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."

Ky. leads nation in cancers that are caused by a virus for which there is a vaccination, but most kids don't get the vaccinations

By Melissa Patrick
Kentucky Health News

Kentucky has the highest overall rate of cancers associated with the human papillomavirus, and among females is tied for highest with West Virginia, while at the same time falling in the bottom 10 states for vaccinations that can keep the virus from causing cancers, according to a federal Centers for Disease Control and Prevention report.

"Kentucky faces many challenges when it comes to encouraging parents, adolescents and providers to understand the importance of the HPV vaccine," Dr. Ardis Hoven, infectious-disease specialist for the  state Department for Public Health, said in an e-mail to Kentucky Health News.

Speakers at a recent HPV conference in Lexington placed most of the blame for the poor uptick of HPV vaccinations on physicians, because many of them still don't strongly recommend it. They cited a study showing that a "clear, same-day recommendation" from a physician to a parent is the most important factor in whether children get vaccinated.

The speakers offered several reasons for the lack of such recommendations: The vaccination isn't required by law, many physicians don't realize its importance, some falsely believe that it takes too much time to explain, and the vaccine treats diseases that pediatricians don't deal with. They also noted that the vaccine's greatest obstacle is that it is associated with a sexually transmitted disease.

“In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer,” Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center in Columbus, told HealthDay News. “Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe,”

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

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for 11- and 12-year-old boys and girls, though it can be given through age 26 for females and age 21 for males. It is recommended at an early age because adolescents have the best immune response to the vaccine, are more likely to keep coming in for annual visits and most are not yet sexually active and therefore not likely to have been exposed to the virus.

HPV infections cause more than 90 percent of anal and cervical cancers and 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.

The CDC report found that there were almost 39,000 annual cases of HPV-related cancers in the country between 2008-12, a 16 percent increase from the previous five year period. Most of these cases were oral cancers in men and cervical cancers in women, 12.638 and 11,771 respectively.

The data showed that almost 80 percent of the cancers were caused by two strains of the virus that are covered by all of the commercially available vaccines and 10 percent were caused by five other HPV strains that are covered by the newer nine-valent vaccine.

In Kentucky, only 37.5 percent of its girls and 13.2 percent of its boys aged 13 to 17 were vaccinated as of 2014. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized, and vaccination coverage did not increase substantially from 2011 to 2014.

Hoven said that Kentucky is working to improve its HPV vaccination rates. She noted such efforts as its HPV initiative team, which has created a comprehensive statewide plan to prevent and control HPV infections; a statewide media campaign last summer to encourage parents to get their children vaccinated; ongoing outreach to universities and colleges about the need to immunize students; and a current survey of knowledge among teens and adults about the importance of HPV vaccinations.

The state health department "has taken up the challenge of improving vaccination rates in the state, and will continue this effort going forward," Hoven said.

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?'"

There's a vaccine for young people that prevents cancer, but most of them don't get it because most doctors fail to recommend it

By Melissa Patrick
Kentucky Health News

The human papilloma virus vaccination is proven to prevent cervical cancer and genital warts, but many pediatricians and family doctors still don't strongly recommend it, and they need to do better.

That was the main message at an HPV conference in Lexington June 21, where more than 100 people, mostly health-care providers, came to learn about the cancer-causing virus and the under-utilized vaccine that prevents it.

Dr. Alix Casler, medical director of pediatrics at Orlando Health Physician Associates in Florida, stressed the importance of teaching everyone in a health-care organization about why HPV vaccinations are so important.

"Every year that we fail to reach our goal, there are thousands of children who are going to go on to develop cancer," Casler said. "It is one of the most lifesaving things we do," but because it isn't mandatory and the diseases that it causes aren't ones pediatricians deal with, it often falls to the bottom of providers' priorities, she said.

Studies show that a "clear recommendation" from a physician is the most important factor in whether children get the HPV vaccine. Casler noted that a 2013 survey found that 80 percent of mothers who received a same-day recommendation had their son or daughter vaccinated that day.

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for 11- and 12-year-old boys and girls.

Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.2 percent of its boys aged 13 to 17 vaccinated as of 2014. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized, and vaccination coverage did not increase substantially from 2011 to 2014.

HPV is spreading. About 79 million people in the United States are infected with it, and about 14 million more become infected each year. It is estimated that half of these new infections occur in people 15 to 24 years old.

Though most HPV infections will clear up on their own, the most persistent strains of the virus are directly linked to 27,000 new cancers a year. About 30 women per day in the U.S. are diagnosed with cervical cancer caused by HPV, and every year, there are about 324,000 new cases of genital warts caused by the virus.

Lois Ramondetta, a gynecologic oncologist at MD Anderson Cancer Center in Houston, who is on a mission to educate health-care providers about the vaccine, told clinicians in southern Texas, “If you are not recommending the vaccine, you are not doing your job. It’s the equivalent of having patients in their 50s and not recommending a colonoscopy — and then having them come back with cancer.” So reports Laurie McGinley for The Washington Post.

HPV infections cause more than 90 percent of anal and cervical cancers and 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.

HPV is most commonly transmitted through sexual intercourse, but it can also be transmitted through any skin-to-skin contact, including genital contact of any kind or simply kissing.

Doctors and parents alike have struggled with the idea of giving young children a vaccine for a sexually transmitted disease. And some parents hesitate because they say the vaccine encourages sexual promiscuity, though research says otherwise.

Caslir said that just like putting on a seat belt to protect yourself before you turn on the engine, the most effective time to vaccinate for the cancer causing HPV virus is prior to exposure. In addition, it is important to vaccinate pre-teens early because they have the best immune response to the vaccine and are more likely to keep coming in for annual visits.

Dr. Daron G. Ferris, a speaker at the conference who works at the Georgia Cancer Center in Augusta, said that a mother of a 21-year-old woman with cervical cancer caused by HPV asked him, "So you mean if my daughter had received the Gardasil shots, she probably would not be having this surgery today?" and that he told her, "Yes. She would not have been there if she had been vaccinated."

Kirk Forbes, whose daughter Kristen died at the age of 23 from cervical cancer caused by a high risk strain of HPV, told the story of his daughter's battle. He and his wife have founded the Kristen Forbes EVE Foundation, whose mission is to eradicate cervical cancer and significantly reduce HPV infection rates. One of the foundation's efforts is a nationally acclaimed documentary that profiles five women, including Kristen, called "Someone You Love: The HPV Epidemic."

"We have the means to stop 90 percent of cervical cancers and who know how many versions of oral cancer, anal cancer, penile cancer... and could literally wipe out genital warts," Forbes said."We've got all the tools we need, now we've got to go out and get the job done."

Kentucky is in the bottom 10 states for cancer-preventing HPV vaccination, probably because it has to do with sex

The human papillomavirus vaccination is nearly 100 percent effective in preventing precancers and noninvasive cervical cancers caused by two strains of the virus, but most parents in Kentucky and the nation are still not getting their adolescents vaccinated.

HPV is a group of more than 150 related viruses, which together are the most common sexually transmitted infections in the U.S.

An estimated 79 million Americans are infected with HPV and about 14 million more become infected each year, according to the federal Centers for Disease Control and Prevention. And while most HPV strains cause no symptoms and go away on their own, 10 percent of HPV infections lead to cancers of the cervix, vagina, vulva, penis, anus and throat.

The HPV vaccination was approved by the federal government 10 years ago and is recommended for all adolescent girls and boys 11 and 12 years old. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized.

Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.3 percent of boys aged 13 to 17 vaccinated as of 2014.

The vaccine can be given to females as old as 26 and males as old as 21, but early vaccination is important. The vaccine is less effective if a person has already been exposed to the virus, because it works to prevent HPV before exposure, and not to treat existing HPV infections or associated diseases. Vaccinating adolescents better protects them before they are likely to become sexually active and exposed to the virus.

And therein lies the key reason health experts say most parents don't get their children vaccinated and health providers are hesitant to push this potentially life-saving vaccine: It has to do with sex, Michael Ollove reports for Stateline.

But guess what? Almost 42 percent of Kentucky's high-school students say they have had sexual intercourse, and almost one-third of them say they are currently sexually active, according to the 2015 Kentucky Youth Risk Behavior Survey. And, almost 10 percent of the state's middle-school students say they have had sex.

Opponents of the vaccine being given to adolescents argue that it encourages them to engage in sex because it removes the fear of contracting HPV, but at least one study shows no increase in sexual activity in girls who have been immunized, Ollove reports.

Health officials often lament that the vaccine wasn't originally sold to the public as an anti-cancer vaccine rather than one to prevent a sexually transmitted disease, Ollove reports.

“It should have been pushed out as an anti-cancer drug,”Walt Orenstein, a professor of medicine at Emory University and the former director of the National Immunization Program at the CDC, told Ollove. “People didn’t understand why their children needed this drug when they were still years away from being sexually active.”

Ollove notes other reasons for low vaccination rates: Health-care providers often don't stress the importance of the vaccine; many don't promote the vaccine because they aren't comfortable talking about sex with their young patients or their parents; and many providers feel the vaccine is not urgent because most adolescents in middle school are not sexually active. Another barrier is that the the HPV vaccine requires three inoculations over several months; the CDC shows a dramatic drop-off between the first and last doses.

Citing Noel Brewer, who does research on immunizations at the University of North Carolina and has studied parental and provider attitudes toward HPV, Ollove writes, "Contrary to what doctors may believe, parents are interested in the vaccine and a strong recommendation from a physician correlates highly with youngsters getting the full course of vaccinations."

Ollove notes that mandatory HPV immunizations have not proven to be successful. “Mandates are a last resort after you’ve built consensus that they are a good thing to do,” Orenstein told him.

Health policy researchers say that "reminder and recall" notices are the best way to keep patients up to date on vaccinations, and yet this is not a common practice, Ollove reports.

Insurance will cover the cost of the HPV vaccine and the Vaccines for Children Program will cover the vaccine at no cost for children who don't have insurance and are younger than 19. Call 800-232-4636 for more details.

The Kentucky Rural Health Association in collaboration with the Kentucky Immunization Program and the state Division of Women's Health will be hosting Kentucky's HPV Summit, "HPV: You ARE the Key!," at the Embassy Suites in Lexington June 21. The cost is $40 until June 1 and $55 afterward. Click here to register.

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.

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.”

Feds fund Ky. campaign to promote shots for human papilloma virus, the most common sexually transmitted disease

By Melissa Patrick
Kentucky Health News

Lt. Gov. Crit Luallen joined public health officials in Frankfort July 13 to launch Kentucky's new "Stop HPV Campaign," to encourage parents to get their children vaccinated against the human papillomavirus, which is known to cause cervical, oral and anal cancer.

"Experts tell us that this vaccine, which is safe and highly effective against the most common cancer-causing strains of the virus, should be a routine part of adolescent health," Luallen said. State laws and regulations to not require the immunization, which is recommended for 11-and 12-year-old boys and girls, but Luallen said, "It is the smart thing to do. It is cancer prevention."

The campaign will feature television, print and online advertisements throughout the state that will promote the benefits of the HPV vaccine. It is funded by a $500,000 grant from the federal Centers for Disease Control and Prevention.

An estimated 79 million Americans are infected with HPV and about 14 million people become newly infected each year, according to the CDC. It is the most common sexually transmitted disease in the U.S.

"According to the 2010 census data, there are about 26 million girls under the age of 13 in the U.S.," Luallen said. "If none of them receive the HPV vaccine, over 168,000 will develop cervical cancer and more than 54,000 of them will die."

Luallen is chair of the Kyhealthnow initiative, which includes as part of its strategy to reduce cancer deaths by 10 percent and increase rates of HPV vaccination by 25 percent.

Health Commissioner Stephanie Mayfield said that she hopes the campaign will contribute to the eradication of the cancer causing HPV virus, as the polio and smallpox vaccines have done.

Mayfield not only called on health-care providers to talk to their patients about the health benefits of this vaccine, she said parents should ask their providers about it if they don't bring it up.

"By getting your child vaccinated with the HPV vaccine, you are preventing the spread of a virus and protecting your child from developing one of the HPV-related cancers," she said.

Kentucky has a high vaccination rate for school-required vaccinations, but only 27 percent of Kentucky's girls complete the full three dose HPV series and only 19 percent of its boys complete the series. The national average is 38 percent.

"The health of our citizens suffers from this type of inaction," Mayfield said. "We want all kids who are 11 or 12 years old to get the three dose series of HPV vaccine."

Insurance will cover the cost of the HPV vaccine and the Vaccine for Children Program will cover the vaccine at no cost for children who don't have insurance and are younger than 19. Call 800-232-4636 for more details.

Mayfield noted that there has been a 56 percent reduction in HPV infections in teen girls in the U.S. since 2006 because of this vaccine, and called on Kentuckians to get their children vaccinated.

"Each year about 17,500 women and 9,300 men are infected by HPV related cancers," Mayfield said. "Let's stop this and eradicate these infections."

Appalachian women are more likely to get cervical cancer and die from it, but pass up vaccine partly because of fatalistic beliefs

By Melissa Patrick
Kentucky Health News

A fatalistic belief that getting or preventing cancer is beyond a person's control is one of many reasons young women in Appalachian Kentucky are likely to not get or complete the series of HPV vaccinations to prevent cervical cancer, according to a study by researchers at the University of Kentucky, published in The Journal of Rural Health.

"Our study found that fatalistic beliefs influenced immunization behaviors, which is concerning, given the high success rates of preventing HPV infection and cervical cancer through HPV vaccination and the elevated burden of cervical cancer in Appalachian Kentucky,” Robin Vanderpool, lead author of the study, said in an email.

The human papillomavirus, or HPV, is the most common sexually transmitted infection in the U.S., affecting an estimated 79 million individuals. Two types of HPV cause two-thirds of all cervical cancers, and unlike any other cancer, there is a three-dose HPV vaccine that can prevent it, according to the federal Centers for Disease Control and Prevention.

The UK researchers found that the women in the study who believed they had limited control over their health generally and limited control over cervical cancer specifically were significantly less likely to complete the HPV vaccine series than those who did not have this belief.

"This is an important finding because rural Appalachian residents often perceive cancer as pervasive, inevitable and mostly hereditary," the authors wrote.

The 344 rural Appalachian women who volunteered for the study were given the first dose of vaccine free of charge, and surveyed about their beliefs regarding cancer. They were followed for nine months after the first dose to determine completion rates.

Other studies had determined that many Appalachian women don't get or complete the HPV vaccine because of cost, lack of transportation, cultural views, lack of knowledge about cervical-cancer prevention and limited support from parents, peers and health-care providers. A belief in fatalism can now be added to this list.

Health advocates are working to get through these barriers because Appalachian Kentucky has the state's highest rates for cervical cancer and deaths from it, according to the Kentucky Cancer Registry. This, in a state that is among the top 14 for the most cases of HPV-related cervical cancers in the nation, according to the CDC.

Kentucky has a low HPV vaccination rate, with only one in four adolescent women initiating the vaccine and less than one in nine receiving the full series, according to The Kentucky Cancer Consortium. These rates are even lower in Appalachia, says the study.

The CDC recommends routine HPV vaccination for females ages 11-12 and catch-up vaccination for females ages 13-26. 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. Males are also encouraged to get the vaccine.

The study acknowledged that future such studies should compare women who have received the first dose of the vaccine, as in this study, against women who had not. It also suggests that these findings indicate a need for future research in how to educate and intervene with Appalachian women in a way that is culturally sensitive to improve HPV vaccination rates and to impact cancer disparities that affect the women in the region.

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."

Avoid virus-linked cancers, including cervical cancer, with shots

With a simple vaccine, you can avoid HPV-linked cancer, including cervical cancer and many cancers of the mouth, throat, anus and genitals, which constitute more than 3 percent of all U.S. cancer diagnoses. Vaccination against the human papilloma virus (HPV) thwarts the virus’s spread, wrecks its ability to jump between people and inhibits a virus that in 2009 led to a cancer diagnosis for 30,000 people in the U.S., according to the National Cancer Insititue. 

HPV infection is common. More than half of women between 14 and 59 catch a genital HPV. Many of these infections are low-risk, but when the body does not sweep out HPV intruders, high-risk HPV infected cells may lead to the unchecked growth of cancerous cells, according to Newswise, a research-reporting service.

HPV is actually a family of more than 150 viruses that infect human skin and mucosa, the moist membranes lining the nostrils, mouth and genital cavities. Two vaccines, Gardasil and Cervarix, prevent people from getting HPV infections by helping the body stockpile a medley of cellular defenses. Gardasil and Cervarix target HPV types 16 and 18, the two responsible for most cervical, anal, genital, and oropharynx cancer.  Blocking infection by types 16 and 18 also fights off other cancers, and the vaccines’ protection could last a lifetime. Gardasil also targets types 6 and 11.

It is important to complete the three-dose series for the vaccines; series completion rates are low for people in the Southern states, especially those that are poor and without private insurance, according to Newswise. Scientists are working to make a single vaccine that blocks infection by all HPV types, but today’s vaccines can prevent infection by two of the most common high-risk HPVs and may be the first step toward preventing HPV-linked cancers. (Read more)

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.

Eastern Kentucky reluctant to accept HPV vaccination that helps prevent cervical, mouth and throat cancers

By Molly Burchett
Kentucky Health News

New research indicates that HPV, the sexually transmitted human papilloma virus, is now the leading cause of mouth and throat cancers in the United States, ranking above both alcohol use and smoking. This problem has a solution, since some cancers caused by HPV can be easily prevented by vaccination, but many Kentucky women are stiff-arming the solution as researchers found they "literally could not give the vaccine away to young women" in Eastern Kentucky.

In Kentucky, vaccination rates remain low, particularly in the east, where the percentage of women who die from cervical cancer is significantly greater than in the rest of state or the nation, notes Tom Collins in a recent Lexington Herald-Leader article. Collins is the associate director of the University of Kentucky's Rural Cancer Prevention Center, which initiated a project to explore the acceptance of the HPV vaccine.

Read more here: http://www.kentucky.com/2013/06/30/2698240/rural-kentucky-slow-to-embrace.html#storylink=cpy

Since 2000, scientists have known that certain strains of HPV are responsible for nearly all cervical cancer in women, and newer studies link HPV to head and neck cancer for many men too. This year, about 14,000 people in the United States will be diagnosed with oropharyngeal cancer, most of them will be young, between 40 and 50 years old and 75 percent will be male, says a Newswise article. A decade ago, patients with head and neck cancer were smokers or drinkers, but now 80 percent of the cancers are caused by HPV.

About half of all Americans will become infected with HPV at least once their lifetime and it's difficult to recognize the symptoms of the virus, making vaccination even more important. The federal Centers for Disease Control and Prevention now recommends that boys and girls both be vaccinated against HPV between the ages of 11 and 12 and up to the age of 26, says Collins.

Collins writes that Eastern Kentucky is slow to accept the vaccine, even when promoted at community events such as hog roasts. Despite the initial reluctance, "Researchers at the center hope that if a community is engaged in the process and allowed to direct the delivery of the necessary change, outcomes can be achieved that will lead to a healthier population," he Collins.

And, there's still hope. The national prevalence of infection in young women has declined by more than half since the introduction of the HPV vaccine, despite low vaccine usage, says recent findings by the CDC. This decline occurred even though only a third of eligible patients received the vaccine, so imagine the benefits afforded to Kentuckians with efforts to improve vaccination acceptance and usage.

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.

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.

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.

HPV-linked cancers on rise, more prevalent in Kentucky

The human papillomavirus, which is generally blamed for causing cervical cancer, is being linked to the formation of several other kinds of cancer, and Kentuckians are getting these diseases in unusually high numbers, reports Laura Ungar of The Courier-Journal.

HPV is being linked to cancers of the vagina, vulva, penis, anus and lung, as well as the head and neck. "It's turning out to be a pretty bad actor ... an extensive health problem," said Dr. Daniel Metzinger, a gynecological oncologist with University of Louisville Physicians.

Kentucky's rates for HPV-related cancer are among the highest in the country. Part of the reason may be that smoking is a risk factor and Kentucky has the nation's highest smoking rate, Ungar reports. "I'm seeing more of it for sure," said Metzinger. "It used to be a disease we'd see in older people. Now, we see it in younger and younger people."

One way to protect against the virus is to be immunized with the HPV vaccine. A federal committee recommends vaccinating 11- and 12-year-old girls through to women up to age 26. Boys and men should also be immunized from age 11 to age 21. The immunization must occur before the patient is sexually active, since HPV is sexually transmitted.

In 2010, just 49 percent of adolescent girls nationwide received at least the first of the vaccine's three doses, and only a third had gotten all three, which are required for full effectiveness. In Kentucky that year, only 25 percent of adolescent females had gotten the first dose, and fewer than 11 percent have received all three doses, according to Cervical Cancer-Free Kentucky.

National Cancer Institute numbers show more than half of sexually active people are infected with HPV at some point. Usually, it goes away on its own within a few years. "But it can also set the stage for cancer," Ungar reports. "Across the nation, about 26,000 new cancers attributed to HPV occur each year, with 18,000 in women and 8,000 in men." (Read more)

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.

UK center promotes at-home test for colorectal cancer, reports on efforts to get young women vaccinated for cervical cancer

More people in Appalachian Kentucky die from colorectal cancer than in any other region of the state. A screening project of the Rural Cancer Prevention Center at the University of Kentucky is working to decrease those rates.

Cancer Registry maps show in color Kentucky counties served by the Appalachian Regional Commission,
and rates for invasive cancer and cancer mortality in Appalachian Kentucky and the balance of the state.

In July 2014, the center received a $3.75 million, five-year grant renewal from the federal Centers for Disease Control and Prevention for a colorectal cancer at-home screening prevention project in Central Appalachia and other rural areas. The UK Center is one of 26 CDC-funded Prevention Research Centers in the country.

Tom Collins, associate director of the RCPC, gave an update on its project at a Center for Clinical and Translational Science clinical research update meeting at UK Oct.18. Robin Vanderpool, associate professor in the College of Public Health, discussed the results and successes of its completed cervical-cancer screening project.

Early screening and prevention are key to surviving colorectal cancer. The CDC says that most deaths caused by colorectal cancer could be prevented if everyone over the age of 50 got screened. And if detected early, treatment for colorectal cancer is highly effective.

In 2013, the last year for which data is available, Kentucky ranked first in colon cancer and fourth in colon-cancer deaths, according to the Colon Cancer Prevention Project.

The project's title and motto is "I did FIT." FIT stands for fecal immunochemical test, an at-home test that allows a person to collect a small stool sample in the privacy of their home and mail it in a provided kit to the lab for testing. The FIT test must be done every year.

Since June 2015, the UK center has distributed more than 700 kits, with a 60 percent return rate in the eight-county Kentucky River Health District. Those with a positive test result, about one in six, have been offered a colonoscopy with follow-up; the rest have been invited to be part of the research, which is ongoing.

To help determine the best way to get people to do a yearly test, researchers divided the volunteer participants into two groups: one that gets social media and personal messages about it along with the traditional standard of care and another that gets standard of care alone. A year and a half remains in this portion of the research.

Cervical cancer and the HPV vaccine

Collins said they are trying to build on the success of the UK Center's previous prevention program for cervical cancer prevention and screening, called "1-2-3 Pap."

Prevention Research Center graphic; click on it to view a larger version

This UK center study promoted the human papillomavirus vaccination to prevent cervical cancer in Appalachia, which also has a higher incidence and mortality rate for cervical cancer than the rest of the state.

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for all adolescent girls and boys 11 and 12 years old. It is approved for females between 9 and 26 and is nearly 100 percent effective in preventing pre-cancers and noninvasive cervical cancers caused by two strains of the virus.

Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.3 percent of boys aged 13-17 vaccinated as of 2014.

An earlier study of adult Appalachian women aged 18-26 that were offered the first HPV vaccination free found that 45.1 percent got the first dose, 13.8 percent got the second dose and only 4.5 percent got all three doses. This and other formative research prompted the UK Center to start a two-stage HPV vaccine promotion program for women aged 19-26 in the Kentucky River Health District.

First, researchers launched a marketing campaign to recruit the women in for the first dose. Then, participants were asked to participate in the study, which was designed to promote adherence to doses two and three. The volunteer participants were randomly separated into two groups; one participated in an informational video-based intervention that was made using local people along with the traditional standard of care; the other was offered standard of care alone.

The study found that 43.3 percent of the young women who watched the DVD completed the three-dose HPV vaccine series, while 31.9 percent of the women in the comparison group completed the series.

Vanderpool said the "take-home message" was that women were two and one-half times more likely to complete the series if they watched the DVD.

Since the completion of the study, 18 Kentucky health departments now use the DVD to promote completion of the three-dose HPV series, and it has also been adapted for use in North Carolina and West Virginia.