Dr. Clarence (Buddy) Creech, Associate Professor in the Department of Pediatric Infectious Diseases and the Director of the Vanderbilt Vaccine Research Program, discusses the effects of HPV and its preventative vaccine.
Stephanie Townsend: Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast. I am Stephanie Townsend with Vanderbilt Occupational Health. We are here today to speak with Dr. Clarence Buddy Creech, Associate Professor in the Department of Pediatric Infectious Diseases, Director of the Vanderbilt Vaccine Research Program, on the subject of HPV and is the vaccine right for you. Can you just give me a little background history on what is HPV and how does it affect myself or anybody else in the community?
Dr. Clarence Buddy Creech: Oh, it is a great question. So, human papillomavirus is what HPV stands for, and I think most people are familiar with it is as a cause of cervical cancer, it is also a cause of common warts, but is also a really common cause of head and neck cancers in both men and women, and it is a cause of cancer after folks have survived say a bone marrow transplant or other cancer therapies. It is one of the leading causes of cancer after that. And so we think about it as an annoyance of warts, and we think about it’s a leading cause of cancer with everything else, and the fact that we have such a successful way to prevent it gives us in the field a lot of excitement that HPV could become a thing of the past.
Stephanie Townsend: Let’s kind of dive into the discussion. So, it can cause cancer and warts. Are there different strains on HPV or is this all one thing? How does somebody know to ask their doctor?
Dr. Clarence Buddy Creech: Yes, so the strains that caused warts and those that cause cancer are thankfully very, very different, and even though warts are annoying, we can deal with them, and there really are not any consequences to those for the most part. The challenge is that some of the warts that we care for are actually highly contagious from one to another, those that are sexually transmitted, and they can be associated with the development of cancer later. So, we are not talking about the warts that are on your fingers, on your feet, or other places on the skin, but we are really talking about sexually transmitted warts, and we are talking about those viral strains that tend to cause cancer. This is why for years we have made the recommendation to women to get Pap smears every few years, and the rationale for that is to say HPV is common. As soon as folks begin to have sex, they get exposed to the virus. In some people, they take care of the virus and they get rid of it and there is no problem, and in others, that virus hangs out for a while and leads to changes that are cancerous. The purpose of a Pap smear is to look for those changes and try to catch them so early that they do not become true cancers because cervical cancers still here and around the world is a leading cause of cancer-related death in women.
Stephanie Townsend: You did mention that there is a way to prevent it. Just in the news and the media, we hear about the vaccine. Everybody needs to get the vaccine. What are the guidelines and who can qualify to get this vaccine, and are there age restrictions or limitations?
Dr. Clarence Buddy Creech: There are some restrictions on that, and I think the take-home points are the following: The vaccine is most effective when you have not yet been exposed to HPV. So, now we are going to limit that population to be those who are not yet sexually active. So, we are talking about teenagers. The other true statement that we know is that the younger you are when you get the vaccine the better the vaccine works. You get a better take of the vaccine. So, when we think about who gets vaccinated, we take it down to the preteenager age group for both boys and girls all the way up to the early 20s because even for those men and women who have engaged in sexual activity, there is still benefit to getting the vaccine. You might have been exposed to one HPV strain, and the vaccine covers another eight in addition to that one. So, there is still potential benefit, but again I think a take home message is that if you get it early it works better. It is probably safer, you can a fewer doses, and it may prevent cancer, and I think that is the take-home that somehow we missed as we have seen this vaccine introduced into the general population is that we truly have a cancer vaccine. And I will tell you in the developing world where folks are seeing a ton of cancers that are not picked up early through Pap smears, HPV vaccine has been lifesaving.
Stephanie Townsend: With the vaccine, just say with our older population those that are just say 30 and over, is the vaccine any help for those people that fall in that category that just say that they have not been sexually active up until that point?
Dr. Clarence Buddy Creech: That is an interesting question. So, we do not have any data that I am aware of to guide that population just yet. So, right now, this is really a vaccine that by licensure and by recommendation you get up until the mid-20s. With that being said, there is a lot of interest in HPV vaccine in a couple of different populations. So, one is the one you just described. Someone who may not yet be sexually active for some reason did not get the vaccine and is older. What’s the disadvantage of giving it? Well, their immune response is not going to be as good as if they got it when they were 11, but it might still offer protection. So, those groups that make recommendations for us like the advisory committee on immunization practices or ACIP, they look at the data as they come out to see if a more broad recommendation could be made. The second one I think that is going to get some traction are those who have survived cancer therapy or bone marrow transplant, who now have a unique risk for head and neck cancer and other malignancies even though they just recovered from one type of cancer. And so that may be a very interesting population for us to vaccinate so that they can be protected. Just keep in mind this vaccine is only about a decade old. We have already seen two vaccines come to be available. We have a newer vaccine that now covers not just two strains or four strains but nine strains of HPV and that is only going to continue to grow. So, there is a lot of movement on this front. It is a remarkably safe, it is a remarkably effective vaccine, and we are seeing cancer drop as a result of it.
Stephanie Townsend: Do you have any websites or any places that you will suggest our listeners to go to be able to get more information on HPV?
Dr. Clarence Buddy Creech: Well, certainly the CDC keeps all this information up-to-date, and it is probably the most comprehensive place to go for HPV related information, both about the vaccine and about the disease. We also have information available on the Vanderbilt website. so that you can look at different research studies that are being done, especially if you are in one of these special populations of maybe older folks wanting to get the vaccine or cancer patients wanting to get vaccine, and I think we are in a place here at Vanderbilt where we have so many folks interested in preventing cancer, preventing sexually transmitted warts, and improving the safety and effectiveness of our vaccines that we are going to see a lot of movement on that front from our medical center and our university, so stay tuned for that as well.
Stephanie Townsend: Thank you. Thanks for listening. Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page. If you have a story suggestion, please email it to us at firstname.lastname@example.org or you can use the "Contact Us" page on our website at healthandwellness.vanderbilt.edu.
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