2016 William Wells Prillaman
After receiving the Hal Tayloe award, I set out to research the human papilloma virus and the use of HPV vaccination. I initiated my research with a review of a database of oncology patients in the Tidewater area. I was able to obtain data from Virginia Oncology Associates from 2010 through 2015 which revealed that there were over 1000 cases of HPV associated cancers locally. I then began to research the impact of HPV on a national and global scale. Searching the Centers for Disease Control I learned that more than 90% of men and 80% of women will become infected with at least one type of HPV at some point during their lives. Although most infections go away without symptoms within a couple of years, some can, and one half of these infections are high risk HPV infections and may result in the development of cancer.
HPV can cause genital warts, and gynecologic cancers in women, genitourinary cancers in men as well as some forms of gastrointestinal cancer and head and neck cancer in both men and women. The majority of cervical cancers, head and neck cancers, and lower gastrointestinal cancers in the United States are caused by HPV and could potentially be prevented with the use of the HPV vaccine.
Pregnant women can pass HPV to their babies during delivery and these children may develop recurrent juvenile onset respiratory papillomatosis which is a dangerous condition caused by the development of warts inside the throat. I turned my attention to local research after learning about juvenile onset respiratory papillomatosis and learned that Dr. Craig Derkay, a professor of otolaryngology (head and neck surgery) at Eastern Virginia medical school has received two $700,000 grants from the Centers for Disease Control to study the impact of vaccinations on the incidence of this condition in the United States. EVMS researchers will monitor and look at the data over 5 years to determine trends in this disease.
I then turned my attention to learning about the HPV vaccine and its safety and effectiveness. These vaccines have performed well in clinical trials and have been shown to provide close to 100% protection against pre-cancers of the cervix and warts. The vaccines must be given before the patient acquires HPV infection to prevent the development of disease. In other countries where vaccination rates are higher than the United States there have been large decreases in HPV associated diseases. Studies also show that the vaccine provides long-lasting protection and there is now data available for 10 years of follow-up. Gardasil 9, for example, has been found to be 97% effective in preventing cancers caused by the HPV types that it targets. This vaccine prevents infection against the 2 most common types of high risk HPV, type 16 and 18 as well as 5 additional high risk types, HPV 31, 33, 45, 52, and 58. Study showed that HPV type XVI and XVIII because 70% of cervical cancers. Importantly, in clinical trials, there were no absolutely no serious safety concerns with the vaccines. No side effects included muscle or joint pain, fainting spells, nausea, headache, fever, or pain at the site of injection.
My next area of research included understanding how the vaccine works to help guard against infection with HPV. The vaccine stimulates the body to make antibodies for proteins that attack viruses. When these proteins come into contact with HPV they attached to the HPV and prevent the virus from infecting cells. The vaccine is made from virus-like particles. These come from HPV surface parts but do not contain HPV DNA, and although they look like the natural virus they do not have any infectious qualities and cannot cause disease.
During the course of my research, the CDC changed their recommendations on vaccination in children and young adults. The CDC now recommends only 2 doses of the HPV vaccine for children ages 9-15, with the second dose being given 6-12 months after the first dose. The HPV vaccine can be given until the age of 26. The CDC continues to recommend a 3 dose schedule for individuals guarding the HPV vaccine series after their 15th birthday or in patients with immunocompromised conditions. In this setting the second dose is given 1-2 months after the first, and the third is given 6 months after the first dose. These changes were based upon scientific data indicating equal benefit to 2 doses versus 3 in the younger patient population. This provides even more motivation to begin vaccinating children at a younger age when their immune systems are strong and can benefit greatly from vaccination.
Once I had an understanding of the benefit of the vaccine and its safety, I began to research the use of the vaccine in our community. I partnered with Hampton Roads Academy's school nurse and we investigated vaccination rates among our students. We determined that the class of 2022 currently has a 50% vaccination rate for HPV while the class of 2023 has a 33% vaccination rate. It is my goal to try and increase this vaccination rate given the safety and effectiveness of the vaccine. I will be sending out information to parents and will also be speaking to one of the seventh grade classes to provide education on the vaccine and its benefits. I then plan to reassess vaccination rates in the fall 2017 to determine if my intervention was successful.
HPV can cause genital warts, and gynecologic cancers in women, genitourinary cancers in men as well as some forms of gastrointestinal cancer and head and neck cancer in both men and women. The majority of cervical cancers, head and neck cancers, and lower gastrointestinal cancers in the United States are caused by HPV and could potentially be prevented with the use of the HPV vaccine.
Pregnant women can pass HPV to their babies during delivery and these children may develop recurrent juvenile onset respiratory papillomatosis which is a dangerous condition caused by the development of warts inside the throat. I turned my attention to local research after learning about juvenile onset respiratory papillomatosis and learned that Dr. Craig Derkay, a professor of otolaryngology (head and neck surgery) at Eastern Virginia medical school has received two $700,000 grants from the Centers for Disease Control to study the impact of vaccinations on the incidence of this condition in the United States. EVMS researchers will monitor and look at the data over 5 years to determine trends in this disease.
I then turned my attention to learning about the HPV vaccine and its safety and effectiveness. These vaccines have performed well in clinical trials and have been shown to provide close to 100% protection against pre-cancers of the cervix and warts. The vaccines must be given before the patient acquires HPV infection to prevent the development of disease. In other countries where vaccination rates are higher than the United States there have been large decreases in HPV associated diseases. Studies also show that the vaccine provides long-lasting protection and there is now data available for 10 years of follow-up. Gardasil 9, for example, has been found to be 97% effective in preventing cancers caused by the HPV types that it targets. This vaccine prevents infection against the 2 most common types of high risk HPV, type 16 and 18 as well as 5 additional high risk types, HPV 31, 33, 45, 52, and 58. Study showed that HPV type XVI and XVIII because 70% of cervical cancers. Importantly, in clinical trials, there were no absolutely no serious safety concerns with the vaccines. No side effects included muscle or joint pain, fainting spells, nausea, headache, fever, or pain at the site of injection.
My next area of research included understanding how the vaccine works to help guard against infection with HPV. The vaccine stimulates the body to make antibodies for proteins that attack viruses. When these proteins come into contact with HPV they attached to the HPV and prevent the virus from infecting cells. The vaccine is made from virus-like particles. These come from HPV surface parts but do not contain HPV DNA, and although they look like the natural virus they do not have any infectious qualities and cannot cause disease.
During the course of my research, the CDC changed their recommendations on vaccination in children and young adults. The CDC now recommends only 2 doses of the HPV vaccine for children ages 9-15, with the second dose being given 6-12 months after the first dose. The HPV vaccine can be given until the age of 26. The CDC continues to recommend a 3 dose schedule for individuals guarding the HPV vaccine series after their 15th birthday or in patients with immunocompromised conditions. In this setting the second dose is given 1-2 months after the first, and the third is given 6 months after the first dose. These changes were based upon scientific data indicating equal benefit to 2 doses versus 3 in the younger patient population. This provides even more motivation to begin vaccinating children at a younger age when their immune systems are strong and can benefit greatly from vaccination.
Once I had an understanding of the benefit of the vaccine and its safety, I began to research the use of the vaccine in our community. I partnered with Hampton Roads Academy's school nurse and we investigated vaccination rates among our students. We determined that the class of 2022 currently has a 50% vaccination rate for HPV while the class of 2023 has a 33% vaccination rate. It is my goal to try and increase this vaccination rate given the safety and effectiveness of the vaccine. I will be sending out information to parents and will also be speaking to one of the seventh grade classes to provide education on the vaccine and its benefits. I then plan to reassess vaccination rates in the fall 2017 to determine if my intervention was successful.
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