Let’s talk shots: The HPV conversation isn’t easy, but it’s important

Assistant Professors at the University of Virginia's School of Nursing, Emma Mitchell (left) and Jessica Keim-Malpass (right) teach students how to approach the topic of HPV vaccinations with parents of young children. Photo: Amanda Maglione Assistant Professors at the University of Virginia’s School of Nursing, Emma Mitchell (left) and Jessica Keim-Malpass (right) teach students how to approach the topic of HPV vaccinations with parents of young children. Photo: Amanda Maglione

Less than 30 percent of Virginia’s adolescent girls were vaccinated for human papillomavirus (HPV) last year, despite the fact that the Commonwealth was one of the first to pass legislation mandating the vaccine for sixth grade girls. The National Cancer Institute (NCI) wants to know why vaccination rates for HPV—the most common sexually transmitted disease in the U.S., which can lead to at least six types of cancer—are so low among girls and boys, and granted $138,000 to the University of Virginia Health System for a study to map out compliance rates across the state.

“What we’ve started doing is addressing both individualized factors and bigger policy factors that are really limiting young kids from getting the vaccine,” said assistant professor of nursing Jessica Keim-Malpass, who’s spearheading the study alongside her university colleague Emma Mitchell.

Since its release, Gardasil has been commonly known as the vaccine that could prevent cervical cancer, but Keim-Malpass wants parents and patients to know that HPV has the potential to affect anybody who’s sexually active, male or female, and can cause cancer in both men and women.

“A lot of parents only associate HPV with cervical cancer, and don’t understand why boys need it too,” she said.

HPV is passed through intimate skin-to-skin contact, and symptoms like warts (papillomas) may take years to develop. Genital warts as a result of an HPV infection can lead to precancerous lesions, and ultimately cancer of the cervix, vagina, anus, penis, mouth and throat. Despite the fact that the vaccine could prevent several types of cancer, Keim-Malpass said a lot of providers and parents alike are uncomfortable talking about vaccinating kids for a sexually transmitted disease when they’re still so young.

“Some parents think it doesn’t apply to them because their kid isn’t sexually active. But that’s how it works—you get it before you’re sexually active,” she said. “Because they’re so far removed, they don’t see the impacts of cancer until decades later, so it can be really hard to make that decision for families.”

Virginia mandates that girls receive the vaccine in sixth grade (no passed legislation includes males in the mandate yet), but Keim-Malpass said because opt-outs are so broad, the policy can only be so effective. The goal of the study is to learn about the contributing factors behind why people decide to opt out of the vaccine, and to understand how communication and policy affect vaccination rates.

According to Keim-Malpass, improved communication between providers and parents could lead to higher vaccination rates. Some providers are very upfront with parents and patients, and present Gardasil as one of the several vaccines that kids are due for at age 11. Because it’s associated with sex, though, she said a lot of providers tend to be squeamish about it, and almost offer it apologetically, and as something to “think about” rather than follow through with.

“When a provider doesn’t make a strong recommendation, a parent certainly isn’t going to follow through,” Keim-Malpass said.

Ultimately, though, she said it’s up to the parents. It should be a provider’s responsibility to present the facts and educate to the extent that they can, and then respect a parent’s decision.

“One thing [providers] can be better about is being concrete about what’s due,” she said. “But we respect people’s decisions. That’s central to how we approach things.”

The vaccine: by the numbers


The year Gardasil, which helps protect against four types of HPV, came onto the market.


The number of injections your child receives over the course of six months.

9-26 years

The age range Gardasil recommends girls get vaccinated. For boys, it’s 9-21.

11 or 12

The age The Center for Disease Control and Prevention recommends the vaccine for boys and girls.

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