Yale Cancer Center scientist urges widespread HPV vaccinations

Linda Niccolai, professor of epidemiology at the Yale School of Public Health

NEW HAVEN — It’s a two-shot vaccination that helps prevent six types of cancer.

The vaccine prevents infection by the human papillomavirus, the most common sexually transmitted infection, 95 percent of the time, said Linda Niccolai, a professor of epidemiology at the Yale School of Public Health and an associate of the Yale Cancer Center. But its effectiveness depends on vaccinating children before they become sexually active, so doctors and public health officials recommend giving it at age 11 or 12.

“This vaccine has near perfect efficacy. It will prevent 30,000 cancers in the U.S. every year,” Niccolai said. “It really is a huge public health success story for cancer prevention.” The vaccine prevents infection from nine types of HPV, and “those nine types are the most common types that cause those six cancers,” she said. Niccolai also is a paid consultant for Merck, maker of the Gardasil-9 vaccine.

HPV causes cancer of the cervix, vagina and vulva in women, of the penis in men, and of the anus and back of the throat in both sexes, according to the Centers for Disease Control and Prevention. Of 34,800 cancers caused by HPV annually, almost a third, 10,900, are cervical cancers.

According to the CDC, 80 million Americans are infected with HPV, and 14 million, including teenagers, become infected every year. Ninety percent of infections, which can cause genital warts, will go away within two years, but cancers can appear years later. The median age for HPV-caused cervical cancer is 49, but for other cancers half of cases appear in people in their 60s and older, the CDC says.

Dr. Timothy Spurrell, medical director for Planned Parenthood of Southern New England, said, “what happens is that HPV integrates into cells particularly cells that are undergoing change.” This is particularly true in what is known as the “transformation zone” of the cervix, where cells change from columnar cells into squamous cells. The vulnerability of the area is the reason women are advised to get Pap smears.

“HPV accounts for almost all of cervical cancer,” Spurrell said. He said Planned Parenthood medical professionals “routinely give HPV vaccines at all of our health centers. It’s a service we commonly provide and we really believe in.”

Niccolai, who has worked in HIV prevention but now is focusing on HPV, would like the vaccine made a requirement for school-age children, and a bill in this year’s General Assembly session would have made it mandatory to enter ninth grade, as well as requiring a meningococcal booster shot before twelfth grade, but it was never brought up for a vote by the Public Health Committee.

A public hearing brought out opposition to it similar to those who opposed a bill removing the religious exemption from currently required immunizations, according to state Rep. Robin Comey, D-Branford, who is a member of the Public Health Committee, as well as vice chairwoman of the Committee on Children, which took up the religious exemption bill.

“We know from other vaccines and from other states that school-entry requirements work,” Niccolai said. “We’ve had this vaccine in the U.S. for 13 years and currently coverage is about 65 to 70 percent, which is suboptimal, and we’re kind of stuck at this level without considering policy options for school-entry requirements.”

Rhode Island, Virginia and Washington, D.C., are the only jurisdictions that require HPV vaccinations to enter school. Niccolai said Rhode Island has been the most successful because Virginia and Washington have “broad exemptions.” In her testimony before the Public Health Committee, Niccolai said Rhode Island has reached a 90 percent immunization rate.

Niccolai said the vaccine is completely safe because it does not contain the papillomavirus, either alive or dead. Instead, “virus-like particles mimic the virus in our bodies,” she said. “It’s perfectly safe … and it cannot make people sick. It tricks the body into thinking that it’s HPV. People who get this vaccine actually get a really high immune response [with] very robust protection.”

Given that the vaccine is safe, effective and there is an adequate supply, “it’s just the political will and public support” that is needed, Niccolai said.

In addition to those who oppose mandatory vaccinations because they believe it should be a personal choice or because they falsely believe that vaccines cause other illnesses, “there’s extra opposition to HPV vaccines being required for school in that it’s sexually transmitted,” Niccolai said. “It’s not like something you can get from coughing or sneezing or touching a doorknob. That argument would be, if you can’t catch it in school, why should you be immunized to go to school?”

The reasons for requiring vaccines for school entry are that “it serves as a safety net,” Niccolai said. “Kids who might fall through the cracks otherwise are getting immunized.

“The other argument for the school-entry requirement is … they signal the importance of immunization. … It sends a message to people that this is important,” she said.

Niccolai said, “I come at this from a public health perspective, to do whatever we can to improve the health of the public. … The tension comes from people feeling like their individual liberties are at risk.”

Besides being the most effective time to receive the HPV vaccination, 11 and 12 years old is also less of a burden. Before age 15, two shots are given 12 months apart. After age 15, three doses are given within a six-month period.

“Individuals may decide, in consultation with their doctor,” to receive the vaccine up to 45 years old, Niccolai said. “It is an option for people.” However, while the vaccine prevents HPV infection, it doesn’t treat it, she said.

Comey said the Public Health Committee heard from many opponents of vaccines, including one who believed they had caused their child to suffer a stroke. Lawmakers were warned about “the number of vaccines we were giving our children, the sheer number and how that has increased over the last decade-and-a-half,” she said.

Comey said she didn’t believe the votes were there to pass bills on vaccinations this year, but that she supports immunizing preteens. “I’ve given my daughter the HPV vaccine and I will probably give my son the HPV vaccine, as well,” she said.

“What’s impressive about the HPV vaccine is we don’t have any other vaccine for cancer out there. … I think it is, in and of itself, and amazing success story.”

Connecticut Media Group