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The HPV vaccine is approved for kids as young as 9.
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The HPV vaccine is approved for age 9, which can give ‘the talk’ a shot in the arm

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The HPV vaccine is approved for age 9, which can give ‘the talk’ a shot in the arm

It can prevent an array of cancers, but some parents struggle with how to broach the subject of a vaccine — one linked to sexual activity — with young kids

No topic is taboo in Jen Gilarski’s Bethel Park home.

As her daughters Madi and Hailey reached their teens, she made sure social alcohol use would not become a mode of rebellion by having open, honest conversations about it. Now that the girls are 19 and 17, the same policy holds when it comes to relationships and sex — but when those topics came up at around age 11, she drew a line.

Like other American parents who seek traditional medical care for their children, Gilarski was challenged to confront her own beliefs about “the talk” when her girls were between 9 and 11 years old, which coincides with the HPV vaccine’s recommended schedule.

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The human papilloma virus is a sexually transmitted infection, though even intimate skin-to-skin contact is enough to pass it on. Its mode of transmission, in part, accounts for why the statistics section of the Centers for Disease Control and Prevention’s HPV webpage offers no numbers or percentages, but simply says, “HPV is so common that nearly all sexually active men and women get the virus at some point in their lives.”

Some of HPV’s more than 100 strains cause genital warts. The vast majority of infections have no symptoms at all — which also explains the rampant transmission of the virus — and are later cleared by the immune system.

Image DescriptionThe HPV series is just two doses if delivered before the age of 15. (AP Photo/John Amis, File)

And in a minority of patients HPV can cause a variety of reproductive and head and neck cancers, especially cervical cancer. That minority still accounts for 37,300 cases of cancer each year, which is why pediatricians are willing to look parents in the eye and bring up a sexually transmitted infection not long after kids stop counting on their fingers.

Knowing the statistics is a start, but parents still need to stare down the gulf between knowledge and how the heck to broach the subject of the vaccine — one linked to sexual activity — with young kids.

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“How was I supposed to have that conversation with them?” Gilarski remembered asking herself. “This is a sexually transmitted disease, and they didn’t even know what that was.”

Gilarski had other hang-ups too.

Madi was born in 2004, the same year the scientific community began investigating now-disgraced physician Andrew Wakefield’s paper proposing a link between the measles, mumps and rubella (MMR) vaccine and autism.

The paper was revoked by its publisher, medical journal The Lancet, in 2010. Wakefield was stripped of his medical license the same year. But for families like the Gilarskis, skepticism about vaccines lingered.

“I waited until they were older so I could talk to them about the vaccine and what it was for, but it also gave me more time to think about it,” she said.

While the HPV vaccine is approved for kids beginning at 9 years old, the CDC suggests giving the first shot at age 11 or 12, which coincides with a child’s sixth dose of “the tetanus shot” (that also includes protection against diphtheria and whooping cough) and their first dose of the meningitis vaccine.

Starting the HPV series before age 15 also shortens it to just two doses, versus three for those starting after their 15th birthday. That factored into Gilarski’s decision-making when she gave the OK to proceed with the vaccine, but other factors were far more impactful.

By the time her older daughter turned 13 or 14, her parents had already discussed STIs and how they’re contracted on their own terms and according to their own timing, an especially important decision for Pennsylvania families since the state has no sex education mandates in schools outside of HIV education.

The biggest influence, however, came from the family’s pediatrician: “If you could have a vaccine for leukemia or breast cancer, and give your child that chance to not have cancer, would you do it? Then, what’s the difference with this?”

The what-it-prevents approach is one also used by Allegheny Health Network Pediatric Institute system chair of pediatrics Joe Aracri.

“The most important thing is to explain the vaccine, what it’s for, and what exactly we’re trying to prevent,” he said. “The HPV vaccine is one of the few, if not the only one, that actually prevents cancer.”

But he’s also careful to follow the lead of his patients’ caregivers, especially given the sensitivity of the topic.

Some parents take the “this is a shot that keeps you safe” tack with few — or no — references to its purpose, he says, but plenty of others desire a more comprehensive discussion.

After offering basic information about the vaccine, he intentionally stops talking, and gives his patients an opportunity to express any concerns.

A common question, he said, is why non-sexually active children need the vaccine.

“The answer is, we’re trying to get them before they’re sexually active,” he said, hoping that Gardasil 9 — the only HPV vaccine currently used in the U.S. — can prevent all nine strains it targets, which is only guaranteed to happen if given before sexual contact occurs.

Another challenge he hears from parents is why boys should get the “cervical cancer vaccine” when they don’t have a cervix.

“It takes two to tango,” Aracri explained.

A study published in The Lancet Global Health on Tuesday concluded that almost one in three men over the age of 15 are infected with at least one HPV type, and one in five of them are infected with at least one HPV type that is considered high risk.

So not only are males potential vectors of the virus, passing it from one female to the next depending on their habits, but they, too, are susceptible to HPV-caused reproductive and head and neck cancers.

“Then, you address a lot of misinformation that’s out there on the internet,” Aracri said. “It doesn’t harm the reproductive system. It won’t make your child sterile. It’s not encouraging sexual activity; it’s just protecting them when they do become sexually active,” he listed as examples.

And, according to Pittsburgh-area sex educator Genna Marie, who primarily practices virtually, removing the stigma of sexually transmitted infections is another important part of that discussion.

“Just like any other illness, there’s nothing to be ashamed of. It’s something you can get even if you’re being careful,” she said. “Approaching it that way then allows kids to open the dialogue with a parent or physician if they do get something, rather than staying quiet and not getting treatment for it.”

The CDC recommends females begin Pap smear screening — a microscopic look at cervical cells that can reveal a HPV infection — beginning at age 21.

Cellular differences caused by HPV are detected well ahead of a cancer diagnosis when completed at the proper intervals. Between the immune system’s ability to clear the virus — usually in about two years — and the interventions made available by modern science, only about 10% of women will develop long-lasting cervical HPV infections that put them at risk for cancer.

Given the virus’ prevalence, that’s good news for most women, but 10% translates to 4,310 predicted cervical cancer deaths — and affected families — this year in the United States.

Knowing that, it’s perhaps shocking to learn that, in Aracri’s experience, some parents view the vaccine as somehow less serious than protecting kids from far-less-lethal measles or mumps.

“I think because HPV is spread through sex, and parents have a very hard time seeing their children eventually being sexual beings,” he said. “They’re tying the vaccine to the act of sex, and not to prevention of infection and cancer.”

Despite their initial reservations, the Gilarskis couldn’t risk joining that 10%, which for them is done through both a vaccine and an open line of communication.

“I lost a very good friend to leukemia a few years ago. I couldn’t stand to think, ‘What if my kid ends up with cervical cancer, and it’s my fault because I didn’t get them the vaccine?’” she said.

“They’re going to have sex. So, we could either be in the dark about it, or we can talk to them and know what’s going on in their lives.”

Abby Mackey is a registered nurse, and can be reached at amackey@post-gazette.com and IG @abbymackeywrites.

First Published: August 20, 2023, 9:30 a.m.
Updated: August 20, 2023, 8:14 p.m.

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The HPV vaccine is approved for kids as young as 9.  (Shutterstock)
The HPV series is just two doses if delivered before the age of 15.  (AP Photo/John Amis, File)
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