The first license for the vaccine against HPV (Human Papillomavirus) was approved in June 2006. This started a new era in the cervical cancer fight and the fight against HPV related illnesses. The HPV vaccine promises to improve the reproductive health of women. Since adolescents have the highest risk of infection because of behavioral and biological factors, the vaccine is of even more benefit to them. From research, about 75% of all the HPV infections occur among adolescents and young women between the age of 15 and 24. Between the two HPV types, high risk HPV accounted for about 50% of infections among adolescents. This type is responsible for cervical cancer (Dunne et al, 2007).
There has been much concern over the strategies used to educate adolescents about the Human Papillomavirus and its vaccines in Australia. It is necessary to develop education strategies as there are a number of new and very successful technologies in the prevention of HPV.
HPV is a common sexually transmitted illness that is responsible for all cases of cervical cancer. Screening has always been done using the Pap test but other technologies have also been used to prevent HPV infection. There are successful vaccines available now.
From the high prevalence of HPV infections, two vaccines have been developed. These are effective in the prevention of vaccine-type specific HPV infections. The quadrivalent vaccine was produced in June 2006. The vaccine provides protection against four types of HPV. These types are associated with 70% of cervical cancer cases and 90% of genital warts accordingaccording to the U.S. Food and Drugto the US Food and Drug AdministartionAdministration. The vaccine was licensed for women in the age gap between 9 and 26 (U.S. food and drug administration). It was also recommended that 11 and 12 year olds receive the vaccine regularly with comprehensive follow up on 13 to 26 year olds (Makowitz et al, 2007).
In addition, a second bivalent vaccine for HPV is expected to be approved in the U.S. This vaccine provides the same kind of protection as the quadrivalent vaccine for cervical cancer. However, the vaccine does not include genital warts liked antigens. The vaccines have been clinically tested and found to be 100% effective in prevention of cervical cancer, lesions in the vagina and vulva and genital warts which are infection caused by HPV types (Harper et al, 2004; Perez et al, 2008).
National HPV Vaccination program in Australia
In Australia, the vaccination of its population against HPV infection started in April 2007 (Smith, M. A. et al., 2008). The vaccination includes regular vaccination of women between the age of 12 and 13. There is also a two-year catch up in women between 12 and 26 years. Smith and his group of researchers report that Thisthis latter one is either school-based or GP-based. They add that coverage in Australia reached 86% in 2008. HPV has been identified in relation to development of cervical cancer.
The vaccines which Australia is emphasizing are based on HPV 16 and 18. A recent study in the country carried out on 191 cases of cervical cancer disclosed that 61% of the patients had HPV 16 while 21% had HPV 18 (Stevens et al, 2006). This could imply that the HPV infection rate in Australia is higher than that in other industrialized countries. This would mean that the HPV vaccine would offer greater protection in the country’s population.
A quadrivalent vaccine has been available in Australia for adolescents and young women and protects against 4 of the HPV types. Public funded vaccination began in 2007 through the National HPV Vaccination program. Girls are vaccinated in their first year of high school which is in the age of 12 and 13. The three required doses are given in the course of that year. The different states have developed programs for delivering vaccines to girls in high school (Australian Bureau of Statistics).The bivalent vaccine was introduced for use by women up to the age of 45 in 2007. This vaccine projects against two HPV types and is sold to women on an elective basis (GlaxoSmithKline).
Impact of vaccination of HPV infection in Australia
A model was developed by researchers on the predicted impact of HPV vaccine in the Australian community (The Australian National University). From this model prediction for age-specific HPV prevalence was compared with study information under varying assumptions concerning the period of time of immunity after natural infection. The researchers assumed that if this was lasting, the estimates for HPV prevalence were much lower than what was reported in the study data. This was especially so for women in the community who were over 30 years old (The Australian National University). Artificial rise in sexual behavior constraints did nor not produce realistic guesses on HPV prevalence under the assumption that immunity would be lasting after natural infection.
The result therefore shows fading immunity after the natural infection. The duration of type-specific immunity after natural infection where 90% of individuals lose protection was found to be around 22 years in women between 10 and 14 years of age as McNeil (2006) writes. The infection rates in older women are however due to recurring suppressed infections.
Smith et al (2008) says that aA planned public immunization program in Australia on HPV in women is expected to reduce swiftly the age-regulated occurrences of HPV from a 56% in the year 2010 by 92% in 2050. The reduction in infection in women population in Australia was not susceptible to the immunity in men. Despite the uncertainty faced in the duration of natural infection of HPV, and thereafter the post-infection, conclusions about the lasting reduction in HPV infection in Australia were strong (Smith et al, 2008).
Smith also adds that fFollow up in women between the age of 27 and 45 results in swift reduction in HPV infection, specifically HPV 16. The lasting incremental population impact on the incidences is however small. If women are covered moderately in the next few years though, impact would be lower. The benefit of vaccinating men has bee found to be consistent with that f of women.
Adolescent knowledge about HPV
Women and young girls need to have adequate knowledge regarding the connection between HPV and cervical cancer and its prevention. This will help them to make appropriate decisions concerning their behavior and the use of the new technologies towards prevention of cervical cancer. The common technologies include Pap screening, HPV DNA testing and HPV vaccines. Providers of healthcare also need to provide adequate counseling to help women and girls make informed decisions on the most appropriate screening method, understand the results of the screen and consequently practice healthy sexual behavior.
Very few adolescents know that a HPV infection can not be cured using antibiotics and that condoms are not effective in protecting them against the infection. Fewer still know that the infection could result in cervical cancer (Kwan et al, 2008). Some have never heard of the Human Papillomavirus.
However, the media attention on HPV in the recent past which has come about as a result of the availability of the HPV vaccine has opened up adolescents to knowledge on the infection. Specific knowledge about the virus and the risk of cancer is however low. Research carried oput in the recent past on British women between the age of 16 and 97 showed that there was little change in knowledge if the HPV infection during the period of time between 2002 and 2006. In 2002, 0.9% had any knowledge in the responsibility of HPV in the cause f of cervical cancer. There was therefore an increase in this percentage to 2.5% in 2007. It is obvious though that not all the women who know about the HPV infection are aware that it can cause cervical cancer (Kwan et al, 2008).
Adolescent knowledge & attitude about HPV vaccine
If all the women and adolescent girls are taught thoroughly about HPV vaccines, they will be able to make wise choices on whether or not to receive the HPV vaccine. Education about those vaccines, the benefits and barriers is also likely to improve the acceptance of the vaccine. It will also enable health providers to encourage healthy sexual behavior and frequent Pap screening among the women even after vaccination.
There has not been much publishing concerning the knowledge adolescents have on the HPV vaccines. However, some have heard about it from health providers and consumer marketing but they also lack in-depth knowledge of the same. Adolescents may be ignorant to the benefits of the HPV vaccine and may also be alarmed that the vaccine will cause an infection or other difficulties. They may not understand that the HPV vaccine provides protection with only some of the HPV infections that result in cancer. This could confuse them. It is therefore necessary to educate these adolescents on the facts involved.
Kahn and other scholars (2008) have examined the attitudes adolescents have towards HPV vaccination in a period of 6 to 12 months after the vaccine was licensed. From their research, only a 5 % of women had received at least one vaccination. The authors say that the reason for taking the vaccine was actually based on two factors. One was the normative beliefs that influential people would consent to the vaccination. Second was high perception of the severity of cervical cancer and genital warts, fewer barriers related to safety and a history of pregnancy. On the other hand, there was the perceived cruelty of HPV a history of STI, coverage by insurance and few barriers to the vaccination. These reasons were related to self-efficacy.
Adolescent education on HPV should include such facts as that HPV is a viral infection which is spread from one person to the other by skin-to-skin contact especially during sexual intercourse. It is grouped among the common STIs. In addition, women who have had sexual contact with another person are at a risk of infection. There are two types of this infection. These are the low and high risk infection. The low risk infection is responsible for genital warts while the other type causes abnormal Pap results and cervical cancer. There are often no symptoms for HPV infection.
When one goes through a Pap test, abnormal cells in the cervix are diagnosed. Cervical cancer can be prevented through frequent Pap tests. Also to note is that the diseases related to HPV can be grave. However, infection does not prevent one from getting pregnant or having healthy children. The only way to clear HPV fro the body is through one’s immune system and antibiotics will not be of much help. Moreover, likely any STI, HPV can be prevented by postponing the first sexual encounter and limiting the number of sexual partners. Using condoms correctly and maintaining a healthy immune system can also be helpful.
Family Doctor’s role in adolescent education about HPV & HPV vaccine
Most providers of public health find the HPV vaccine to be acceptable and even admit that they would recommend the same to women. Studies show that about 75% of all the clinicians would recommend the vaccine (Duval et al., 2007). Some of the family doctors reported predictable barriers related to educational strategies (Kahn et al, 2008; Tissot et al, 2007; Duval et al, 2007). They seem concerned that once adolescents receive the vaccine, they will not return for Pap screening or they might involve themselves in risky sexual behavior.
The educational strategies involved therefore have to promote responsible sexual behavior and encourage Pap screening after the vaccine. According to Tissot (2007), family doctors have a role to educate both adolescents and their parents on the benefits of the vaccine and responsible sexual behavior. He adds that educational material covering the same should be developed. Such material will help overcome the barriers that exist towards vaccination.
Developing educational strategies based on specific content could use research on the knowledge and attitude clinicians and adolescents have towards the HPV vaccine. Education should include the procedure involved in the vaccine, the side effects if any are there and the importance of following up on the vaccination program. It should also include the fact that vaccine protects one from only specific types of HPV infection (Kollar and Kahn).
Other facts to know about the vaccine are: A HPV vaccine works in the body by triggering production of antibodies that fight HPV. The vaccine does not contain any virus and therefore can not cause infection in a person. Adolescents should know that the younger one in when they take the vaccine, the better they are likely to respond to it. This is because younger girls produce more antibodies and are not likely to be already infected.
The HPV vaccine has been proven to be safe and does not have any long-term effects. There are however minor side effects which include redness and pain at the place where one is vaccinated. HPV vaccines have been found to be very effective. The vaccine can prevent most of the cancer cases but does not protect one form the types of infection that re not found in the vaccine.
Adolescents should be made aware that in order for the vaccine to be effective, it is important to follow the vaccination schedule. Adolescents who have had sexual contact with even one sexual partner are likely to get infected. The diseases related to HPV infection can be very critical and include cervical cancer and Pap test abnormalities. Once a person is vaccinated, they should continue practicing safe sexual behavior and follow up on Pap screening as the vaccine does not protect them from all types of infection and sexually transmitted illnesses. Finally, health providers and organizations should support the vaccine and encourage teenagers to take it by providing adequate information on the same.
Australian Bureau of Statistics. 4221.0 Schools, Australia. Australia: Australian Bureau of Statistics, 2006.
Dunne E. F., Unger E. R., Sternberg M., et al. Prevalence of HPV infection among females in the United States. JAMA 2007; 297:813–819.
Duval B., Gilca V., McNeil S., et al. Vaccination against Human Papillomavirus: A baseline survey of Canadian clinicians’ knowledge, attitudes and beliefs. Vaccine 2007; 25:7841–7847.
GlaxoSmithKline. Another Australia first in the fight against cervical cancer: New vaccine for women 27–45 years, Press Release, 2007.
Harper D. M., Franco E. L, Wheeler C., et al. Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with Human Papillomavirus types 16 and 18 in young women: A randomized controlled trial. Lancet 2004; 364:1757–1765.
Kahn J. A., Rosenthal S. L., Jin Y., et al. Rates of Human Papillomavirus Vaccination, attitudes about vaccination, and Human Papillomavirus prevalence in young women. Obstetric Gynecology 2008; 111:1103–1110.
Kollar L. M. & Kahn J. A. Education about Human Papillomavirus and Human Papillomavirus vaccines in adolescents.
Kwan T. T., Chan K. K., Yip A. M., et al. Barriers and facilitators to Human Papillomavirus vaccination among Chinese adolescent girls in Hong Kong: A qualitative-quantitative study. Sex Transmit Infect 2008; 84:227–232.
Markowitz L. E., Dunne E.F., Saraiya M., et al. Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007; 56:1–24.
McNeil C. Coming soon: Cervical cancer vaccines, and an array of public health issues. J Natl Cancer Inst 2006;98:432–4.
Perez G., Lazcano-Ponce E., Hernandez-Avila M., et al. Safety, immunogenicity, and efficacy of quadrivalent Human Papillomavirus (types 6, 11, 16, 18) L1 virus-like-particle vaccine in Latin American women. Internal Journal of Cancer 2008; 122:1311–1318.
Smith, A. M., Rissel, C. E.,Ritchers, J.,Grulich, A. E.,de Visser, R. O. Sex in Australia: Reflections and recommendations for future research. Aust N Z J Public Health 2003; 27: 251-6.
Stevens M. P., Tabrizi S. N., Quinn M. A., Garland S. M. Human Papillomavirus genotype prevalence in cervical biopsies from women diagnosed with cervical intraepithelial neoplasia or cervical cancer in Melbourne, Australia. Internal Journal of Gynecological Cancer 2006;16: 1017–24.
The Australian National University. The Australian Social Science Data Archive. Web.
Tissot A. M., Zimet G. D., Rosenthal S. L., et al. Effective strategies for HPV vaccine delivery: The views of pediatricians. J Adolescent Health 2007; 41:119–125.
U.S. Food and Drug Administration. Product approval information: Licensing action, Gardasil. Web.