Early detection of cancer can mean all the difference in patients鈥� outcomes. Even better is preventing the cancer altogether.

That鈥檚 why researchers and clinicians supporting MUSC Hollings Cancer Center鈥檚 HPV Initiative were thrilled to see the latest vaccination rates that were just published from the NIS-Teen adolescent vaccination survey. This is the primary survey used to monitor adolescent HPV, or human papillomavirus, vaccination rates in the nation. For the first time, South Carolina鈥檚 rates are on par with the overall national rates.

鈥淭he change we saw this year was extraordinary,鈥� said Kathleen Cartmell, Ph.D., a Hollings Cancer Center researcher and associate professor in Clemson University鈥檚 Department of Public Health Sciences. The HPV vaccine, which requires two doses, saw an 8% increase in vaccine initiation and 12% increase in vaccination completion.

鈥淲hile we saw a similar big jump in our HPV vaccination rates back in 2016, the increase we saw this year is phenomenal, considering that having these big increases many years in a row is what will be needed to get our HPV vaccination rates up to 80%, which is the national goal set by the Centers for Disease Control and Prevention.鈥�

Every year in the United States, HPV causes more than 30,000 cases of cancer in men and women, and the HPV vaccine can prevent about 90% of these cases from ever occurring.

Helping kids

MUSC Health pediatrician James R. Roberts, M.D., said the rise in rates reflects the past three years of concerted effort by statewide partners and nationwide health organizations to educate parents and health providers as well as a focus on integrating preventive care into health care systems. 鈥淭his is where the immunizations happen, in the health care provider鈥檚 office 鈥� the medical home. It鈥檚 important that the medical home is strong and intact, as otherwise we have a fragmented health care system.鈥�

The rise in rates also reflects efforts to begin the immunization series at an earlier age. The HPV vaccine is recommended for all boys and girls at ages 11 to 12, and it can be given as early as the age of 9. 鈥淲e are now seeing some of the benefits of that practice,鈥� he said. Catch-up vaccination also is recommended for adolescents and young adults up to the age of 26 who missed getting the vaccine earlier.

 

Roberts said his goal is to make sure parents understand how safe and effective the vaccine is and how it can  affecting both males and females. 鈥淚t鈥檚 one of the first vaccines we have ever had against cancer. It does not increase the likelihood their child will start having sex. More importantly, this vaccine should be given well before their first sexual encounter 鈥� another benefit of initiating the series early, before that is even an issue in most parents鈥� minds.鈥�

Cartmell, who leads Hollings鈥� statewide HPV initiative, said it takes a wide range of diverse activities and strong partnerships to make real change like this happen. Partners include the Department of Health and Environmental Control, South Carolina Cancer Alliance, American Cancer Society, American Academy of Pediatrics, South Carolina Cervical Cancer Awareness Initiative, and statewide colleges and universities including the University of South Carolina, Clemson and College of Charleston.

鈥淚n addition to what Hollings is doing, our other state partners are making similar robust and coordinated efforts to increase HPV vaccination. So, I think what we are seeing is synergy in the work that's being done by a lot of great partners in the state,鈥� she said.

Innovative approaches

Tactics the groups are using include social media and digital campaigns, educational events with providers and school nurses and targeted programs within health systems. Cartmell said it has to be a multifaceted approach, and they are studying what tactics are the most successful to leverage resources more effectively.

One innovative approach has been the 鈥淗PV Vaccination NOW: This is Our Moment鈥� social media campaign, an initiative of Hollings and the South Carolina Cancer Alliance. This statewide social media campaign, targeting the increase of parental awareness and creation of positive attitudes toward HPV vaccination in the state, was led by Cartmell and Beth Sundstrom, Ph.D., a College of Charleston associate professor who specializes in strategic health communication.

Sundstrom said the goal of this campaign was to increase HPV vaccination in the state through consistent messaging that the HPV vaccine is essential for protecting children鈥檚 health. A 10-week campaign in 2019 had more than 370,000 total impressions, reaching more than 33,000 people and eliciting 2,700 engagements on Facebook and Twitter. She said an important part of the campaign was correcting misinformation through peer-to-peer dialogue.

 

As part of that effort, an HPV parent ambassador initiative was launched last fall where more than 20 parents from across the state went through a three-month training program to become HPV vaccination ambassadors. The study combined education and health promotion messages with skills-based communication training to empower parents to raise their voices in support of HPV vaccination.

鈥淭o our knowledge, this is the first collaborative online learning environment to train and support parents to serve as proponents and social media influencers to overcome barriers to HPV vaccination,鈥� Sundstrom explained. 鈥淭his technology-mediated intervention increased parents鈥� confidence and motivated them to speak more freely about HPV vaccination in person and online with others in their social networks.鈥�

Hollings Cancer Center researcher Marvella Ford, Ph.D., who also is associate director of Population Sciences and Cancer Disparities at Hollings, said she鈥檚 glad to see the use of community social networks, as this tactic helps to reach rural and medically underserved communities that make up much of the state.

Social media use, particularly on Instagram and Twitter, tends to be higher among Black and Latino populations than among whites, and research is showing it as an effective way to do outreach to minority populations, she said. 

COVID-19 impact

Cartmell said it鈥檚 important to stay focused on the goal despite the recent rise in rates.

鈥淭he increase in HPV vaccination we've seen this year won't reflect any slowing of HPV vaccination that may occur due to COVID-19 because the NIS-Teen survey was done prior to the pandemic. Hopefully, we won't lose too much ground due to COVID-19 in terms of our HPV vaccination rates.鈥�

Roberts, who is site leader for the HPV initiative at MUSC Health, said he understands parents鈥� fears and concerns about bringing their child to their health care provider鈥檚 office, particularly earlier in the summer when COVID rates were higher. 鈥淚 would suggest that at this point in the pandemic, coming to the doctor鈥檚 office is probably safer than going to many places in public now. All health care providers are wearing masks, and most, if not all, attempt to limit all sick visits or at least do a better job separating sick visits from well visits and immunization only visits.鈥�

Roberts said the vaccination issue is critical for all age groups and not just the HPV vaccine. 鈥淢any families have not brought their child in for important vaccine series. This will result in a drop in the herd immunity to the point that we are likely to see a return of pertussis and measles. Equally concerning will be the coming flu season this fall and winter with COVID, influenza and possibly pertussis all circulating in the community, so families should definitely get a flu shot this year.鈥�

Meanwhile, Hollings researchers and health professionals will keep up the rallying cry to help to support ongoing efforts in the state to maintain the upward trend in HPV vaccination. Cartmell said the good news from the recent survey makes the years of hard work worth the effort.

鈥淲hile we knew of the great work going on in the state, it always makes you happy to see that the evaluation metrics show that the work has been successful,鈥� she said. 鈥淭his year, there will be almost 600 new cases of HPV-related cancer diagnosed in the state. We know we can do better and prevent our children from getting HPV-related cancers in their future. For this, we do have a vaccine.鈥�

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