to be higher than the number of cervical and uterine cancers in women. That’s how important this is.
Dr. Smith: Wow. And so, what, besides the cancers--the oral cancers in men and the cervical cancers – are there other consequences of the infection that that we don’t know as much about?
Dr. Pahud: Yes. So, for example, if a woman has HPV and she has warts, which – you will not die of warts, it’s just a sexually transmitted infection – but let’s say that you have a wart, and you have not been treated, and you have a baby, that baby will be exposed to the HPV virus when it’s going through the birth canal. That baby may have warts in their nose, throat and airways, which leads to horrible consequences, as you can imagine. So, that’s just one of many other examples of other things that HPV can do, that we are not very aware of.
Dr. Smith: So, let’s move the discussion, then, into the HPV vaccination. So, what, ultimately, do you see as the benefits of getting more people vaccinated?
Dr. Pahud: Well, before talking about the benefits, I would like to tell you a little bit about the vaccine because this is actually my favorite vaccine of them all. Imagine that you order something from Amazon and you get all the goodies inside of the box, but all that you see is the box, right? If you grab it and move it around, you’ll know that it’s full of something but if you just see the box sitting there, it’s just a box. Well, imagine now that that box full of Amazon stuff is the virus. The outside of the virus is the box, and all that stuff that produces cancer and warts is the stuff that’s inside the box, okay? Now, the vaccine is just the box, without anything inside of it. So, it’s a brilliant vaccine, because it looks exactly like the virus, but it has no way of causing disease, because all the contents--all the DNA that caused the problems--is out, it’s not there. So, the body sees the box and attacks it in the exact same way that it would to a normal virus but, in this case, it produces an even better immune response than if you were infected with a regular virus. And, the reason for that is, when you have the normal virus, and it infects you, all those things inside of the box come out, and defend the virus from you. This vaccine has nothing inside, so the body can attack it, defend it, and produce a very good immune response, so that when you actually see the real virus, it will not cause an infection.
Dr. Smith: And so, Dr. Pahud, when you use that analogy that you just went over with me, what kind of response do you get from your patients, especially maybe a young girl’s parents who are concerned about more vaccinations? When you use that story, what do people say to you?
Dr. Pahud: Well, the reality is, when I have face-to-face contact with patients and families, most of the time, they will vaccinate. Unfortunately, with HPV, there’s a lot of misinformation and misconceptions and rumors and problems through social media. But, once I’m able to sit down with somebody and explain to them the dangers of HPV, and how real they are, and how safe the vaccine is, most people are absolutely okay with vaccinating, and every time I give talks about this, people usually come to me and say, “I did not know this. My doctor had not told me this. I’m going to go get the vaccine.” Now, a lot of doctors are recommending the HPV vaccine, don’t get me wrong, but we are not seeing as much recommendation for this vaccine as we do with infant vaccines, for example.
Dr. Smith: So, speaking of getting more people vaccinated, what’s the plan? What are you going to do? What’s Children’s Mercy going to do to increase the number of vaccinations? Is there a plan at work here?
Dr. Pahud: Yes, fortunately, here at Children’s Mercy, we’ve been looking at our own numbers and we are doing pretty well compared to the state. Kansas, unfortunately, is the lowest state, with the lowest rates of HPV vaccination in the entire country, which is very sad. We don’t know but that maybe is due to the fact that it is such a rural state, and maybe physicians out in the community are not recommending the vaccine as vigorously as other physicians or if it’s the parents that are misinformed or not obtaining it. So, there’s been a lot of effort in the Kansas City to increase administration. The NCI Institutes, or National Cancer Institutes, have gotten together and put out a statement saying, “This is a cancer-preventing vaccine and we need to immunize.” We have collaborated with KU to make sure that people get information that is accurate about HPV vaccines. We are offering the vaccine, of course, to every child that comes in through our clinics. There’s also some work being done through the medical society where different colleagues from different institutions are trying to get together to put projects together to increase HPV vaccines in the state.
Dr. Smith: Dr. Pahud, when you go out and speak, are you talking more to the patient, or are you speaking more and more to the world, doctors, you’re talking about, in Kansas City?
Dr. Pahud: I have to be very honest with you, and I’m saddened to say this, but I speak mostly to healthcare providers—so, nurses, nurse practitioners, physicians, because in my experience, the biggest problem is we are not recommending this vaccine as much as we should. As soon as a physician understands the importance of this vaccine, they can recommend it to the parents and parents will trust them. We have data studies showing that parents trust their doctors but if the doctors don’t have the information, they are not giving an effective recommendation. So, I am focusing most of my efforts in educating the healthcare providers.
Dr. Smith: Got you. So, Dr. Pahud, I want to thank you for the work that you’re doing and also thank you for coming on the show today. You’re listening to Transformational Pediatrics with Children’s Mercy Kansas City. For more information, you can go to childrensmercy.org. That’s childrensmercy.org. I’m Dr. Mike Smith. Thanks for listening.