Alabamians are at greater risk than those in other states from certain types of cancers related to the human papillomavirus – or HPV - because of lower vaccination rates among children, officials say.
Twenty percent of children in Alabama age 11 to 15 have had both of the recommended doses of the HPV vaccine, compared to 49 percent nationally, according to the Centers for Disease Control and Prevention.
HPV is a common virus that can lead to six types of cancers including cervical cancer. According to a study by Human Rights Watch, Alabama has the highest rate of cervical cancer deaths in the nation.
Cindy Lesinger, the immunization director at the Alabama Department of Public Health, said the HPV vaccination rate is the only one that hasn’t increased in the 13 years she’s worked at ADPH.
"Providers are not recommending the vaccine routinely,” Lesinger said. “It is a standard of care to offer and administer that vaccine. There’s some things we don’t quite understand because we can’t see the motive or don’t know the provider’s specific reason for not feeling comfortable with the vaccine enough to engage the parents and convince them this is the safest, effective vaccine.”
Lesinger heads the Alabama Adolescent Vaccine Task Force, which has helped address Alabama’s trailing vaccine rates. She said schools in Alabama have recently decided to update the vaccine requirements for entry, but it hasn’t yet gone into effect.
Nine in 10 people get HPV at some point in their lives. Lesinger said Alabama’s current vaccination rate of 20 percent is not going to make a difference in this statistic.
ADPH partnered with UAB last year to study why Alabamians are behind on the HPV vaccine. UAB concluded Alabamians were most concerned in the “belief in link between sex and vaccine, and vaccine safety.”
Lesinger said the vaccine is the safest vaccine on the market and has little to no side effects.
Survivor turned advocate
Tracie Richter never missed a Pap smear. But 10 months after delivering her second child, her labs came back abnormal at her yearly gynecological appointment. The teacher and mother of two ended up having a radical hysterectomy and chemotherapy and radiation to treat cervical cancer.
She has since beat her diagnosis twice and become an outspoken advocate for the HPV vaccine.
“There is a perception that everybody believes their child is going to be completely abstinent until they’re married. And maybe that’s true. But what about their partner? And what about non-penetrative sex. So many parents I’ve talked to feel like if they vaccinate their 11-year-old and tell them why they're giving them permission to partake in any kind of sexual activity.”
Richter said there are not a lot of cervical cancer survivors who speak out in Alabama. She said she thinks it’s because of the stigma cervical cancer associates with sex. She began talking with her friends openly after her diagnosis to bring awareness to the commonality of abnormal Pap smears and HPV.
“In Alabama, I shouldn’t talk about my private parts,” Richter said. “We should. It’s our body. It’s our health. We need to be comfortable talking about the hard stuff with our family and our friends and especially our healthcare partners.”
Mary Anne King, executive director of the Laura Crandall Brown Foundation, which raises awareness for gynecological cancers in Alabama, said the dismal vaccine rates are due to practitioners not offering the vaccine at the same time other adolescent vaccines are suggested and Alabama’s prudish ways of talking about sex.
King said parents should look at the vaccine as a way to prevent cancer, not as a way to prevent a sexually transmitted disease.
“Parents have to ask questions,” King said. “There has been stigma associated with HPV, associated with ‘oh my child doesn’t need that.’”
By the numbers
In Alabama, the county with the lowest HPV vaccination rate is Clarke County where 7 percent of adolescents between 11 and 15 get both recommended HPV vaccines. Clarke County doesn’t have a pediatrician along with 19 other counties in the state. Bullock County has the highest rate of HPV vaccinations at 41 percent, still trailing the national average by 8 percent.
According to the CDC, cancers caused by HPV can effect both men and women including cervix, vagina, vulva, penis, anus and oropharyngeal cancers.
The CDC recommends all boys and girls get two doses of the HPV vaccine at ages 11 or 12. Adults can get the vaccine if they were not vaccinated as children up until age 45.
“It’s not anything to be ashamed of,” Richter said. “The rate of people that have some form of HPV at some point in their life is extremely high. It’s really not always that you’ve been promiscuous. Most of the times it’s not. You didn’t deserve it. It’s not your fault. You’re not dirty. You didn’t bring it on yourself.”