Study finds that one dose of HPV vaccine that targets only cervical cancer is as effective as three doses, now recommended

By Melissa Patrick
Kentucky Health News

A study has found that one dose of the human papillomavirus vaccine Cervarix appears to be as effective in preventing HPV infections that lead to cervical cancer as do three doses, the recommended course of vaccination. Only 25 percent of Kentucky adolescent women initiate the vaccination, and fewer than one in nine of those who do get three does, according to the Kentucky Cancer Consortium.

"Many women around the world and in the U.S. don't get the full three doses that are recommended, so this is promising news," said Elisia Cohen, an associate professor of communication at the University of Kentucky, who does extensive research on community strategies to improve adolescent and adult vaccinations. However, she cautioned that the drug Cervarix is "only 1 percent of the U.S. market" and that the findings from this study do not apply to Gardasil, the drug most commonly used in the U.S.

Dr. Diane Harper of the University of Louisville, one of the researchers, said in a news release, “Kentucky is one of the states that has not had a program in place to make Cervarix available to all of its citizens, and has very low three-dose completion rates of Gardasil.”

Most health departments and physicians choose Gardasil over Cervarix because it protects against four strains of HPV: two strains that cause 70 percent of all cervical cancers and two strains that cause genital warts and oral and anal cancers, concerns for males as well as females. Cervarix only protects against the two strains that cause cervical cancer. "Generally, the thinking is that protection against four strains is better that two," Cohen said.

She said Gardasil 9, which will protect against 90 percent of HPV strains that cause cervical cancer as well as pre-invasive cervical cancer lesions, has just been approved by the U.S. Food and Drug Administration and is going through its labeling process, and will be recommended for both boys and girls.

HPV is the most common sexually transmitted infection in the U.S., affecting an estimated 79 million individuals, according to the federal Centers for Disease Control and Prevention.

The study, published in The Lancet Oncology, analyzed data from two large trials of Cervarix. In the trials, women were randomly chosen to receive three doses of Cervarix or a control vaccine. All of the women were evaluated, regardless of how many doses of the vaccine they received, for the effectiveness of the vaccine for a period of four years. The analysis found that the protection from one dose was similar to that achieved by three doses of the vaccine.

“Knowing that Cervarix offers protection in one dose reassures public health agencies that they are not wasting money when most of their vaccines are given to those who never complete the three-dose series,” the researchers wrote.

The CDC recommends HPV vaccination for girls 11 and 12 years old, and catch-up vaccination for females from 13 to 26. The second dose should be given one to two months after the first injection; the third dose should be administered six months after the first dose.

Summer is a good time to make sure your teenagers or preteens get their four recommended vaccinations

Vaccines aren't just for babies. Preteens and teens also fall into an age group that has both required immunizations for school and recommended vaccines that can save their lives.

Summer is a great time to take care of getting caught up on these vaccinations, because many pre-teens and teens see their primary-care provider anyway for sport and camp physicals. Taking care of them in the summer also helps to miss the back-to-school rush that typically happens as August approaches.

Four vaccines are recommended for preteens and teens, according to the federal Centers for Disease Control and Prevention. The flu vaccine is recommended yearly for teens, but three less familiar vaccines and boosters are also recommended. Also, it is recommended that during a vaccination visit, you make sure your child is up to date on all of the vaccinations they should have received when they were younger.

Click here more details.

The CDC's Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians and other medical societies recommend these vaccines:

Meningococcal vaccine: This vaccine protects against some of the bacteria that causes meningitis and sepsis, which are very serious and sometimes fatal. It is recommended at 11 or 12 years old and a booster shot is recommended at age 16. Even if your child got the meningococcal vaccine at 12, 14 or 15, the booster is recommended. Older teens who haven't gotten this vaccine should get one as soon as possible.

HPV vaccine: This vaccine protects against the many cancers caused by the human papillomavirus, including cervical cancer in girls, and anal cancer and genital warts in both girls and boys. HPV vaccines are given in a three-dose series that should be started and finished when the boy or girl is 11 and 12. Pre-teens and teens who have not gotten this vaccine series should ask their primary care provider about getting them.

TDAP vaccine: This vaccine protects against three serious diseases: tetanus, diphtheria and pertussis, which is commonly called whooping cough. Preteens should get Tdap at 11 or 12. If your teenager didn't get a TDAP shot as a preteen, he or she should get it as soon as possible. This vaccine takes the place of what used to be called the tetanus booster.

Flu vaccine: Preteens and teens should get the flu vaccine every year as soon as it's available, usually in the fall. It is especially important for preteens and teens with chronic conditions like asthma or diabetes to get the flu shot.

"The vaccines for preteens are very safe," says the CDC. Side effects for these vaccines are usually mild and include redness and soreness at the site of the injection, or fainting from the medical procedure.

"Most side effects from vaccines are very minor, especially compared with the serious diseases that these vaccines prevent," says the CDC.

If you don't have insurance or if your plan does not cover vaccines, the Vaccines for Children Program provides vaccines for children ages 18 and younger, who are not insured or are under-insured. Vaccinations are covered on all plans purchased through the Patient Protection and Affordable Care Act.

How has the federal health-reform law changed your care?

Despite the controversy that continues to surround the Patient Protection and Affordable Act five years after its passage, it has probably changed the way your health care is delivered as it drives new models of payment, forces providers to approach care differently, and changes how health care is evaluated, Kavita Patel and Domitilla Masi report for the Brookings Institution.

Here are five ways the authors say that your health care might be different than it was five years ago because of the reform law:

Your physician might be part of a patient care team. New payment models in the ACA encourage an interdisciplinary team-based approach, which evidence shows "can lead to higher quality care and better health outcomes for patient." This approach allows the physician to spend more time diagnosing and devising a treatment plan, while the patient may spend more time interacting with non-physician staff for support care.

Prevention and wellness are more important than ever. The ACA requires health plans to cover all preventive screenings, immunizations and well visits for women at no cost, as part of the minimum benefits required in order for health-insurance plans to participate in exchanges like Kynect. The new payment models also pay physicians who work toward keeping their patients healthy, instead of just treating them when they are sick. " Since the policy took effect in September 2010 it is estimated that an additional 76 million people now receive preventive care," the authors write.

You may have better access to care on evenings and weekends. New payment models are driving this change as practices are often required to offer extended hours to decrease the overuse of emergency departments. Many offices now offer clinical advice around the clock with a clinician who has immediate access to their medical records.

Chances are your health information is being stored in an electronic health record, not a paper file. A separate law encouraged the use of EHRs, but "participation in the new ACA-promoted delivery models is practically impossible" without them. And while EHRs can be used to greatly improve patient care, not all EHRs are created equal and it will take time before patients see seamless integration and exchange between different doctors and settings in "real-time".

You can access care remotely, wherever you are. Doctors are using mobile technology and tele-health in rural and remote areas to provide more efficient care to patients. Insurance companies and employers are beginning to recognize this mode of treatment not only as a way to save money, but to also provide timely access to care, that does not involve the emergency room.

At least 14 counties had vaccination rates in 2011-12 below level experts say is needed to protect kindergartners from measles

As concern about the spread of measles from lack of vaccination grows, many Kentucky counties probably have vaccination rates below the minimum that experts say is needed to create "herd immunity" and prevent spread of the highly contagious disease among students in kindergarten.

At least 14 Kentucky counties had measles vaccination rates below 90 percent in the 2011-12 school year, according to state data analyzed by USA Today, in a survey of states that track vaccination rates and make them public. The Courier-Journal published the Kentucky figures in an online database.

The counties under 90 percent were Bath (89%), Boyle (83%), Bullitt (88%), Christian (89%), Harlan (88%), Jefferson (86%), Laurel (85%), Lawrence (88%), Lee (80%), Nelson (82%), Robertson (88%), Rowan (86%), Taylor (82%) and Webster (86%). Data from several counties was not available. For the database with county-by-county figures, click here.

The statewide vaccination rate was 93 percent, pulled down by a rate of 86 percent in Jefferson County, the state's most populous. The lowest rates were 80 percent in Lee County and 82 percent in Nelson and Taylor counties.

Jefferson County officials told The Courier-Journal that the county's rate rose above 90 percent in the last two to three years. Bullitt County school-health coordinator Lesa Bodine told the Louisville newspaper that her data show 94.3 percent of the county's kindergarten students "have been properly immunized," The C-J's Darla Carter reports. "However, she said there are some parents who choose not to immunize their children. She also noted that there can be a delay in receiving proof of vaccination because a child has, for example, transferred from another county or state."

Like many states, Kentucky allows parents to exempt their children from required vaccinations for medical or religious reasons. Measles outbreaks in other states have been blamed at least partly on parents who still believe discredited reports that vaccines cause autism or other disorders. Generally, the stricter the laws, the higher the vaccination rate, Stateline reports. Here's a Stateline map showing how states differ:

Belief in bogus studies and stories undermines use of vaccines that have been proven safe, resulting in spread of diseases

UPDATE: Jan. 16, 2014 4:50  Kentucky has not had any reports of measles in the past three years. It has had two cases of mumps in 2013 and two cases of mumps in 2014. Kentucky continues to have a large number of  pertussis, or whooping cough, cases with 666 in 2012; 383 in 2013; and 292 in 2014. The 2014 reports have not been finalized at this time.

The United States has recently seen a significant rise in the number of cases of vaccine-preventable diseases such as measles, mumps and pertussis, commonly called whooping cough.

A recent report blames this on an anti-vaccine movement caused by widespread misinformation about the safety of immunizations, John Wihbey reports for Harvard University's Shorenstein Center on Media, Politics and Public Policy.

"Over the past two decades, a combination of fraudulent scientific studies, irresponsible reporting, and well-meaning but misinformed citizen activists has led to a steady increase in the proportion of parents who have concerns about the recommended childhood vaccine schedule," says a 2014 report from the American Academy of Arts and Sciences.

Many young parents in the United States have no memory of  the time before vaccines and don't realize how important successful vaccination programs are to prevent the reemergence of the diseases they protect us from. In 2014, the United States had 610 confirmed cases of measles and 20 outbreaks, the highest number of cases since measles elimination was documented in the U.S. in 2000, according to the federal Centers for Disease Control and Prevention.

Chart provided by the federal Centers for Disease Control and Prevention

The origin of much of this misinformation is a "fraudulent" 1998 study, published in a well-respected British medical journal, that linked the measles-mumps-rubella (MMR) vaccine to autism. And while the study never claimed a definite link between the vaccine and autism, "sensational media reports ignited a public panic and MMR vaccinations fell dramatically," WebMD reports.

The study has since been discredited and retracted from the journal because it "was proven entirely false and even labeled "fraudulent,"" Wihbey writes. A new study, that updated this 1998 fraudulent study, has also shown that the MMR vaccine is not the cause of autism, Daniel J. DeNoon reports for WebMD.

"We are convinced there is no link between MMR vaccination and autism," study leader W. Ian Lipkin, MD, director of the center for infection and immunity at Columbia University in New York City, said at a news conference, DeNoon reports. Lipkin noted that this study did not address the theory that the mercury-containing preservative thimerosal might cause autism. The MMR vaccine does not contain thimerosal.

As for thimerosal, "A very large number of scientific studies have been carried out, and extensive scientific reviews, that have concluded there is no causal connection between vaccines or the preservative thimerosal and autism," Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, told DeNoon in a different article for WebMD.

The rate of vaccination in the United States is 92 percent for measles, mumps and rubella, which is relatively high, Wihbey reports.And only 1 percent of children in the United States do not receive any vaccines, according to the CDC..

But, "if we stop vaccinating, even the few cases we have in this country could very quickly become tens or hundreds of thousands of cases," says the CDC website.

How "herd immunity" protects us all.

National Institute of Allergy and Infectious Diseases

One concern is that as the vaccination rate drops, the United States will loose its "herd immunity," which offers a level of protection across an entire community that protects even the un-vaccinated. This type of noncompliance occurred in 2011, when 15 states saw MMR vaccination levels below the target level of 90 percent, Wihbey reports. Adding to misinformation about immunizations is media coverage of activists and celebrities with anti-vaccine positions.

In an in-depth article about the media's role in spreading misinformation that childhood vaccines cause autism, Curtis Brainard, for Columbia Jouralism Review, writes: "The consequences of this coverage go beyond squandering journalistic resources on a bogus story. There is evidence that fear of a link between vaccines and autism, stoked by press coverage, caused some parents to either delay vaccinations for their children or decline them altogether."

And it looks like many choose to believe unsubstantiated stories rather than public-health campaigns that attempt to address this misinformation, according to a recent study published in the peer-reviewed medical journal Pediatrics.

“None of the pro-vaccine messages created by public health authorities increased intent to vaccinate with MMR among a nationally representative sample of parents who have children age 17 years or younger at home," the study concluded.

The researchers said there should be more careful testing of public health campaign messages, suggesting that pediatricians, rated by parents in the study as the most trusted source of vaccine safety information, could be an "especially persuasive source" for this information.

The vast majority of Kentucky's children have been immunized, possibly because state law requires immunizations for admission to school, with exemptions made only for medical or religious purposes.  The CDC reported that less than 1 percent of Kentucky kindergarten children were exempted from one or more vaccine during the 2013-14 school year.

If you haven't gotten your flu shot yet, this week is an excellent time to get it, with the holidays coming up

State health officials are encouraging Kentuckians to get a flu vaccination during National Influenza Vaccination Week, Dec. 7-13.

"Getting a flu vaccine is an early holiday gift you can give to yourself and your family,” said Dr. Stephanie Mayfield, commissioner of the Department for Public Health. “As the holidays approach, people will be traveling, and families will gather together, increasing the potential for exposure to the flu. We are strongly urging anyone who hasn’t received a flu vaccine, particularly those at high risk for complications related to the flu, to check with local health departments or other providers.”

National Influenza Vaccination Week is a reminder to those people who have not yet received a flu vaccine that the time to get vaccinated continues into winter – through January or later, when flu season typically peaks. Because it takes about two weeks for the body to develop protective antibodies against the flu following vaccination, Kentuckians who have not had a chance to be vaccinated should seek out the opportunity during this season.

Throughout the week, health departments and the federal Centers for Disease Control and Prevention will highlight the importance of vaccinations for those people at high risk, their close contacts and all those who want to be protected against the flu. In addition, good health habits such as washing hands often with soap and warm water; avoiding touching your eyes, nose or mouth; and staying at home from work or school when sick will also be emphasized.

Kentucky’s flu activity level has recently increased to regional, which indicates an upturn in influenza-like illness or outbreaks of flu in some regions of the state.

The best way to protect against the flu is to receive a flu vaccination. The CDC’s Advisory Committee on Immunization Practices recommends flu vaccine for all individuals 6 months of age and older. People who should especially receive the flu vaccine because they may be at higher risk for complications or negative consequences include:

• Children ages 6 months through 18 years;
• Pregnant women;
• People 50 years old or older;
• People of any age with chronic health problems;
• People who live in nursing homes and other long-term care facilities;

• Health care workers;                               
• Caregivers of or people who live with a person at high risk for complications from the flu; and
• Out-of-home caregivers of or people who live with children less than 6 months old.

Kentuckians should receive a new flu vaccination each season for optimal protection. Healthy, non-pregnant people ages 2 through 49 can be vaccinated with either the flu shot or the nasal vaccine spray. Children younger than 9 years old who did not receive a previous seasonal flu vaccination should receive a second dose at least four weeks after their first vaccination.

High-dose flu vaccine is available for persons aged 65 years and older this year.

The CDC says some of the nation’s circulating flu viruses may not be covered well by this year’s vaccine.  That is not unusual. "Despite the possibility of a poor vaccine match for one of the circulating strains, vaccination still provides the best protection against influenza," a state news release said. "The vaccine appears to be a good match for many of the strains which are being transmitted, and because of antibody cross-protection, should help to reduce hospitalizations and deaths, even in persons who may contract the mismatched strain of influenza."

In addition to flu vaccine, the health department strongly encourages all adults 65 years and older and others in high risk groups to ask their health care provider about the pneumococcal vaccines. These vaccines can help prevent a type of pneumonia that is one of the flu’s most serious and potentially deadly complications. The CDC now recommends that adults 65 years or older receive the pneumococcal conjugate vaccine (PCV13, Prevnar-13) in addition to the pneumococcal polysaccharide vaccine (PPSV23, PneumoVax-23). Getting both vaccines offers the best protection against pneumococcal disease. Between 3,000 and 49,000 deaths are attributed to flu and pneumonia nationally each year, with more than 90 percent of those deaths occurring in people age 65 and older.

Lots of research has established that children with egg allergies can still get a flu shot; those with asthma especially should

Flu season can start as early as October, and  children with egg allergies are now encouraged to get a flu shot, especially if they have asthma, according to a news release from the American College of Allergy, Asthma and Immunology.

Children with egg allergies may have been told in the past to not get a flu shot because of a possible reaction to trace amounts of eggs in which the vaccine is produced, but recent research now says that the vaccine is safe for these kids.

“We now know administration is safe, and children with egg allergies should be vaccinated,” Michael Foggs, president of the American College of Allergy, Asthma and Immunology, said in the news release. “We recommend that, as with any vaccine, all personnel and facilities administering flu shots have procedures in place for the rare instance of anaphylaxis, a life-threatening allergic reaction.”

The release says "a large number of research studies published over the last several years have shown that thousands of egg-allergic children, including those with a severe life-threatening reaction to eating eggs, have received injectable influenza vaccine as a single dose without a reaction."

More than 21,100 children under the age of five are hospitalized annually because of the flu, with only 55 percent of children ages 5-17 getting a flu shot, according to the Centers for Disease Control and Prevention, says the release.

Foggs especially recommended that children with asthma get the vaccine, because even though they are not more likely to get the flu, it can be more serious for those with asthma, says the release.

"Children with asthma really need to get the flu vaccine," Foggs said in the release. “Asthma sufferers are among the most vulnerable because the flu compromises their airways even further than they already are.”

Getting ready to go back to school is also a reminder that it's time for that yearly 'well visit' with the pediatrician

As you're making that back-to-school checklist of things to do to get your kids ready, don't forget to put a yearly physical examination.

While parents of kindergartners and sixth graders are motivated to schedule these appointments to take care of required immunizations and those who have kids in athletics need sports physicals, the American Academy of Pediatrics recommends an annual well-check physical for all children after age 4.

“Back-to-school checkups are often the only visit most kids and teenagers have with their doctor every year,” Dr. Paul Stricker said on the academy's website. “The annual physical gives the pediatrician a chance to give the child a thorough physical exam. It’s also a good chance to address important questions, especially with teenagers, including adolescent issues of drinking, smoking, drugs, sexual activity, and depression.”

And while sports physicals offer important screening tools for potential athletic health problems, this type of physical does not address the child's overall health and is not as detailed or in-depth as a pediatrician's exam, Stricker said.

Here are other suggestions to help you make the most of your yearly well-visit with your pediatrician:

• Bring any updated immunization records along if you have them
• Bring your school's required physical forms
• Bring a list of questions about anything that you have concerns about including sleep, allergies, medications, behavior and development.
• Ask to see your child's growth chart and discuss your child's nutrition/caloric intake and exercise needs
• Be mentally prepared for any vaccinations that may be due.

“Though no one likes to get shots, vaccines are an integral part of keeping kids and our community safe. They work to safeguard children from illnesses and death caused by infectious diseases and protect our kids by helping prepare their bodies to fight often serious, and potentially deadly diseases,” Heidi Renner, primary care physician at Loyola University Health System, said in a press release.

Centers for Disease Control and Prevention

Click here for a chart of Kentucky's state requirements for immunizations.

“Yearly physicals are a great time to touch base with your child’s physician to make sure everyone is on the same page," Renner said. " Don’t hesitate to ask questions. We can’t help you if we don’t know a problem exists.”

U.S. measles cases highest in 2 decades; blamed mainly on Americans' foreign travel, but also on opting out of vaccination

By Melissa Patrick
Kentucky Health News

In the wake of the highest number of measles outbreaks in the U.S. in the last 20 years, it is important to make sure you and your children are fully immunized, especially if you are traveling abroad.

"The current increase in measles cases is being driven by unvaccinated people, primarily U.S. residents, who got measles in other countries, brought the virus back to the U.S. and spread (it) to others in communities where many people are not vaccinated," Ann Schuchat, director of the Center for Immunizatons and Respiratory Diseases of the federal Centers for Disease Control and Prevention, said in a press release.

Centers for Disease Control photo

Measles is a virus and is one of the most contagious diseases known. It spreads through the air when an infected person coughs or sneezes and will infect 90 percent of those who are exposed if they are not protected. It starts with a fever, followed by a cough, runny nose and red eyes. Then a rash of tiny, red spots breaks out, which starts at the head and spreads to the rest of the body. It can lead to pneumonia, swelling of the brain and death. Of every 1,000 children who get the disease, one or two will die, the CDC says.

Kentucky requires measles immunizations for children in child care and school, with exemptions made only for medical or religious purposes.

The Kentucky Annual School Immunization Survey for Kindergarten and Sixth Grade reports that for the 2013-2014 school year: 148 kindergarten students (0.3 percent) and 228 sixth graders (0.4 percent) opted out of immunization under the medical exemption, while 359 kindergartners (0.6 percent) and 249 sixth graders (0.5 percent) opted out for religious reasons.

As of May 23, measles cases have been reported in 18 states and New York City, with most reported from Ohio (138), California (60), and New York City (26). Ninety percent have been among people who have not been vaccinated or have unknown vaccination status, according to the CDC. Most of the patients report religious, philosophical or personal reasons for avoiding vaccines. Through May 23, no deaths had been reported.