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Teen vaccination rates against sexually transmitted virus lag

Girl getting flu shot

About half of the Washington area's teenagers are vaccinated against a sexually transmitted virus linked to numerous cancers, lagging behind vaccination rates for other diseases despite the efforts of local and national health officials over the last decade.

In Maryland, 45.7 percent of females between the ages of 13 and 17 had at least one of the three recommended human papillomavirus shots in 2011, compared with 46.9 percent in Virginia and 55 percent in D.C., according to the U.S. Centers for Disease Control and Prevention.

Nationally, about 53 percent of teenage girls have had at least one HPV shot, according to CDC estimates. Boys are also at risk, but HPV vaccine recommendations for them are relatively new, making for scarce data.

New cases of HPV-related cancer, 2009
Cervical 11,388
Anal 3,500
Vulvar 3,242
Oral 2,478
Vaginal 734
Total 21,342
Oral 10,511
Anal 1,934
Penile 1,001
Total 13,446
Vaccination rate for girls 13-17
At least one HPV shot All three HPV shots
D.C. 55% 36%
Virginia 46.9% 29.8%
Maryland 45.7% 29.9%
National 53% 34.8%
Source: U.S. Centers for Disease Control and Prevention estimates

Those rates pale in comparison to 68.3 percent of all teens who were immunized for varicella, 70.5 percent who were immunized for meningitis, and 78.2 percent who were immunized for tetanus, diphtheria and pertussis.

HPV is best known for causing cervical cancer, but infections also can lead to cancer in the penis, anus, vagina, vulva and throat, as well as genital warts. While there are 100 types of HPV -- there are more than 14 million new cases each year, and almost every sexually active person will be infected at some point in their life -- only a few are dangerous, according to the CDC.

Virginia and the District require girls in public school to begin getting the vaccine for HPV before attending sixth grade. But parents are allowed to opt out for any reason.

"I haven't seen enforcement of that requirement anywhere," said Dr. Russell Libby, a pediatrician at the Inova Fairfax Hospital for Children. "There's a very easy opt-out."

While Maryland does not have an HPV vaccine requirement in place, state lawmakers created a task force to study the issue three years ago.

The two HPV vaccines on the market, Gardasil and Cervarix, protect against four of the most dangerous types. Two account for 70 percent of all cervical cancer cases, according to the CDC, while the other two are associated with genital warts and other, rarer conditions

While rates of HPV vaccination have increased since the CDC began recommending them for all girls in 2008 and all boys in 2011, many experts attribute their relatively slower growth to the vaccine's newness as well as an increase in misinformed skepticism surrounding it.

"By parent report, the rate of those that were getting up to date was increasing more slowly for HPV than the other vaccines, though it was increasing, " said Dr. Paul Darden, a pediatrician with the University of Oklahoma who led a study of Americans who opted not to get the vaccine. "We also found, disturbingly, that those who expressed that they didn't have an intent to get a vaccine in the next 12 months was also going up."

The percentage of parents who cited safety and side-effect concerns in eschewing the HPV vaccine jumped, from 4.5 percent in 2008 to 16.4 percent in 2010. No other vaccine broke 1 percent.

While some parents are worried about potential side effects, Libby said, others don't think their children will be sexually active and thus avoid the vaccine altogether. There's also a gender gap SEmD while girls are at greatest risk for HPV-related cancers, rates for throat and anus cancer, both of which affect men, have risen in the past few years.

"Parents are less aware of the recommendations for boys, and providers may also be less aware," said Dr. Eileen Dunne, an epidemiologist with the CDC. "It is early, though, so hopefully that will be on the increase."