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HPV vaccination rates low nationwide

Tiana Williams, 13, receives a vaccination against human papillomavirus in Washington, D.C. Illinois falls is below the national average in vaccination rates for HPV, which causes cervical cancer.

Because most cervical cancer cases and some less common malignancies are caused by human papillomavirus, or HPV, area physicians and public health experts were thrilled when the U.S. Food and Drug Administration in 2006 approved the first vaccine to prevent HPV.

But five years later, local pediatricians and family physicians say they still see scores of teen girls who have not been vaccinated.

It's not just a local problem. A nationwide survey of 13- to 17-year-old girls by the federal Centers for Disease Control and Prevention in 2010 found that only about half had received at least one dose of the three-part HPV vaccination series.

Illinois was at the low end, according to the CDC results released in August, with only 39.7 percent of female adolescents receiving at least one dose of the series and only 26 percent receiving the full three doses.

A host of reasons are behind the disappointing vaccination rates, say public health experts. Chief among them: Parents don't understand why the vaccines are needed or they believe getting the shot somehow promotes sexual activity.

Dr. Rachel Caskey, an internist and pediatrician at the University of Illinois Medical Center, said many teens don't get physicals until they are in high school. That's several years after the recommended vaccination age of 11 or 12, before they become sexually active.

The vaccine must also be done in three stages, requiring three visits. Some parents can't afford the vaccine or balk at the cost — each of the three shots costs $130 — which is covered by some insurance companies.

"One of the identified barriers, particularly in young adolescents and adults, is that they just don't go to the doctor, so the traditional health care setting turns out to be not a very good avenue for administering adolescents the vaccines," said Caskey.

Only a small percentage of girls who contract the virus will develop cancer, so parents might think their daughters don't need the shot. Some parents also fear side effects, though doctors consider the vaccine safe.

There are dozens of types of HPV but only a few cause cervical cancer, if left untreated, as well as cancer of the anus, vulva, vagina and penis, which the vaccines protect against. They also protect against HPV infections that cause benign genital warts, according to the National Cancer Institute.

By getting vaccinated, girls can avoid multiple Pap smears or biopsies of the cervix, invasive evaluations used after HPV infection, said Dr. Joseph Pavese, who heads the obstetrics and gynecology department at Advocate Christ Medical Center in Oak Lawn. High-risk HPV infections transmitted through oral sex can cause throat cancer.

In 2011, the Illinois Department of Public Health predicts that 590 women will be diagnosed with cervical cancer and 180 of them will die from the disease.

According to the CDC's survey, Massachusetts, Rhode Island and Washington state had the highest vaccination rates, which researchers said might have been the result of better communication between health care programs and schools, and school vaccination requirements.

Dr. Shannon Lightner, deputy director of the Office of Women's Health for the Illinois health department, said funding for a public education campaign could boost rates in Illinois. "I think we just have to dispel some of the myths about the vaccine because it really is amazing that for the first time we can try to prevent a cancer from even occurring," said Lightner.

Lightner said many people aren't aware that one of the vaccines, Gardasil — which prevents cervical cancer and genital warts –– has also been approved for boys. Gardasil was approved in 2006, and a second vaccine, Cervarix, in 2009.

The shots can be costly for those without Medicaid or other insurance, said Patricia Donald, a nurse and associate director of population health services for the Lake County Health Department. Local health departments typically offer the vaccine, as do pediatricians, but gynecologists or internists aren't likely to carry it.

"I think providers may also need to be reminded to take every opportunity to vaccinate," said Donald.

The low vaccination rates in Illinois could be falling under the radar because most counties don't track the vaccines, some public health officials said. The McHenry County Health Department is one of the few in the Chicago area that do, and it found that about 4 percent of adolescents completed the three-shot regimen in 2010 and 24 percent started it.

Caskey said she is pushing to get the word out to parents and providers and to develop better access to the vaccine. She and other researchers began a pilot project in eight Chicago public schools two years ago to offer the vaccine to teens.

"Our long-term goal would be if we can create a program that is easily transferable to other schools, which could radically improve vaccination rates and hopefully change the epidemiology of cervical cancer," said Caskey.