Hollings Cancer Center celebrates rise in HPV vaccination rates

September 03, 2020
rendering of the human papillomavirus
The human papillomavirus (HPV) can cause six types of cancer, but vaccination can prevent about 90% of these cases from ever occurring. HPV vaccination rates in South Carolina have steadily increased over the last four years. iStock

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

That’s why researchers and clinicians supporting MUSC Hollings Cancer Center’s 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’s rates are on par with the overall national rates.

Kathleen Cartmell 
Dr. Kathleen Cartmell leads Hollings Cancer Center's statewide HPV initiative. Photo by Emma Vought

“The change we saw this year was extraordinary,” said Kathleen Cartmell, Ph.D., a Hollings Cancer Center researcher and associate professor in Clemson University’s 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.

“While 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.”

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. “This is where the immunizations happen, in the health care provider’s office — the medical home. It’s important that the medical home is strong and intact, as otherwise we have a fragmented health care system.”

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. “We are now seeing some of the benefits of that practice,” 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.

line graph showing hpv vaccination rates in South Carolina and the US from 2016 to 2019 
HPV vaccination rates in South Carolina now equal or exceed overall national rates based on 2019 survey data.

Roberts said his goal is to make sure parents understand how safe and effective the vaccine is and how it can prevent six types of HPV-related cancers affecting both males and females. “It’s 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 — another benefit of initiating the series early, before that is even an issue in most parents’ minds.”

Cartmell, who leads Hollings’ 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.

“In 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,” 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 “HPV Vaccination NOW: This is Our Moment” 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’s 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.

HPV parent ambassador Katie Fox holds her baby in her lap 
Katie Fox serves as an HPV vaccination advocate in her community through the Hollings parent ambassador initiative. Photo by Vagney Bradley

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.

“To 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,” Sundstrom explained. “This technology-mediated intervention increased parents’ confidence and motivated them to speak more freely about HPV vaccination in person and online with others in their social networks.”

Hollings Cancer Center researcher Marvella Ford, Ph.D., who also is associate director of Population Sciences and Cancer Disparities at Hollings, said she’s 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’s important to stay focused on the goal despite the recent rise in rates.

“The 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.”

Roberts, who is site leader for the HPV initiative at MUSC Health, said he understands parents’ fears and concerns about bringing their child to their health care provider’s office, particularly earlier in the summer when COVID rates were higher. “I would suggest that at this point in the pandemic, coming to the doctor’s 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.”

Roberts said the vaccination issue is critical for all age groups and not just the HPV vaccine. “Many 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.”

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.

“While 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,” she said. “This 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.”