Thursday, January 24, 2013

Protecting Our Children for the Future

January is Cervical Health Awareness Month.  Our big thanks to guest blogger and SC Campaign First Lady, Dr. Heather M. Brandt, PhD, CHES, Assistant Professor, Arnold School of Public Health, University of South Carolina for contributing a great piece to increase awareness of this issue.

If I asked you, if you could do something for your child today that would protect him or her from suffering in the future, how would you respond?

While I am not yet a mother, most parents and caregivers that I know would respond positively and want to do anything and everything they could to protect their child. Protecting children has been oft discussed and most recently in the context of gun control after the events at Sandy Hook Elementary School in Newtown, Connecticut. Parents make decisions everyday that are in the interest of protecting their children – now and in the future – without hesitation.

Why is vaccination for a common sexually transmitted infection linked to cancer any different?

Before a newborn leaves the hospital, it is likely that he or she has received the first dose of Hepatitis B vaccine (which I should mention can also be sexually transmitted, but I digress). Well child visits during the first few years involve routine vaccinations that are questioned rarely. School mandates, financial access to infant and child vaccinations, provider recommendation, and generally high levels of awareness and acceptance by parents result in protecting children from a number of preventable diseases. Childhood vaccination coverage hovers around the 90th percentile for most vaccines. I do not believe that parents love their children any less when they reach adolescence, but adolescent vaccination is very different. The Centers for Disease Control and Prevention (CDC) recommends three vaccines during adolescence: Td (tetanus and diphtheria toxoid)/Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis), MenACWY (meningococcal conjugate vaccine), and HPV (human papillomavirus). In the U.S., Td/Tdap and MenACWY coverage is in the 70th percentile while HPV uptake is about half of that (~35%), according to the 2011 National Immunization Survey-TEEN by the CDC. Rates of adolescent vaccines in South Carolina are lower than the U.S. averages overall (Tdap=59.4%; MenACWY=55.4%; HPV females >3 doses=23.3%). The coverage gap in HPV vaccination, which is the difference in coverage estimates between the adolescent vaccine with the highest uptake (Td/Tdap) and HPV vaccine uptake, is approximately 36% among 13-17 year old females in South Carolina. This means that among adolescent females who receive the other adolescent vaccines that 36% fewer receive the HPV vaccine in South Carolina. Between 2010 and 2011, the overall rate of HPV vaccination among 13-17 year old females decreased and remains significantly lower than the U.S. average in South Carolina. HPV vaccination rates for males are abysmal despite the CDC recommendation for 11-12 year old females and males to receive the HPV vaccine. HPV is linked to cervical cancer and other anogenital and head and neck cancers in men and women in addition to several other HPV-associated diseases. Low rates of HPV vaccination are the antithesis of protecting our children. We must change low rates of HPV vaccination if we are to have any impact on reducing HPV-associated diseases in the future.

When it comes to protecting our children for what they may encounter in the future, several “P”s play a prominent role. Parents (caregivers), providers (pediatricians, family physicians), partners (schools, community groups, youth serving organizations), and policy are key to increasing initiation and completion of the HPV vaccination series among young people in South Carolina. We need parents to learn more about HPV vaccination and the importance of vaccinating during the recommended age period. We need providers – regardless of their personal opinions – to recommend the HPV vaccine to adolescents. We need partners, not only parents and the medical system, to join in efforts to increase HPV vaccination. Perhaps above all, we need policy. Policy is one mechanism for addressing gaps in HPV vaccination among our young people in South Carolina to level the playing field so that disparities in HPV-associated diseases do not persist. Rep. Bakari Sellers introduced the Cervical Cancer Prevention Act (H.3236), which narrowly missed being passed into law last session following the governor’s veto, in the South Carolina legislature to address HPV vaccination through increased access and parent education. Rep. Sellers has indicated that too many of our mothers, sisters, daughters, and other women whom we love have suffered unnecessarily, and we can do something today to change that. He is right. And, not to mention, HPV affects our fathers, brothers, sons and other men whom we love too. We might not be able to protect children from everything in the future, but we can protect them from acquiring types of HPV linked to cancer and other diseases and save them from unnecessary suffering.

So, I am asking you, if you could do something for your child today that would protect him or her from suffering in the future, how would you respond?

I hope that you would respond no differently when you learned that “something” meant the HPV vaccine.

Legislation is timely and critical to reverse the trend of decreased initiation and completion of the HPV vaccine series in South Carolina and will be one of the focus areas of Cervical Cancer-Free South Carolina, a partner of the Cervical Cancer-Free America movement. Cervical Cancer-Free South Carolina is focused on utilizing comprehensive, evidence-based strategies to prevent cervical cancer in our state. Join us in our work to make South Carolina cervical cancer-free.

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