Inoculation numbers for a cancer-preventing vaccine took a plunge during the pandemic, UVA staff say. 

CHARLOTTESVILLE – It’s easy to forget, but the COVID-19 vaccine isn’t the only one some people need to take. However, during the pandemic, vaccinations for things like HPV dropped dramatically, according to University of Virginia (UVA) medical staff.

“I think people were very fearful of getting exposed [to COVID],” said Emma McKim Mitchell. She serves as co-director for the Global Initiatives program at UVA’s School of Nursing, providing students with research opportunities. One of those involves HPV or the human papillomavirus and how dramatically use of the vaccine dropped over the past year.

Among teens, for example, HPV vaccinations dropped 75%. Since March 2020, teens with public insurance missed an estimated 1 million doses. 

“We really do have a lot to catch up on in terms of HPV vaccination,” McKim Mitchell said. “I think that we won’t know for a few years how big the impact is going to be of those missed appointments.”

She’s talking about appointments for the Gardasil 9 vaccine. It can prevent most cases of cervical cancer – and some other forms – if given before exposure to HPV.

The National Conference of State Legislatures noted that approximately 79 million Americans had an HPV infection. UVA expects more than 36,000 HPV-related cancer diagnoses this year.

Most strains of the virus do not produce cancer or any symptoms and disappear on their own. But for the strains that do, serious medical complications can arise. That’s where the vaccine comes in handy.

“Any tool that we can use to prevent disease is a really good one. And this is a really strong cancer prevention tool,” McKim Mitchell said. “It’s one of our only vaccines that can help prevent cancer, so it’s really exciting.”

Now, healthcare professionals are spreading the word about the importance of the vaccination. UVA Cancer Center recently joined 70 other National Cancer Institute designated cancer centers and partner organizations in urging physicians, parents and young adults to get cancer-preventing HPV vaccinations back on track. 

Does HPV Really Cause Cancer?

HPV itself is not uncommon.

“There are a couple hundred different genotypes of human papillomavirus,” McKim Mitchell said. “It’s essentially ubiquitous. In other words, everyone has some kind of HPV.” 

However, just because HPV is common doesn’t mean every case brings about an ordinary situation. 

“There are specific genotypes that then lead you to be at risk for six different types of cancer,” McKim Mitchell said.

The six forms are cervical, vaginal, vulvar, anal, penile and oropharyngeal (throat) cancers. Some occur more frequently than others.

“Oropharyngeal cancer cases, in terms of new cases being diagnosed, are starting to surpass cervical cancer cases, which of course we’ve seen because here in the US, we’ve had systematic screening for several decades,” McKim Mitchell said. “That is a big surprise to a lot of people.” 

While researches expected the eventual shift of more throat than cervical cancer cases, the trend occurred far sooner than expected. Rather than the anticipated surpassing date of 2030, oropharyngeal cancer eclipsed cervical cancer diagnoses in 2018.

HPV Infections

So how do people get HPV? Well, a number of ways – and it might not be the first way that comes to mind.

HPV infections occur through both sexual transmission and non-sexual acquisitions. McKim Mitchell explained some of the forms of transmission people typically don’t expect.

“A lot of people say, ‘Well, why are you starting at such a young age?’ Or ‘I’ve only been in a monogamous relationship with one person.’ All it takes is one exposure. You can be in a monogamous relationship with one person and have HPV transmitted. It really is that ubiquitous,” McKim Mitchell said. “And so the best thing we can do is try to help dispel those myths and encourage people to get the vaccine.”  

Transmission of non-sexually acquired HPV occurs when infected skin or peeled skin gets into direct contact with broken or macerated skin – that’s skin that came into contact with moisture for too long. 

“In talking with parents, one thing that was really impactful for them to hear was that you could even be put at risk through something as simple as kissing,” McKim Mitchell said. “So I think that there’s a lot of misinformation out there.”

Cancer Prevention

After reviewing educational materials approved by the Board of Health, a parent or guardian may elect for their child not to receive the HPV vaccine. However, in 2019, 57.8% of Virginia boys ages 13 to 17 received the HPV vaccine, compared to 52.5% of Virginia girls the same age. 

“It’s a great primary prevention strategy,” McKim Mitchell said. “In other words, we want to give it before there’s been any exposure. And so the younger we can go, the better.”

The Federal Drug Administration approves and the Centers for Disease Control and Prevention recommends the HPV vaccine for children as young as nine years of age. 

In 2007, the Virginia General Assembly enacted House Bill 2035, which required HPV vaccination for girls entering the seventh grade.

In 2020, five jurisdictions required the HPV vaccination for school attendance. Virginia was on that list, along with Hawaii, Rhode Island, Washington, D.C. and Puerto Rico

Beginning July 1, new legislation from 2020 House Bill 1090 takes effect. Among other changes, the bill amends the dosage for the HPV vaccine to two, rather than three doses, required for both boys and girls entering the seventh grade.

UVA Explains The Process 

Gardasil 9, the only HPV vaccine approved in the United States, protects against nine different high-risk genotypes. Even if someone experienced exposure to one of the genotypes, the vaccine still protects against the others.

Children are not the only people eligible to receive the HPV vaccine. 

“It’s definitely approved, definitely safe. It’s actually safe for women from ages nine to 45, it’s approved from a safety perspective. And it’s safe for men from nine to 26,” McKim Mitchell said. “But that’s only because that’s all that the science has found so far. It’s kind of like what we’re seeing with the COVID vaccine, where it’s evolving sort of what those age groups are where it’s going to play out.”

Even though over 1 million people missed their HPV vaccine opportunity last year, McKim Mitchell noted there’s still time to schedule an appointment and get back on track.

“The CDC absolutely has a catch-up schedule for the HPV that’s approved and that is able to be covered by insurance. And also, I’ll just mention, too, that there are programs at every health department in Virginia where you can have a subsidized low or no-cost vaccine. You can always get the vaccine, whether it’s at your healthcare provider or the health department,” McKim Mitchell said. “But I think that it’s never too late. You know, I’m a nurse, so I want to say it’s never too late. If you want to do it and catch up, you should.” 

Amie Knowles reports for Dogwood. You can reach her at amie@couriernewsroom.com 

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