UK has a new group to research infectious diseases, including treatment and prevention through community engagement

By Lindsay Travis
University of Kentucky

A new partnership between researchers at the University of Kentucky will combat the threat of infectious diseases through research directed at prevention and treatment.

The CURE-KY team: Front row left to right: Vincent Venditto,

Steven Van Lanen, Ilhem Messaoudi, Rebecca Dutch. Back

row: Feng Li, David Burgess, Beth Garvy, Richard Greenberg.

Not pictured: Krystle Kuhs. (UK photo by Jeremy Blackburn)

The Consortium for Understanding and Reducing Infectious Diseases in Kentucky (CURE-KY) will foster multidisciplinary collaborations to address the burden of infectious diseases in the state and beyond.

“I am thrilled by the boundless possibilities our collaborative efforts promise at the University of Kentucky,” said Ilhem Messaoudi, founder of CURE-KY and chair of the Department of Microbiology, Immunology, and Molecular Genetics in the College of Medicine. “With a steadfast commitment to advancing knowledge and fostering transdisciplinary alliances, we aim to propel infectious-disease research to new heights, creating a healthier Kentucky and nurturing future scientific leaders.”

She added, “We have an excellent team of scientists here at UK and on our leadership team. Together we can tackle infectious diseases from an array of perspectives to make a difference in the health of our community.”

CURE-KY grew from, and took most of its acronym from, UK’s Covid-19 Unified Research Experts Alliance. It has experts from the College of Medicine, College of Public Health, College of Pharmacy, Martin-Gatton College of Agriculture, Food and Environment and the Markey Cancer Center.

It will focus on research in five areas: microbial pathogenesis; vaccines, therapeutics and antimicrobial resistance; public health and community engagement; animal health; and engineering and systems. IT will also work to address vaccine hesitancy and misinformation to foster trust between Kentuckians and the scientific community.

“From studying prevention, control and understanding transmission dynamics to assessing risk, promoting health equity and engaging communities in disease-control efforts, this work is critical toward our goal of creating a healthier Kentucky,” said Public Health Dean Heather Bush.

Dr. B. Mark Evers, Markey director, said “Kentucky is home to the highest cancer rates in the country, including several cancers caused by infectious diseases such as HPV and hepatitis C. . . . By better understanding and combating diseases that can lead to cancer, CURE-KY will contribute to this mission and make progress toward our ultimate goal of conquering cancer in the commonwealth.”

More information about CURE-KY and upcoming events is on on its website.

UK hosts national meeting to raise immunization rate for vaccine against cervical and other HPV cancers, in which Ky. leads U.S.

Kentucky Department for Public Health illustration

By Melissa Patrick

Kentucky Health News

Kentucky leads the nation in the rate of cases of and deaths from cervical cancer, a disease that is largely preventable by a vaccine.

The vaccine targets the human papillomavirus, which can cause cancers of the cervix, genitals, anus, neck and head. Kentucky also leads the nation in cancers caused by the HPV.

"The good news is that the HPV vaccine can prevent the vast majority of those cancers, but not everybody knows about it," said Pamela Hull, associate director of population science and community impact for the University of Kentucky's Markey Cancer Center. 

Between the HPV vaccine and cervical screening, cervical cancer could be virtually eliminated, Hull said. The combination wouldn't prevent all cases, she said, but "Within the next few decades, we can eliminate cervical cancer as a public-health threat in this country." 

Cervical cancer screening is done through a pap smear, which looks for cancerous cells on the cervix, which connects the uterus and vagina. It can also find precancerous changes that have not yet developed into cancer. Screenings usually begin at age 21 or three years after the first sexual intercourse.

The HPV vaccine protects against six cancers: cervical, anal, penile, vaginal, vulvar and head or neck. According to the Centers for Disease Control and Prevention, it can prevent over 90% of sexually transmitted cancers caused by the HPV from ever developing, 

Hull said these cancers cause 36,000 new cancer cases every year in the U.S. in men and women, but only about half of Kentucky teenagers have received it because state law does not require it.

The vaccine's greatest obstacle appears to be that that it is associated with a sexually transmitted disease. Researchers have said improving the vaccination rate depands on changing the perception that the vaccine is something that prevents STDs to the knowledge that it primarily prevents cancer.

Conference discusses anti-HPV strategies

Raising awareness about the importance of HPV vaccination was the focus of a national conference held in Lexington on April 16-17 by the Markey center and the National Cancer Institute. 

Hull, who spke with reporters before the conference, said researchers all over the country are collectively working to answer this question: "How can we work with health-care providers and community organizations and parents to make sure more and more kids get vaccinated to protect them from cancer as they grow older?" 

A "social organization" program called "Operation WIPE OUT Cervical Cancer Alabama" aims to do just that through a program that involves a number of community partners, Isabel Scarinci of the University of Alabama at Birmingham told attendees at the conference in Lexington. 

Scarinci said the program first engaged the support of the Rotary Club of Birmingham and the state health department. Together, they launched a program to increase HPV vaccination rates in the Alabama county that had the highest rates of cervical cancer in the state.

She said through the involvement of groups in the county and the local school superintendent, they started an education program in the school system that resulted in the students organizing an HPV vaccination campaign, which has become part of an official plan for the state. 

Scarinci said there is no official funding for the program because they "want this to belong to everybody." Thus, funding comes from a number of sources. 

According to a post on the Alabama health department website, the program offers free HPV immunizations for children and adults; provides free cervical cancer screenings for low-income and uninsured women; and provides follow-up tests for those who need it. All services are offered through county health departments.   

HPV vaccines and Kentucky

While the HPV vaccine is not required in Kentucky, it is given around the time students enter middle school and are required to get an initial vaccine for meningitis and a booster for diphtheria, tetanus and pertussis (more commonly known as whooping cough), collecitvely called TDaP.

The timing of the two required vaccines and the HPV vaccine create a good opportunity to include it in the children's immunizations. "Even though it's not required," Hull said, "we really, really strongly encourage it because it's one tool that parents can use to prevent cancer for their children."  

Two doses of the HPV vaccine are recommended for all 11- and 12-year-olds, but the series can begin at 9. It is also recommended for those 13 to 26 if unvaccinated; three doses are recommended for people who get their first dose at 15 or later, and for people with certain conditions that weaken immunity.

In addition, it is also recommended that anyone between 27 and 45 who is not vaccinated should talk to their health-care provider about their risk of infection and the benefits of getting vaccinated.

Asked why boys and girls as young as 9 should get the vaccine, Hull said they have a better immune response than older chuildren. As a person gets older, she said, they need an extra dose of the vaccine for protection against the cancers because it takes more of the vaccine to build up their immunity.

"We really want to see our rates of HPV vaccination go up in Kentucky," Hull said. "Right now, just over half of teenagers have gotten the vaccine, all the doses of the vaccine, and we really want to get that up to, closer to, 80% or even higher." 

In 2022, Kentucky ranked 44th in HPV vaccination, with only 55% of teens 13-17 having received all recommended doses, according to America's Health Rankings. That was a decline from the 57% reported in 2021 and well below the national average of 63%.

"What I like to explain to a parent is . . . you're not going to put your seatbelt on after you get in a car accident, you have to have it on before," Hull  said. "So age for the vaccine is really important to get it early, build up the body's defenses so then one day when the body is exposed to the virus, it is ready to fight it." 

Hull said there is an emphasis on getting more people vaccinated in rural areas because HPV vaccination rates are lower in rural areas, and they have higher rates of HPV cancers.

Kentucky has nation's highest rate of a type of cancer that can be prevented with a vaccine recommended for 11- and 12-year-olds

Photo by Inside Creative House via iStock/Getty Images Plus

By Erin Poteet
University of Kentucky

Kentucky has the nation's highest rate of cancers caused by the human papillomavirus — a dire statistic considering HPV can be largely preventable through vaccination.

The HPV vaccine can prevent over 90% of sexually transmitted cancers caused by the human papillomavirus, including cervical, anal, penile, vaginal, vulvar and head/neck cancers.

Today, you can take an extra step toward protecting your children against HPV-related cancers with the HPV vaccine. The Centers for Disease Control and Prevention now recommends that all 11-12 year-old children (girls and boys) get just two doses, with the second being given 6-12 months after the first.

While the vaccine is most effective when given to children, it can still provide protection against HPV for teens and adults. So if you have not yet been vaccinated for HPV, it may not be too late. The FDA now approves the use of the HPV vaccine in men and women up to age 45.

People aged 26 to 45 should discuss the benefits of the vaccine with their doctor. Getting vaccinated in this age range can still have benefits, since people can acquire different strains of HPV over time. If you’re unvaccinated, you can still acquire the higher-risk strains later in life.

In addition to the HPV vaccine, it’s important for women to get regular screenings for prevention and early diagnosis of cervical cancer. Also known as a pap smear, this test looks for cancerous cells on the cervix, and can even find precancerous changes that have not yet developed into cancer. Screenings usually begin at age 21 or three years after first sexual intercourse. Talk to your doctor about a timeline for regular screenings.

One reason the vaccine (and for females, cervical screenings) is so important is because HPV-related cancers often don't cause obvious symptoms until more advanced stages.

For cervical cancer, some of the most common symptoms reported include abnormal bleeding or bleeding after sexual intercourse, and an abnormal discharge. As the cancer advances further, it can cause urinary blockage, back pain, leg swelling, or neuropathic pain, such as a "pins and needles" sensation in the skin.

Erin Poteet, Pharm.D., is director of retail and community pharmacy services for UK HealthCare.

It's time to make sure your children are up to date on vaccinations required for school; Kentucky lags behind all the states it borders

State Dept. for Public Health graphic

By Melissa Patrick
Kentucky Health News

With just a few weeks left before school starts, it's time to make sure your school-aged children are up to date on their required immunizations. It's especially important because Kentucky's children fell behind on their immunizations during the pandemic, and many of them still haven't caught up. 

"Kentucky is really low on a lot of childhood vaccines . . . and when that happens . . . when people are not vaccinated, especially children with developing immune systems, that can cause these diseases to run rampant," said Ryan Babb, manager of the University of Kentucky's retail pharmacy services.

At a recent Immunization Summit hosted by the Immunize Kentucky Coalition, State Epidemiologist Kathleen Winter said Kentucky is behind all of its bordering states in routine childhood vaccination rates and is well below the national average. 

Winter said the greatest concern right now is among kindergarteners, because their measles-mumps-rubella vaccination rate has dropped in the last two school years. 

She also noted that since 2018, fewer Kentucky children have received the DTap or Tdap vaccine against tetanus, diphtheria and pertussis (whooping cough), and this is especially true among seventh-graders. 

Also, she said only 57% of Kentucky teens have taken the human papillomavirus (HPV) vaccine that protects against more than 90% of cancers caused by it. 

Babb encouraged Kentucky parents to get their children vaccinated at their local pharmacy, noting that while all Kentucky pharmacists can offer vaccinations to children between the ages of 9 and 17, some have a  "collaborative care agreement with a pediatrician," like UK's pharmacies do, that allows them to offer them to children as young as 6 months.

"We feel like it's really important to increase access, it's much easier than to . . . walk in and get a vaccination rather than having to schedule an appointment with a provider," Babb said. 

And if your child has gotten behind on their routine vaccination schedule, there are catch-up schedules to get them up-to-date. "You can always catch up," he said. 

Babb said it's also important to remember that immunizations provide "herd immunity," which occurs when enough people have been immunized against disease to protect others who are not immunized. Some can't get vaccinations because their immune systems are too weak to allow them to get shots, or because they are too young.

Children can also get their routine vaccinations at health clinics, health departments and doctor's offices, but it's important to make those appointments soon because school typically starts in August and students are required to provide up-to-date immunization records at the beginning of each school year, unless exempted for religious or medical reasons. 

Babb cautioned people who are hesitant about vaccines to make sure they are listening to reliable sources on the subject because there is a lot of vaccine misinformation out there. 

"My recommendation to anybody is before you do a Google search or before you start checking any other social media or getting opinions based on that, just call your local pharmacist [or] . . . even a primary care provider . . .  to get the right information the first time before digging down a rabbit hole of misinformation," he said. 

Ruth Carrico, a senior research scientist with Norton Infectious Diseases Institute, talked at the summit about ways to combat vaccine hesitancy. She placed the bulk of that responsibility on health-care providers and their employees. 

"You need to be all in," she siad. "And then be honest, unashamed, and unafraid of your position. It doesn't mean that you're sanctimonious, and you're high and mighty, and you don't listen to others. .  . But the idea is, if you are all in for immunization, then that needs to be where we are heading and that needs to be the basis for our interactions as we move forward."

Further, she said health-care professionals must have a firm understanding and expertise of how vaccination and the immune system work to answer people's questions in a "truthful, credible and sustainable" way. 

"Our time to understand vaccines and promote vaccine confidence is now," she said. "We need to remember very clearly, lest we get influenced by misinformation and pushback in social media, that vaccines save lives."

Ky. kids still aren't as immunized as they were before pandemic; pertussis threat rises; cancer-preventing vaccine rates still low

Slide shown by state epidemiologist at Immunization Summit shows Kentucky's rate of vaccination against childhood diseases is lower than all bordering states. (For a larger version, click on it.)

By Melissa Patrick
Kentucky Health News

The Immunize Kentucky Coalition's Immunization Summit, held May 10 in Lexington, opened with a warning that Kentucky's children fell behind on their immunizations during the pandemic and still haven't caught up. 

State Epidemiologist Kathleen Winter
(Photos by Melissa Patrick)

Citing 2021-22 school immunization data, State Epidemiologist Kathleen Winter said Kentucky is behind all its bordering states in routine childhood vaccination rates and is well below the national average. 

The greatest concern right now is kindergartners, she said, because their measles-mumps-rubella vaccination rate has dropped in the last two school years. (MMR rates among seventh and 11th-graders remained about the same, but that's no surprise, since two doses of the vaccine are recommended before a child turns 6.) 

"We really need to focus on this particular age group that maybe has missed vaccines . . . because of the pandemic," Winter said. 

Winter said Kentucky's kindergarten two-dose MMR rate of 86.5% ranks in the bottom five states nationally. The national rate is 93.5%. The National Immunization Survey by the Centers for Disease Control and Prevention, which runs behind school data, shows that Kentucky's decline in immunization is similar to a national decline.

Regular well-child visits help parents and health-care providers keep children current on immunizations. Winter said one study found that 41% of Kentucky parents of children 12 and younger reported their child had missed a well-child visit during the pandemic. This rate was even higher among Hispanics (48%). 

"We're getting back on track with routine visits now, but we still have not caught up for where we had this big decline during the pandemic months," Winter said. 

Winter said there are "dramatic differences" in immunization rates between those who have private health insurance, publicly paid insurance, and those who are uninsured.

The National Immunization Survey for the recommended seven-vaccine series for children under 2 shows that 78% of children with private insurance had received all of them, but only 64.3% of those on Medicaid had received all of them, and only 45.2% of uninsured children had. 

"There's some real work to be done with these vulnerable populations, not just here in Kentucky, but nationwide," Winter said.

Pertussis concerns

Since 2018, fewer Kentucky children have received the DTap or Tdap vaccines, which protect against tetanus, diphtheria and pertussis (whooping cough). Rates among kindergarteners and 11th graders have been "pretty stable," but there has been a steady decline among seventh graders since 2018, with rates between 80% and 85%, Winter said.

The United States has a spike in pertussis about every five years, Winter said, noting there was a "major epidemic" in 2012 and "We are well positioned to have another one." 

She added, "We are concerned about this in particular because we have had outbreaks of pertussis reported this year; several counties have already noticed outbreaks. . . . So this is the time we really need to focus on getting kids vaccinated for pertussis."

Cancer-prevention vaccine rates are low

 

According to the CDC, human papillomavirus (HPV) is a very common virus that can cause cancer -- and the HPV vaccine can prevent more than 90% of cancers caused by it, including cervical cancer. But only 57% of Kentucky teens have taken it. 

"Kentucky is another state that really needs to be worried about HPV," Winter said. "We have some of the highest rates of cervical cancer here in Kentucky."

Even more concerning, said Winter, is that fewer than half Kentucky females are up-to-date on HPV vaccines and two-thirds of them haven't gotten a single dose of the vaccine, which is given in either a two or a three-dose series, depending on age. Kentucky ranks 37th among the states for this measure. 

HPV can also cause cancers of the vagina, vulva, penis, anus, rectum, throat and the back of the tongue. The CDC reports that each year, about 47,199 new cases of cancer are found in parts of the body where HPV is often found. Of those, about 37,300 of them are caused by HPV.

Covid-19 vaccines still available and free

Winter noted that the end of the national public-health emergency for Covid-19 means that getting Kentuckians vaccinated against the disease has become normalized.

And because the now single-dose bivalent vaccine is recommended for everyone 6 months and older, Winter said it needs to be considered a routine childhood vaccination. 

"We have to routinize it in every way possible, routinize it for our conversations with parents and for routine childhood visits, getting it incorporated fully into the childhood schedule," she said. 

That's not being done yet, the data shows.

"When we look specifically at children, 94% of those under the age of 5 have never been vaccinated against Covid and 74% of children in the 5- to 11-year age group have never been vaccinated," Winter said. "So we are still not making this routine for children. It's not being offered and provided in the settings that it  needs to be offered and provided." 

Winter also stressed that Covid-19 vaccines are still readily available and free, even though the commercialization of the vaccine is expected to come in late summer or fall. 

"This is why we need to work now to get this routinized as much as we can into clinics and settings where people are routinely getting vaccinated," she said. 

She added that the latest guidance is for people 65 and older to get an additional booster and that guidance for everyone else is likely coming. 

Vaccinations work

Winter said the measles exposure that thousands of people had in February at the spontaneous revival at Asbury University in Wilmore turned out to be a public-health success story.

An unvaccinated Jessamine County resident who attended the revival in Februrary had Kentucky's third reported case of measles in three months, but Winter said there has not been one secondary measles case from that exposure. She noted that the person with measles wore a surgical-type mask at "a lot" of the events.

"The reality is, most people are immune to measles," Winter said. "Most people are fully vaccinated or had measles as a child. So we do not have this crisis of a population-level issue. What we have are targeted individuals and ages where we need to get back on track. So, this is where we need to focus."

To register for this event, click here.

Even with this public-health victory, Winter cautioned that without a high level of population immunity, the potential for a super-spreading event would remain. 

Organizers of the summit hope it will be an annual event. Amber Malott, chair of the Immunize Kentucky Coalition, which is part of the Kentucky Rural Health Association, said its mission is to "create equitable access to vaccinations across the commonwealth." As part of that mission, she said they will hold free pediatric immunization symposiums in Morehead June 20 and Owensboro June 29.

HPV Vaccine Conference on April 14 will be virtual; vaccine stops human papilloma virus, which causes certain types of cancer

The Kentucky Rural Health Association is devoting a one-day conference to discuss a vaccine that can protect against infections and cancers caused by the human papillomavirus.

The HPV Vaccine Conference, which was to be held in Bowling Green, will now be held virtually on April 14 between 9 a.m. and 3 p.m. ET. Click here to register. 

Among other topics, speakers who will talk about strategies to improve HPV immunization rates, rural HPV data, HPV vaccine resources and inter professional collaborations to increase HPV vaccination.

HPV is the most common sexually transmitted infection in the U.S. and can cause cancers of the cervix, vagina, vulva, penis, anus, rectum, throat and the back of the tongue. More than 90 percent could be prevented by the vaccine, according to the Centers for Disease Control and Prevention.

The vaccine is recommended for all 11- and 12-year-olds, but can be given up to the age of 45. In 2020, only 55.7% of Kentucky teens aged 13 through 17 had received all recommended doses of the HPV vaccine, slightly below the national rate of 58.6%, according to the America's Health Rankings. Kentucky ranks 29th among the states.

Registration is open for April 14 conference in Bowling Green on youth vaccine that prevents certain types of cancer

Screenshot of flyer; for registration information, click here.

By Melissa Patrick
Ky. Health News

The Kentucky Rural Health Association is devoting a one-day conference to discuss a vaccine that can protect against infections and cancers caused by the human papillomavirus.

The HPV Vaccine Conference will be held at the Knicely Conference Center on Nashville Road in Bowling Green from 8 a.m. to 3 p.m. CST on April 14. Click here for registration. 

The conference agenda has not been released, but a draft agenda says it will include, among other topics, speakers who will talk about strategies to improve HPV immunization rates, rural HPV data, HPV vaccine resources and inter professional collaborations to increase HPV vaccination.

HPV, or human papillomavirus, is the most common sexually transmitted infection in the U.S. and can cause cancers of the cervix, vagina, vulva, penis, anus, rectum, throat and the back of the tongue. More than 90% could be prevented by the vaccine, according to the Centers for Disease Control and Prevention. 

Two doses of the HPV vaccine are recommended for all 11- and 12-year-olds, although the series can be started at age 9. It is also recommended for those 13 to 26 if not vaccinated already. A three-dose schedule is recommended for people who get their first dose on or after their 15th birthday and for people with certain immunocompromised conditions. 

In addition, it is also recommended that anyone between 27 and 45 who is not vaccinated should talk to their health-care provider about their risk of infection and the benefits of getting vaccinated. 

In 2020, only 55.7% of Kentucky teens aged 13 through 17 had received all recommended doses of the HPV vaccine, slightly below the national rate of 58.6%, according to the America's Health Rankings. Kentucky ranks 29th among the states. 

Those rates are even lower in rural Kentucky. Research published in the Journal of Rural Health found that HPV vaccination rates are 11% lower than urban rates. 

America's Health Rankings reports that among Kentucky's 13-to-17-year-olds, 65.5% of the HPV vaccines were given to girls and 46.4% were given to boys.

Sen. Rand Paul makes inaccurate remarks about virus, vaccines and 'naturally acquired' covid-19 disease, FactCheck finds

U.S. Sen. Rand Paul's Nov. 17 tweet

U.S. Sen. Rand Paul of Kentucky is being taken to task for a series of remarks he has made about the novel coronavirus, vaccines and immunity. FactCheck.org, a nonpartisan, independent unit of the Annenberg School of Communication at the University of Pennsylvania, found several inaccuracies in his statements.

Paul, an ophthalmologist, suggested on Twitter that “naturally acquired” immunity to the virus was better than that from a vaccine.

"But it’s not known how immunity from the two sources compares — and the entire point of a vaccine is to offer immunity without the risk of getting sick," Jessica McDonald reports for Fact Check. She writes:

Paul made his claim in a Nov. 17 tweet in which he listed interim efficacy figures from two ongoing vaccine clinical trials and then provided his own calculation of the “effectiveness” of natural infection with the coronavirus.

In a follow-up tweet, the Kentucky Republican shared a link to a New York Times article about a new unpublished study that found evidence of some immunity to the coronavirus in most people for at least six months. He commented: “Why does the left accept immune theory when it comes to vaccines, but not when discussing naturally acquired immunity?”

Paul, who has previously spread misinformation about childhood vaccines, has inaccurately argued during the covid-19 pandemic that parts of the U.S. have reached herd, or community, immunity because of pre-existing immunity to other coronaviruses. Herd immunity is when enough people in a population are immune to prevent spread of the disease.

Public-health experts, however, have said that threshold is still a ways off — and that allowing the virus to spread uncontrolled would lead to many needless deaths. A better approach, they say, is to stave off the spread of the virus until a vaccine is widely available.

A Paul spokesperson told us that the senator was not suggesting that immunity through natural infection with covid-19 is better than getting immunity from a vaccine, but rather, “highlighting research that says immunity is real.”

We were directed to subsequent tweets, including one in which Paul said he was not “arguing against vaccines” but that covid-19 patients “can celebrate immunity if lucky enough to survive,” as well as Paul’s support for alternative options to speed along access to covid-19 vaccines.

Still, the efficacy figure Paul provides for natural covid-19 infection isn’t accurate. And the juxtaposition of the numbers implies a kind of superiority of natural infection over vaccination — a dangerous notion, given that contracting the virus poses a serious risk.

As University of Florida biostatistician Natalie Dean pointed out in response to Paul’s tweet, “The key distinction is that vaccines are a safe way to achieve immunity. Getting sick with covid-19 is inherently unsafe. We would never ever tolerate a vaccine that carried even a fraction of the risks of natural infection.”

Bogus ‘efficacy’ figure

While Paul purports to offer a precise percentage for how “effective” natural infection is relative to vaccines, experts told us that the comparison is premature and faulty.

The efficacy figures for the vaccines come from interim results released in press releases by the two companies, Pfizer and Moderna, and refer to the ability of the vaccines to prevent symptomatic covid-19 infection in phase 3 trials. (The day after Paul’s tweet, Pfizer announced additional data reflective of the full trial, which showed 95% efficacy.) But the number for natural infection is a broad-strokes calculation Paul made based on reinfections.

“We don’t really know how many reinfections there have been,” virologist Angela Rasmussen said in a phone interview, adding that many reinfections have not been confirmed and that efficacy of naturally-acquired immunity “isn’t a thing.”

“It’s just really ridiculous to try to use the way that efficacy is calculated in clinical trials for vaccines and apply that to epi[demiologic] data across the entire population,” she said.

Dr. Paul Offit, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and a member of the Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee, agreed.

“Clearly, there are people who can be reinfected. As a general rule, it’s usually more mild reinfection,” he told us. But, he added, “most people aren’t tested, so you don’t really know who’s getting reinfected and who isn’t.”

It’s true that reinfections so far appear to be rare, which bodes well both for a vaccine and for people who may have immunity as a result of infection. But no one knows yet how the immunity from each will compare.

Most vaccines do not offer quite as good protection from a pathogen as a natural infection will — but of course, a person has to survive or suffer through the infection to get that future protection, sidestepping the entire function of a vaccine. It’s therefore largely irrelevant whether or not vaccine immunity is superior to that from natural infection.

There are some instances in which a vaccine does elicit a better immune response. That’s the case for vaccines against human papillomavirus, or HPV; tetanus; Haemophilus influenzae type b; and pneumococcus.

Whether covid-19 will be one of them remains to be seen. Rasmussen said it was possible, but still hypothetical at this point. “We don’t really know. We only know that these vaccines typically induce levels of neutralizing antibody that are comparable to the higher levels of neutralizing antibody that’s been observed in convalescent patients,” she said, referring to the type of antibody that can prevent cells from becoming infected with the virus.

Based on the performance of the shingles vaccine, Offit speculated that some of the later-arriving vaccine candidates that include powerful adjuvants, or chemicals that are added to vaccines to boost the immune response, such as those from Sanofi-GSK or Novavax, might be better than natural infection.

Immunity unknowns

For both the vaccine and natural infection, important questions about covid-19 immunity remain.

“We do know that most people who get covid-19 do develop some kind of measurable antibody response, but we don’t know what that really means in terms of protection against either reinfection or whether you will mount protective immune responses upon a re-exposure,” said Rasmussen.

As a result, public health officials have cautioned that for now, even if people have previously contracted covid-19, individuals should still follow the standard recommendations.

The Centers for Disease Control and Prevention, for example, advises all people, including those who have recovered from covid-19, to continue to physically distance, wear masks, wash their hands and avoid crowds.

Similarly, the CDC notes that it doesn’t yet know “if or when” it will stop recommending masks or physical distancing after vaccination.

This is in contrast to Paul’s assertion that people “can celebrate immunity.” In a Nov. 12 interview on Fox News, Paul used similar language and advocated that people drop these precautions.

“We have 11 million people in our country who’ve already had covid. We should tell them to celebrate,” he said. “We should tell them to throw away their masks, go to restaurants, live again, because these people are now immune.”

A huge question is how durable immunity will be. Although the study Paul highlighted suggests that most people will be protected for at least six months — and might mean they are protected against severe disease for many years — it’s still not definitive, and doesn’t mean that those timeframes will apply to everyone.

Shane Crotty, an immunologist at the La Jolla Institute for Immunology and one of the senior authors of the paper, noted on Twitter that the team observed a wide range of immune responses in people, including a lack of a measurable response in some people.

“That led us to speculate,” he said, quoting his manuscript, that “‘it may be expected that at least a fraction of the SARS-CoV-2-infected population with particularly low immune memory would be susceptible to re-infection relatively quickly.’”

The CDC, notably, has said that people who have had covid-19 may still benefit from a coronavirus vaccine. And some experts envision a future in which multiple vaccines are on the table for everyone.

“It strikes me as not unlikely that we will learn what the duration of protection is and people will need — whether naturally infected or vaccinated — to have booster shots over some period of time, once a year, once every two years, once every five years,” Barry Bloom, an immunologist and global health expert at Harvard’s T.H. Chan School of Public Health, said in a press call.

Why naturally acquired herd immunity is a bad idea

In his tweet about the new immunity study, Paul also suggested that Democrats were somehow denying realities about immunity from natural infection.

“Why does the left accept immune theory when it comes to vaccines, but not when discussing naturally acquired immunity?” he asked.

Scientists, however, objected to Paul’s characterization.

“I don’t think anybody’s dismissing [immunity following natural infection]. I think what people are saying is, it’s a bad idea as a strategy for dealing with infection,” said Offit, who noted that 30% to 40% of the population could be considered at high risk for covid-19.

Both Offit and Rasmussen also pointed out that historically, there isn’t a lot of precedent for building herd immunity through natural infection.

“People were getting smallpox for millennia,” Rasmussen said, and “the herd immunity threshold was never really reached.”

The much safer way of getting to herd immunity is to use a vaccine instead, especially when multiple candidates are on the horizon.

“Trying to achieve herd immunity [without a vaccine] would result in hundreds of thousands more — if not millions — of unnecessary deaths and debilitating illness for millions more,” Rasmussen said. “So I think it’s not really right to talk about vaccine-induced herd immunity versus naturally-acquired herd immunity without mentioning the fact that one of them has a very, very large price tag in human lives and quality of life attached to it.”

Dentist gives warning signs of oral cancer, 'not always definitive'

By Dr. Shelley Shearer

There are nearly 50,000 new cases of oral cancer in the United States each year, accounting for 3 percent of all cancer diagnoses. Most are discovered in a dental office.

Oral cancer is caused by the uncontrolled growth and reproduction of cells in some regions of the mouth. It can occur inside the cheeks, under the middle and front of the tongue, or on the tissue lining of the mouth or gum. That’s why it is worthwhile to ensure that people know the symptoms, causes and risk factors.

Shelley Shearer

Early detection and treatment of oral cancer can help prevent the cancer from developing further or spreading to other areas. Be sure to tell your dentist is you have experienced any of the following for more than two weeks:
• difficulty chewing or swallowing
• a lump or sore area in the mouth, throat or on the lips
• a white or red patch in the mouth
• difficulty moving the tongue or jaw
• unexpected weight loss
• a sore or ulcer that does not heal or bleeds
• tenderness, pain, or lumps anywhere in the mouth or on the lips.

These are not always definitive signs of oral cancer and may be caused by other conditions, such as an allergy or an infection. But it’s better to check out these occurrences before it’s too late.

Patients often ask what causes oral cancer so they can try to avoid it. Here are some of the main causes and risk factors:
• Tobacco and alcohol use: Any form of tobacco use involves carcinogenic substances entering the mouth, which significantly increases the risk for oral cancer. Excessive alcohol use can also increase the risk.
• Age: The risk of oral cancer increases with age, with the average age of diagnosis at 62 years old.
• Human papillomavirus (HPV): This is a sexually transmitted infection that has strong associations with several forms of oral cancer.
• Sun exposure: The sun emits rays that can burn the lips and trigger the development of oral cancer.
• Gender: Males are more than twice as likely to develop oral cancer than women. Researchers have yet to discover a reason why.

As with most other cancers, it is not always possible to prevent oral cancer. Some risk factors for oral cancer, such as being male or aging, are not preventable. However, consider some lifestyle factors that can reduce the risk of oral cancer such as:
• avoiding tobacco
• consuming alcohol in moderation
• maintaining a healthy diet
• using screen around the mouth and a balm on the lips when exposed to sun
• exercising regularly
• maintaining good oral hygiene by brushing and flossing twice a day
• regularly visiting a dentist for check-ups.

Conduct Your Own Self-Check: Just as women take time for a monthly breast self-exam, those with oral cancer risk factors should conduct their own self-check.

First, look at and feel your head and neck in a mirror. Do the left and right sides of the face have the same shape? Are there any lumps, bumps, or swellings that are only on one side of your face? Also view the skin on your face for changes in color or size, sores, moles or growths. To check the neck, press along the sides and front of the neck for tenderness or lumps.

Lips and cheeks can reveal much as well. Pull your lower lip down and check for sores or color changes. Then use your thumb and forefinger to feel the lip for lumps, bumps, or changes in texture. Repeat this on your upper lip. Examine your inner cheek for red, white, or dark patches. Put your index finger on the inside of your cheek and your thumb on the outside. Gently squeeze and roll your both sides of your cheeks between your fingers to check for any lumps or areas of tenderness.

Often the roof of the mouth is an indicator that something is off. Tilt your head back and open your mouth wide to look for any lumps and see if the color is different than usual. Touch the roof of your mouth to feel for lumps. Extend your tongue and look at the top surface, sides and underneath for lumps, swelling or changes in color and texture.

Tell your dentist if you suspect anything unusual in your mouth. Catching oral cancer early can save time, money and most importantly, your life.

Shelley Shearer is founder of Shearer Family and Cosmetic Dentistry in Florence, and wrote this for the Northern Kentucky Tribune and KyForward.

Pharmacies could help get more teens vaccinated for a virus that causes sex-related cancers, in which Kentucky leads the nation

Alabama Department of Public Health

There's a vaccine for a virus that causes sex-related cancer, but rural teens are less likely to get it or know about it. Rural pharmacies could help improve vaccination rates, writes Casey Daniel, a Ph.D. pharmacist who teaches in the family medicine department at the University of South Alabama.

"Human papillomavirus (HPV) is the most common sexually transmitted infection, with 80 million Americans currently infected and 14 million new cases of infection each year," Daniel notes, but only about two-thirds of 13-to-17-year-olds start the HPV vaccine series, and fewer than half have up-to-date vaccinations. Kentucky's rates are much lower; less than half get any shots and only a third get the full series. Probably due to that, the state has the highest rate of HPV-related cancers in the nation.

Rural HPV vaccination rates are 11 percent lower than urban rates, partly because rural areas have fewer health-care providers, Daniel writes in the Journal of Rural Health. He says that gap could be filled by pharmacies, which are more widespread than doctors' offices and open longer hours. "In the 2018 President's Cancer Panel report on HPV vaccination for cancer prevention, pharmacies were specifically recommended as a way to increase vaccine accessibility," he writes. "Most pharmacies are also ideally suited for immunizations because of their inherent infrastructure and storage capacity for various medications. Many pharmacies offer vaccines such as flu, pneumonia, and shingles, and therefore, they have established immunization protocols that can be easily adapted to HPV."

Convenience is important for HPV immunization "because this vaccination is a multi-dose series requiring subsequent visits," Daniel writes. "While large chain pharmacies have a broad, mass market appeal, there is a considerable case to be made for collaborating with 'community pharmacies' as alternative settings for HPV vaccination, particularly in rural and small-town settings. In these areas, independent community pharmacies are often an established part of the community. Community pharmacists frequently have personal relationships with their patients, knowing them both within and outside the bounds of the pharmacy, and have a unique, established trust. They are trusted providers within the community, acting as the first line of health care and consultation for many patients."

That's also important for HPV immunization because research has shown that rural parents are less likely to be aware of HPV and the vaccine. Community pharmacists "frequently have personal relationships with many local individuals," Daniel writes. "Therefore, they can function in both education and reinforcement regarding the importance of HPV vaccination. . . . In the exploration of alternative settings to increase HPV vaccination, community pharmacies have been significantly overlooked. Particularly in rural settings, these pharmacies have vast potential to reach under-served, disparate populations and serve crucial roles in addressing community health care needs and filling resource gaps."

UK gets $11 million grant to decrease cervical cancer in Eastern Ky. with focus on risks: smoking, HPV and low rates of screening

The University of Kentucky has been awarded a five year, $11 million grant to work toward reducing the rates of cervical cancer in Eastern Kentucky, a region that has some of the highest rates of incidence and deaths from it in the nation.

The research will address three of the risk factors that contribute to these high rates -- smoking, the human papillomavirus (HPV) and low rates of cervical-cancer screenings among women in the region, according to the news release.

The first project in the program will work to reduce smoking among women in rural communities through various interventions, including strategies to help women who are not quite ready to quit, the lead investigator of this project told Alex Acquisto of the Lexington Herald-Leader.

"Instead of ignoring the smokers who are not ready to quit today, we're going to work with them anyway," said Jessica Burris, an assistant professor of psychology and a member of UK's Markey Cancer Prevention Control Program.

Eastern Kentucky has some of the highest rates of smoking in the nation, which contributes to its likewise high rates of cervical cancer. Smoking not only causes cancer almost anywhere in the body, it can also block your body from fighting it once you have it, says the federal Centers for Disease Control and Prevention. And women who smoke are about twice as likely as non-smokers to get cervical cancer, according to the American Cancer Society.

Mark Dignan, professor in the UK College of Medicine and co-leader of the Markey Cancer Prevention and Control Program, will lead two projects that focus on the human papillomavirus, or HPV, which the CDC attributes to 90 percent of all cervical cancers.

"We really shouldn't have cervical cancer," Dignan told Acquisto. "We know what causes it, we can detect it, and we can treat it." It is the only cancer for which there is a vaccine, but Kentucky's children are among the least vaccinated for HPV, one of the most common sexually transmitted diseases.

The grant will fund a project to improve HPV vaccination rates among people between 11 and 26. The other will mail HPV self-testing kits to women in the region who are not being screened for cervical cancer or are "underscreened."

In addition to cervical cancer, HPV can also cause cancers in the vagina, vulva, penis, anus, rectum and the back of the tongue and throat. Among these cancers caused by HPV, more than 90% could be prevented by the vaccine, according to the CDC.

Burris and Dignan told Acquisto that they expect around 70,000 Kentuckians to be impacted by their project, which is scheduled to start in a couple of months.

The project is funded by the National Cancer Institute and involves a collaboration by the Markey center with Ohio State University, the University of Virginia and West Virginia University. It will involve 10 health systems in Appalachia, including two in Kentucky: Big Sandy Health Care, which operates seven clinics in Eastern Kentucky, and Juniper Health, which has locations in Wolfe, Lee, Breathitt and Morgan counties.

Ky. children among least vaccinated for cancer causing human papillomavirus; state has highest rate of HPV-related cancers

Did you know there's a vaccine that can prevent certain types of cancer? Many Kentuckians don't know. As part of a statewide effort to educate them, a Bardstown woman told her story to a group in Louisville about being told at age 30 that she would have to have her uterus removed because she had cancer of the cervix, Darla Carter reports for Insider Louisville.

Jessica Saxe, a Kentucky mother who was diagnosed with
cervical cancer at age 30, promotes the HPV vaccine.
(Saxe provided this family photo to Insider Louisville.)

Jessica Saxe told those attending the Louisville event that her son, Charlie, was 9 months old at the time of her diagnosis. She recalled thinking, “I don’t know if I’m going to live to see him walk. … I don’t know if he will remember me,” her voice breaking. “That was the hardest part as a mother, knowing that I might not be able to be there for my son.”

Charlie is now 6. Carter reports that Saxe has since become an advocate for encouraging others to get vaccinated against the sexually transmitted human papillomavirus, often referred to as HPV.

She was speaking at an event sponsored by the American Cancer Society, along with the Kentucky Department for Public Health and others, to promote HPV vaccines, which are effective in preventing cervical cancer and genital warts. They will be traveling around the state over the next few months to promote the life-saving vaccine.

HPV is one of the most common sexually transmitted diseases, and Kentucky's children are among the least vaccinated for it. HPV can cause cancers in the cervix, vagina, vulva, penis, anus, rectum and the back of the tongue and throat. Among these cancers caused by HPV, more than 90 percent could be prevented by the vaccine, according to the Centers for Disease Control and Prevention.

“Kentucky has the highest cancer burden for HPV-related cancers in the nation, so morally we have to” take action, Elizabeth Holtsclaw, the state and primary-care systems manager for ACS, said at the event. She said the goal of their outreach is to increase vaccine rates by 8% in the next 12 months.

In 2017, about 38% of Kentucky youths 13 to 17 were up-to-date on HPV vaccinations, meaning they’d received the full series of doses, according to the CDC, which is providing funding for the meetings. That was up from 34% in 2016 but well below the U.S. rate of nearly 49%.

The HPV vaccine is recommended for girls and women starting around age 11 until 26. For boys, it’s recommended starting at age 13 until 21. Until 12, children receive two doses of the vaccine at least six months apart. Those 15 and older get three doses. The earlier the vaccine is given, the better the immune response. It is important to note that the vaccine is the only one known to prevent any form of cancer.

The vaccine is proven to be a safe and effective way to protect against the HPV virus, but can be a tricky sell to parents, Carter reports. “Part of it is nobody wants to admit that this 12-year-old is ever going to have sex, which is a fantasy,” Connie White, senior deputy commissioner of the health department, said at the event.

Another contributor to the state's low HPV vaccination rate is that health-care providers don't seem to be promoting it strongly enough, Carter reports. Studies show a "clear, same-day recommendation" from a physician to a parent is the most important factor in whether a child gets vaccinated or not. That also means doctors must carry the vaccine in their offices, but many don't. The vaccine is not on the list that must be administered to incoming students or sixth graders.

“Somehow, we are treating the HPV vaccine as an ‘other’,” Holtsclaw said at the event. “Whether it’s because it’s not mandatory, we don’t know. But other states are doing all right without a mandate. … The doctor needs to feel comfortable and confident making that strong recommendation.”

Another reason for getting the vaccine when young is that it is supposed to be given before exposure to HPV, so ideally, before the person becomes sexually active, according to the CDC. “It’s a cancer vaccine; it’s not a sex vaccine,” Saxe said.

Saxe, who recently had a second child with the help of a surrogate, told the group that it’s critical for cancer survivors to share their stories to help persuade more people to get their children vaccinated and prevent other women from getting cervical cancer, Carter reports.

“We can stop this, but we can’t do it alone,” she said. “We need the doctors and the nurses and the pharmacists. We need the people in public health. We need policymakers. We need you guys to stand with us on this. We need you to make this a priority.”

Ky. vax rates for HPV, which causes cancer, rose last year but still lag rest of nation; 'Parents feel their children will always be angels'

Kaiser Family Foundation map, adapted by Kentucky Health News; for a larger version, click on it

"Human papillomavirus is the most common sexually transmitted disease in the nation . . . but Kentucky children remain among the least vaccinated in the U.S.," Caroline Eggers reports for the Bowling Green Daily News.

The HPV vaccine is the only one that can prevent any form of cancer. "There are more than 100 types of HPV," Eggers notes. "Most infections go away on their own, but some forms of HPV cause genital warts – and some types cause cancer."

Kentucky's HPV vaccination rate is going up, but remains far behind the national rate, Eggers reports: "In 2017, about 31.4 percent of Kentucky children aged 13 through 17 had the first dose of the HPV vaccine. In 2018, that number increased to 42 percent, according to the Kentucky Immunization Registry."

The national first-dose rate in 2018 was 66 percent, "and about half of all adolescents were up to date with the vaccine in 2017," Eggers reports. "Kentucky's HPV vaccination rate is estimated at 39 percent or less, and rural areas reported less vaccination coverage . . . The percentage of children who received two or more doses dropped significantly," but a spokeswoman for the Kentucky Cabinet for Health and Family Services told Eggers that could be due to under-reporting.

Texas Medical Association poster; for a larger version, click on it

There are three main reasons children don't get immunized for HPV, Dr. Rebecca Shadowen, an infectious disease specialist at The Medical Center at Bowling Green, told Eggers, who writes:

"First, there is no requirement to get the HPV vaccine. The Kentucky General Assembly has introduced legislation in the past to require HPV vaccination for students entering sixth grade, but never passed a measure, according to the National Conference of State Legislatures.

Second, 'There is a real problem with people who are anti-vaccine,' Shadowen said. 'They’re that way, unfortunately, with outdated information. Vaccines are not linked to autism; that is very well proven.'

"Third, children cannot give consent to protect themselves from the virus." Shadowen said many parents don't understand the risk of sexually transmitted diseases: "Parents feel their children will always be angels.”

Fred Wyand, communications director at the American Sexual Health Association, told Eggers that many parents don't understand why their 12-year-old, who is unlikely to be sexually active, needs the vaccine. "The earlier the vaccine is given, the more robust the immune response," Wyand said, adding that if children get vaccinated by age 12, the series can be completed in two doses instead of three.

"I think really the vaccine is a public health marvel," Wyand said. "The disappointing thing about it is we're not getting it to the people who need it the most." But he added that HPV affects most sexually active people at some point in their lives.

HPV "causes cancers in the cervix, vagina, vulva, penis, anus, rectum and the oropharynx – the back of the tongue and throat," Eggers notes. "More than 90 percent of both cervix and anus cancers and 70 percent of pharynx cancers are attributed to HPV. About 63 percent of penis cancers and 75 percent of vagina cancers are probably caused by HPV. . . . Among the cancers caused by HPV, more than 90 percent could be prevented with the vaccine."

More education is needed, Wyand said: "If you had a vaccine for HIV, chlamydia or syphilis, almost everyone has a cultural reference for that. But with HPV, they're like, 'What is that?'"

Dwain Harris of Southern Kentucky Area Health Education Center named first chief executive officer of National AHEC Organization

Dwain Harris

Dwain Harris, director of the Southern Kentucky Area Health Education Center in Mount Vernon for the past 14 years, has been named the first permanent chief executive officer of the National AHEC Organization (NAO). He will assume the position Jan. 21 and will be based at his home in Somerset.

AHECs train students in health-care professions, especially for rural and under-served communities. In Kentucky, the eight regional centers are a collaborative effort of the University of Louisville and the University of Kentucky.

The national organization lobbies on issues important to its members and the populations they serve. It says its mission "is to enhance access to quality health care, particularly primary and preventive care, by improving the supply and distribution of healthcare professionals via strategic partnerships with academic programs, communities, and professional organizations."

Harris said, "The NAO leadership has done such an incredible job of advancing the AHEC network in the last few years. I am honored to join this team, and I am eager to begin work strengthening our existing partnerships while creating new ones." Harris is a past president of the Kentucky Rural Health Association.

The NAO said "Harris has a track record of proactive and innovative program outcomes, particularly through finding and developing funds in service of the AHEC mission. Under his direction, the Southern Kentucky AHEC partners in the NAO National Training Center’s CDC partnership that has led in the HPV immunization program grant since 2015. He has led his team to develop new revenue streams with continuing professional development programming services. More recently, he has fostered advancements in private sector sponsorships to diversify resources and better support health careers pipeline work."

With Harris's appointment, the CEO job "has now been adjusted from a 0.5 to a 0.75 FTE," or full-time equivalency, the NAO said. "We look forward to expanding our NAO national relationships for future growth and opportunities, in which Dwain’s excellent insights, well-rounded experience and unique leadership style will serve to foster a dynamic continuum of developing our longstanding tradition of AHEC excellence in providing academic progression and advancing the strength of our healthcare workforce across the nation."

Sept. 18 webinar will explore why rural areas lag in getting children a vaccine that can prevent a major type of cancer

The Rural Health Information Hub will hold a webinar to discuss the Centers for Disease Control and Prevention's recent report showing that rural teens are less likely than their urban peers to know about the human papilloma virus or meningococcal conjugate vaccines or receive them. HPV is the known cause of several genital, anal, and throat cancers. Featured speakers will be:

• Tanja Walker, an epidemiologist at the CDC’s National Center for Immunization and Respiratory Diseases
• Electra D. Paskett, a cancer-research professor at Ohio State University
• Robin C. Vanderpool, an associate professor in the Department of Health, Behavior & Society in the University of Kentucky College of Public Health

The free webinar will take place at noon ET on Sept. 18. A recording will be available on the RHI website afterward. Click here for more information or to register.

Ky. has two new vaccine requirements this year for students, adding to existing requirements for kindergarten and 6th grade

Going back to school requires more than just making sure you have all the required school supplies; it also means making sure your child is up to date on their vaccines, especially since Kentucky has two new vaccine requirements.

Normally, vaccine records are only required for entry into kindergarten and sixth grade, but this year Kentucky schools will be checking every student to make sure they are up to date on the two new required vaccines: hepatitis A and a meningitis booster for students 16 and older.

"We encourage parents to contact their medical provider to review their child’s immunization status to help ensure a smooth back-to-school transition for the upcoming year," Public Health Commissioner Jeffrey D. Howard said in a news release.

The state now requires all school-aged children in kindergarten through 12th grade to show proof of having received two doses of the hepatitis A vaccine to attend school.

Because the two-dose hepatitis A vaccine is given six months apart, the state health department recognizes that some students may have only received one dose when school starts -- and that's OK, according to the news release.

The health department says if a student has not yet received the second dose of the hepatitis A vaccine for this school year, the student's immunization record will be considered "provisional" and will expire 14 days after the second dose is required.

In addition to the hepatitis A vaccine, students 16 and older are required to get a meningitis booster, called the meningococcal ACWY vaccine. This means that their immunization record must show proof of having received two doses of the vaccine.

However, it's important to note that if the first dose of the meningitis vaccine was received at age 16 or older, the second dose is not required for school entry.

The new requirements add to the list of vaccines required for students entering kindergarten and sixth grade.

Those entering kindergarten are required to have the combined TDAP vaccine for for diphtheria, tetanus and pertussis; a measles-mumps-ruebella vaccine; and vaccines for hepatitis B, polio and chicken pox.

Students entering sixth grade are required to have all of the immunizations that were required to enter kindergarten, as well as a TDAP booster, a meningitis vaccine, and a second chicken-pox vaccine.

The HPV vaccine, which protects against the human papillomavirus, is recommended for 11- and 12-year old boys and girls, but is not required. HPV infections cause more than 90 percent of anal and cervical cancers and around 70 percent of vaginal, vulvar, penile and middle throat cancers, and two of the HPV strains are associated with more than 90 percent of anal and genital warts.

Flu vaccine is also recommended for school-aged children every year as soon as it is available, but is not required. This vaccine is especially important for those with chronic conditions like asthma or diabetes.

Vaccines are generally covered as a no-cost preventive service by most health insurance plans. But if your child does not have health insurance, you should contact your local health department for assistance.

Any child with a medical condition who is unable to receive the vaccines will be issued a medical exemption certificate by their health-care provider.

And if a parent chooses not to immunize a child based on religious objections, the parent must complete a sworn and notarized religious exemption form that can be found online. All immunization forms can be found on the Kentucky Immunization Program and Kentucky Department of Education websites.

The federal Centers for Disease Control and Prevention reminds parents that it is never too late to catch up on their child's missed immunizations, and that primary care providers can help set up an adjusted immunization schedule.

Ky. teens still far below average in getting vaccine that prevents cervical cancer, a disease more common here than most states

By Melissa Patrick
Kentucky Health News

Fewer than half of Kentucky's teenagers are getting the human papillomavirus vaccine, which is known to prevent several cancers, including cervical cancer -- a disease for which Kentucky leads the nation.

A federal Centers for Disease Control and Prevention report, using data from the 2016 National Immunization Survey for teenagers, found that 48 percent of Kentucky's teens between 13 and 17 received one or more doses of the HPV vaccine, but only 34 percent completed the recommended series of doses. Both rates were lower than the national average.

Nationwide, the report found that 60.4 percent of teens received one or more doses of the vaccine in 2016, up from 56.1 percent in 2015; by the age of 17, 43.4 percent had received all recommended doses.

"For a state recognized for high rates of all HPV-related cancers, it's troubling to see HPV vaccination rates among our adolescents lag behind the rest of the country," Dr. Robin Vanderpool, an associate professor at the University of Kentucky College of Public Health, said in an e-mail to Kentucky Health News.

Vanderpool said requiring the vaccine for entry to school would boost the HPV vaccination rates in Kentucky, but she also recommended state and local approaches to improve parents' knowledge of HPV vaccination as cancer prevention -- as well as efforts to increase health-care provider recommendations of the vaccine, a major obstacle.

Experts at an immunization conference last year placed most of the blame for the poor rate of HPV vaccinations on physicians, citing studies that show a "clear, same-day recommendation" from a physician to a parent is the most important factor in whether a child gets vaccinated.

"Through population-level HPV vaccination coverage, a whole generation of Kentucky youth could be protected from ever developing cancer," Vanderpool said. "What a tremendous public health achievement Kentucky could be a part of!"

HPV causes more than 90 percent of anal and cervical cancers; 70 percent of vaginal, vulvar and middle-throat cancers; and more than 60 percent of penile cancers. And two of the HPV strains are associated with more than 90 percent of anal and genital warts.

The report says that every year, an estimated 31,500 newly diagnosed cancers in men and women are attributed to HPV, and approximately 90 percent could be prevented by the HPV vaccine, which protects against nine different strains. Kentucky ranks in the top 10 states for cervical cancer incidence, and the top 20 for deaths from it.

Another obstacle to vaccination is the need for more than one dose. New CDC guidelines recommend a two-dose series if given before the age of 15 and a three-dose series if given after 15. The vaccine is recommended between 11 and 12, but can be given to females up to 26 and males as old as 21.

HPV is most commonly transmitted through sexual intercourse, but it can also be transmitted through intimate skin-to-skin contact.

The report found that HPV vaccine is becoming more common among boys. Nationally, 65 percent of girls received the first dose of HPV vaccine in 2016, compared to 56 percent of boys, a 6 percent increase from 2015 for boys and about the same rate for girls. In Kentucky, 55 percent of girls received at least one dose of the HPV vaccine in 2016, compared to 42 percent of boys.

It also found that HPV vaccination rates were lower in rural areas (50.4 percent) compared to urban areas (65.9 percent).

The CDC news release says that since the introduction of the first HPV vaccine over 10 years ago, "infections with HPV types that cause most of these cancers and genital warts have decreased by 71 percent in teen girls and 61 percent in young women."

Louisville's Our Lady of Peace opens first retail pharmacist-operated, long-acting injection clinic; will mostly treat opioid abuse

                               Insider Louisville photo

Kentucky is again leading the nation in finding ways to combat the opioid epidemic, as Louisville's Our Lady of Peace has become the nation's first behavioral health care center to open a retail pharmacist-operated, long-acting injection clinic, Joe Sonka reports for Insider Louisville.

Pharmacists at the clinic will provide monthly shots of long-acting medications to help patients with opioid addiction and schizo-affective disorders, and the director told Sonka that they will soon be able to provide Vivitrol shots to patients who come in with a prescription for it.

Vivitrol is a compound used to thwart addictions to opioids such as heroin. It contains a non-addictive drug that blocks the opioid from attaching to brain receptors, thus blocking its euphoric effects. The long-acting shots remain in a patient's system for 30 days.

“We’re excited about our new clinic and we’re hoping that we can make a difference in people’s lives who are undergoing addiction,” Steve Cummings, director of the new clinic, told Sonka. “And hopefully that 30 days of sobriety that the Vivitrol shot allows the patient to have will allow them to show up for behavioral health care outpatient therapy sessions sober and alert and more engaged with what they’re trying to do or not do.”

Pharmacists at the clinic will also be able to administer up to six different long-acting anti-psychotic medications for patients with schizo-affective disorders, Sonka reports.

Cummings told Sonka that the monthly shots have greater success in patients with schizo-affective disorders because these patients often stop taking their daily oral medication when their hallucinations subside, which can lead to relapse and hospitalization.

The clinic will also provide immunizations for HPV, tetanus, hepatitis B and other diseases.

Cummings estimated that pharmacists at the new clinic will be able to administer 20 to 25 shots in an eight-hour shift, and that most patients will be receiving Vivitrol.

The clinic will also hire a medication access coordinator, who will help patients and prescribers navigate the "challenges of insurance coverage and reimbursement when it comes to medication-assisted treatment," Sonka writes.

Sonka explained that one shot of Vivitrol can cost more than $1,000, and though it is covered by Medicaid and certain private insurance companies, obstacles such as prior authorization and frequent denial of claims, often keep patients from getting it.

The coordinator will also help patients schedule accompanying therapy or counseling, make sure they schedule their next injection appointment and will provide follow-up services to make sure they don't miss appointments.

Our Lady of Peace is part of the KentuckyOne Health system.