Guest Post: Preventing HPV and Treating Science Illiteracy

Yesterday, Katie Couric’s daytime talk show weighed in on HPV vaccines. It seems the lack of representation of the benefits of the HPV vaccine was disappointing as many others have pointed out. Read this from Phil Plait for a good breakdown of the segment and corresponding issues. This from Alexandra Sifferlin on the dangers of vaccine misinformation a la Jenny McCarthy. This from Matthew Herper on “Four Ways Katie Couric Stacked the Deck Against Gardasil.” And this from Seth Mookin, really illustrating how disheartening this choice was given literate showrunners.

I have not seen the segment myself but I think more information about HPV, the vaccine and what it can lead to is in order. I’m pleased to introduce Megan Tetlow’s informative guest post on HPV. Megan Tetlow is a Physician Assistant in the subspecialty of gynecologic oncology, providing healthcare to women with cervix, vulvar, vaginal, uterine, and ovarian carcinoma. She is a graduate of the University of North Carolina at Chapel Hill and Nova Southeastern University in Florida.

HPV[Photo credit: http://bit.ly/1d1U1jf]

What is HPV?

HPV (human papilloma virus) is an extremely common virus that is transmitted by sexual contact. In fact, it is the MOST common sexually transmitted infection (1). It has been estimated that 50+% of sexually active adults have had the infection (2), with general medical opinion estimating that today it is probably higher. Rates of infection are highest among young women less than 25 years old (3).

Beyond that, according to the CDC, almost all sexually active adult men and women will be infected with this virus at some point in their lives, even if they’ve had only one sexual partner (1). Additionally, while condoms do prevent other sexually transmitted diseases, they may not prevent transmission of HPV (3).

The lack of knowledge about exactly how widespread this virus is may be one of the barriers to its prevention. Last year I watched an episode of Girls, and the main character’s biggest “baggage” was that she had HPV, when in reality every person on the show probably has HPV and most of the show’s viewers as well. The bottom line is that if you are an adult who is or has been sexually active, it is likely you have or have had HPV, and are potentially at risk for the diseases associated with this virus.

There are over 100 subtypes of the HPV virus. While most of these infections will be cleared by our immune systems, scientists have identified certain sub-types of the virus (specifically subtypes 16 and 18) that are oncogenic, meaning they can give rise to cancer. Oncogenic HPV subtypes are responsible for over 99% of cervix cancers (3). These virus subtypes (16 and 18) have also been found to cause cancers of the mouth, tongue, throat, anus, penis, vulva, and vagina (4). The CDC estimates that vaccination could prevent 22,000 cases of cancer in the US each year (5).

What is the HPV vaccine?

There are two HPV vaccines currently on the market. One is a bivalent HPV vaccine (Cervarix) that works against the oncogenic HPV subtypes 16 and 18.  The other is a quadravalent vaccine (Gardasil) which protects against those two subtypes, as well as sub-types 6 and 11 that are associated with anogenital warts.

Both vaccines are given in a 3 shot series over a 6 month period. Both HPV vaccines are approved and recommended for females ages 9-26. Gardasil has also been approved and is recommended for males ages 9-26. Since HPV is sexually transmitted, the goal age for males and females to be vaccinated is at around 11, with the hopes of being able to administer all 3 vaccinations before an individual becomes sexually active.

Is the HPV vaccine safe and effective?

Both vaccines are licensed, have undergone stringent testing, and have been approved by the Food and Drug Administration for the groups listed above. The CDC and FDA have several systems to continue to monitor safety of a vaccine, including the Vaccine Adverse Event Reporting System (VAERS). VAERS uses patient reporting to track and detect possible new or unexpected adverse reactions to a vaccine (7). Of adverse events reported from 2006 to 2013 through this system, only 7.9% were classified as serious in nature; among these, headache, nausea/vomiting, fatigue, dizziness, syncope (fainting), and weakness were the most frequently reported (8).

While decades of follow-up are certainly required to determine rates of cancer prevention following vaccination, short-term follow-up results have been very promising. The National Health and Nutrition Examination Survey published this year demonstrated a 50% decrease in HPV infections caused by subtypes 6, 11, 16, and 18 in females between the ages of 14 and 19 (9). Countries like Australia that have incorporated the HPV vaccine into the national vaccination program have noticed a significant decrease in genital warts infection among young men and women (10).

What are the barriers to vaccination?

Despite encouraging results, the majority of young men and women are still not being vaccinated.  Based on results of the 2012 National Immunization Survey-Teen, who have been collecting vaccination information on teens with the CDC since 2006, found that only 33.4% of appropriately aged adolescent females had received all 3 doses of the vaccine (8).

Additionally, over 23% of parents surveyed stated they did not plan to vaccinate their child (8). Why are adolescents not getting vaccinated against high risk HPV? In the same study, the most commonly listed reasons against vaccinating were parents felt the vaccine was not needed or not recommended, safety concerns, lack of knowledge about the vaccine and/or diseases it prevents, and that their daughter is not sexually active (8).

As a health care provider, I hear apprehension from parents that vaccinating their child will somehow cause them to be sexually promiscuous or that they are condoning sexual intercourse among adolescents, which is certainly not the case. If an adolescent ever has intercourse over the course of his or her lifetime with just one partner, then he or she is at risk for HPV and HPV-related diseases including cancer.

Overall, these results illustrate how dire education is needed—for patients, parents, friends, and the public. If you are a twenty-something male or female, consider vaccination. If you are a parent who would like to reduce the risk of your child getting cancer but have reservations, tell your healthcare provider and get more information. Only through increased education and awareness can we hope to prevent HPV-related cancers and one day cure science illiteracy.

References

  1. Centers for Disease Control and Prevention. Genital HPV Infection—CDC Fact Sheet. Centers for Disease Control and Prevention. 2010.
  2. Myers ER, McCrory DC, Nanda K, et al. Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol 2000;151:1158–71.
  3. Kevin A. Ault. Epidemiology and Natural History of Human Papillomavirus Infections in the Female Genital Tract. Infect Dis Obstet Gynecol. 2006; 2006: 40470.
  4. Cogliano V, Baan R, Straif K, et al. Carcinogenicity of human papillomaviruses.
    Lancet Oncol 2005;6:204.
  5. Centers for Disease Control and Prevention. HPV Vaccination- CDC fact sheet. Centers for Disease Control and Prevention. 2013.
  6. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guide- Human Papilloma Virus. Centers for Disease Control and Prevention. 2010.
  7. Centers for Disease Control and Prevention. Vaccine safety: HPV Vaccination. Centers for Disease Control and Prevention. 2013.
  8. Centers for Disease Control and Prevention. Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007–2012, and Postlicensure Vaccine Safety Monitoring, 2006–2013 United States. Centers for Disease Control Morbidity and Mortality Weekly Report. 2013.
  9. Markowitz LE, Hariri S, Lin C, et al. Reduction in HPV prevalence among young women following vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003–2010. J Infect Dis 2013;208:385–93.
  10. Ali H, Donovan B, Wand H, et al. Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data. BMJ 2013;346:f2032.
Advertisements

Guest Post: How a two hour commute changed my research (for the better)

This guest post is written by Amanda Keener, a graduate student at UNC-Chapel Hill in Microbiology and Immunology interested in science writing. You can check out more pieces from Amanda at http://amandabkeener.wordpress.com/. Here she offers excellent advice on maximizing productivity and minimizing stress in grad school. The floor is yours Amanda!  

I’ll never forget the time I responded to my lab mate’s complaints about his twenty minute commute to campus by asking “well, why do live so far away?”  To me, there was no reason to live more than a few miles away from lab. I expected to work long hours and had no desire to have to do more than hop on a free town bus or a bicycle at the end of the day.  I found a happy little rental in a walkable, well-bused part of town and stayed there for over three years.  In that time, I met a guy, he moved to a thousand miles away, we stayed together, we got engaged,  he moved back to my state and we decided to get married.  His new job was two hours away from my happy little rental, so we’d both have to make sacrifices if we wanted to live together. This is how I ended up commuting fifty miles to lab each way—a situation I mourned and resented at first.  I now recognize the positive impacts it’s has had on my research, and see lessons in it that other students may also find useful.

Image

Partitioning real life from lab

I’m quite effective at keeping my private life out of work, but I sure have trouble keeping work out of my private life.  My research could be on my mind at any time of day, any day of the week—especially when something in lab isn’t going right.  It was hard not to feel guilty about not being in lab when I lived only two miles away.

Being fifty miles away is actually kind of freeing.  I’m not tempted to beat myself up over not going to lab on the weekend.  I’ve had to discern what’s urgent and what’s not. On weekdays, the drive home is a fantastic “de-fusing” period that allows me reset before I walk in the door. I have a completely separate, satisfying life at home, and I’m allowed to enjoy it even if I’m in the midst of troubleshooting frustrations at lab.

Intentional scheduling

Once I moved I knew I had to shape up my schedule. Commuting costs me two hours a day and I can no longer run home for dinner during an incubation or set up an experiment that would require a 5 minute step on a Saturday or Sunday. My time is now starkly partitioned. I plan my experiments weeks in advance and only schedule certain types of assays on certain days of the week.  This means I have built-in time for planning experiments and writing up results.  It also means that on long experiment days I can immediately start working without spending an hour in the morning drinking coffee and writing protocols.  This works especially well for long term animal studies because it lets me give my PI (and myself) realistic expectations for my progress.  I am more flexible with shorter day-to-day experiments, but set weekly deadlines so I don’t put anything off for too long.

Fine-tuning my research

My first couple of years in lab were defined by a pattern of constant, often thoughtless “doing.” I felt that as long as I was active, I must be making progress. But a pile of uninterpretable data isn’t exactly progress. I realized if I was going to justify my new commuting lifestyle, I needed to be more critical about which experiments absolutely had to be done to answer a specific question. I stopped doing experiments just because they were suggested by my advisor or a collaborator in passing.  I decided I would only set up experiments that I felt truly fit into my research plan.

Of course this hinged on actually having a research plan, so I had to commit to one that I could point to when my PI brought up rabbit trail experiments to do. This doesn’t mean she can’t convince me that an experiment fits, but it forces her to take a comprehensive view of my project, even if just for an hour before she gives me a list of things to do and goes off to think about someone else’s project, a grant, invoices, etc. (I’m not against exploratory or risky research. I just don’t think it’s advisable for a graduate student late in her career.)

Respect for my time

Before moving, I thought nothing of a quick trip to lab over the weekend. This strategy often backfired, though, because I was more likely to put off tasks during week and dissipate my focus and productivity in lab. Moving has forced me to be more efficient while I’m in lab, and to reserve weekends for reading and writing. If there are enough tasks to fill up several hours on a Saturday, I consider the drive worthwhile, but taking control of my calendar helps me avoid that. What it really comes down to is having respect for my time.

Respecting my time helped relieve that guilty feeling that used to come when I left lab at 3pm, even if I intended to spend the rest of the evening analyzing data. I came to realize I’m not in a corporate job, I’m not a customer service representative and I don’t have to hang around until someone needs my services. I am in lab to learn skills, do experiments, and confer with my advisor and others about my science. There is an appropriate level of making yourself available to help others in the lab, so I’ve had to learn to communicate my schedule to be respectful of their time as well.

Carpooling

About six months into my commuting life I found a carpool buddy on a listserv. He too is a grad student and is commuting due to his and his wife’s job circumstances. Carpooling (and commiserating) with a fellow grad student has had a great impact on my outlook on school. In the past, I could go for months without having a conversation with another student about troubles in lab and the frustration of an uncertain future. My isolation gave me a sense that I was the only one having those troubles. Comparing experiences and brainstorming several times a week with another student has broadened my perspective.

No regrets

Sometimes I really miss this one long steep hill that I used to ride my bike down on the way home from work. I would bounce my front tire up and down while the houses and trees whooshed past me on either side. But at the end of my ride, all there was to come home to was Skype.  I don’t regret the trade-off I made. Yes there are many downsides—like increasing my carbon footprint—but I’m glad to have had a chance to redefine my approach and outlook on lab research. My situation won’t last much longer, and in the meantime, I just offset my carbon footprint by eating less red meat.