Iowa HPV vaccination rates lag other teen vaccines

Shots protect children from cancers but face misconceptions

A recent report from the Iowa Department of Public Health shows parents throughout the state are less likely to have their teens receive the HPV vaccine compared to other vaccines.

Locally, the participation rates are well below the state goal of vaccinating 80 percent of 13- to 15-year-olds by 2020.

Natoshia Askelson, assistant community and behavioral health professor at the University of Iowa’s College of Public Health, finds that gap concerning, given that the vaccination rates for tweens for meningitis and Tdap — tetanus, diphtheria, and pertussis (whooping cough) — are at or near 80 percent.

“It seems to be a situation in which kids are probably getting to the doctor to get the other two vaccines, but they aren’t getting the HPV vaccine,” she said.

The human papilloma virus, or HPV, is a virus associated with cancers in both men and women and is also associated with genital warts.

“HPV is a whole range of strains of viruses and some don’t do anything, some give you warts, and some of them can give you cancer,” Askelson said.

Dr. Lance Goodall, who practices at UnityPoint Clinic Pediatrics-Westdale in Cedar Rapids, said the Centers for Disease Control and Prevention recommends the vaccine for those between the ages of 9 and 27 years old and is usually given during the 11- or 12-year-old well-child exam.


“If the HPV vaccine is started before 15 years of age, it is a two-shot series,” he said. “If started after 15 years of age, it is a three-shot series.”

Goodall said the vaccine is important because it protects individuals from those cancers associated with HPV.

“Individuals who are sexually active have a high chance of being exposed to HPV in their lifetime,” he said. “And vaccinations given before exposure to HPV increases the effectiveness of the vaccine, which is why we encourage vaccination starting at 11 to 12 years old.”

Askelson agreed and noted that studies have shown ages 11 and 12 are when the immune system is able to mount the most effective response.

“Most people end up having some strain of HPV at some point in time in their body and usually they will just get rid of it on their own,” she said.

“But for those strains that cause cancer, there’s a chance that your body can’t get rid of it. We have this very highly effective vaccine that targets those strains that cause cancer.

“What’s interesting is that it’s really the most effective thing we’ve seen for cancer prevention in a very long time. We are coming close to 100 percent effectiveness.”

Askelson, who runs the cancer prevention research control network collaborating site for the UI, noted the HPV vaccine was introduced in 2006 after going through years of research and clinical trials, one of which was held at the UI.


She said one reason for the low vaccination rates is that at this stage in a child’s life, parents may not be as good about taking their children in for regular well-child exams.

“But this is a great time for the kids to get back into the doctor, go in for a sports physical or a preventive exam and get all those vaccines that they need to get them ready for adolescence, heading off to college and becoming an adult,” she said.

“We make sure they get swimming lessons. We make sure they go to driver’s ed. Getting these vaccines, including HPV, is one of those things to do to prepare them for adult life.”

Misconceptions abound and can be a hindrance to vaccinations.

“One such misconception is that getting the vaccination will make a child more likely to start having sex,” Goodall said. “But studies tell us that getting the HPV vaccine doesn’t make kids more likely to start having sex.”

With oral and throat cancers on the rise among younger people, Askelson said the vaccinations are key.

“We are talking about a vaccine that protects your kids from cervical cancer, cancer of the penis, cancer of the anus, and oral and throat cancers,” she said. “Why would you not protect a child against that? “I tend to think that if I could provide a vaccine to prevent your daughter from ever getting breast cancer, it would be hard for me imagine that people wouldn’t be lined up to get that.”

Children also may be hesitant to receive “an extra shot during their well-child exam,” Goodall added. “But I think it’s important for physicians to have conversations with teens and their families to provide relevant information and for the teen to make their own educated choice.”

He noted that a teen can request to receive the HPV vaccination without parental knowledge or consent. That’s allowed because it’s covered under the section of Iowa code dealing with prevention of sexually transmitted diseases.


“Parents are actually less concerned than we might think they would be about giving their child a vaccination related to sexual activity,” Askelson said. “They understand their children are going to grow up to be adults. But we sometimes find health care providers are somewhat afraid to bring it up.

“If you’re being told your kid needs Tdap and meningitis vaccinations and then there’s another vaccine called HPV that they could have if they want, it’s not a very strong recommendation from a provider.”

She noted the UI is working with providers to make those conversations more effective and the recommendations stronger.

“We want them to set it up so that they issue the HPV vaccine like other vaccines,” she said. “When your child was younger, if they didn’t get their MMR, you got a reminder postcard telling you. We want that to happen with HPV, too.”

Efforts also are underway to set up alternative venues for youths to get an HPV vaccine, such as a pharmacy, at a back-to-school sports physical clinic or even through dental providers, who are eager to reduce the rate of oral and throat cancers.

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