1. Verklan, M. Terese PhD, CCNS, RNC, FAAN

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The year 2013 saw a live birth rate of 26.5 per 1000 women aged 15 to 20 years, a record low for teens in this age group.1 It is unknown why the rate declined; however, it appears that teens now are less sexually active, and those who are active are more motivated to use birth control.2 Nonetheless, the teen pregnancy rate in the United States remains substantially higher than other developed countries.3 Sexual activity, especially without proper protection, increases the risk that the woman will contract a sexually transmitted infection (STI). The most common STI is the human papillomavirus (HPV) infection, and the majority of women in the adolescent/young adult group lack awareness of this STI, as well as how to take preventive measures and decrease their risks through behavior change.4 Immunizations have been in the headlines with respect to measles recently, and perinatal nurses need to educate their patients regarding the importance of the HPV vaccine. The HPV vaccine can play a significant role in decreasing the incidence of not only HPV infection but also invasive cervical cancer (ICC).


According to the Centers for Disease Control and Prevention and the Advisory Council of Immunization Practices, the optimal time to vaccinate females against HPV is through the ages of 11 to 26 years.5 Not too long ago, it was recommended that males aged 11 to 26 years also obtain the vaccination.5 While treating male adolescents is outside the scope of our practice, we could ask our female patients if their partners have been vaccinated and provide knowledge of how the HPV vaccine is protective for both parties. Gardasil and Cervarix are given as a 3-injection series, independent of other vaccines. There are substantial data that the vaccines are safe and effective, with 99% to 100% immunogenicity as long as there is completion of the 3-dose regimen.6 Side effects most commonly reported include syncope, pain at injection site, nausea, and dizziness.7


Why is it important to discuss HPV vaccination with our young women in the perinatal and neonatal periods? This is because cervical cancer is not only the most common cancer but also one of the most preventable ones. Personally, I don't want to lose one more friend to any type of cancer. My age group is beyond the vaccination stage; however, the younger generations must gain awareness from their providers regarding the measures that can be taken to prevent cervical cancer. It is surprising that HPV infection is not considered a reportable STI! However, it is estimated that nearly 20 million people in the United States have HPV infection and 6 million new infections occur annually.8 The organism can cause cervical intraepithelial neoplasia, and if not treated/detected can progress to ICC or adenocarcinoma of the cervix. Approximately 12 360 new cases of ICC will be diagnosed annually, and about one-third of the women receiving this diagnosis will die from the cancer.9


The cost of the HPV vaccine pales in comparison with the $4 billion spent annually in treating HPV-related diseases.4 The majority of state and federal programs cover cervical cancer screening, but fewer are covering the costs of colposcopy and loop electrosurgical excision procedures. Those who are uninsured or underinsured may not have the resources to cover the costs of treatment. Low-income adolescents up to the age 19 years can receive the HPV vaccination free of charge through Medicaid and the Vaccines for Children Program.10


Disparities of receiving the HPV vaccination and completing the series need to be noted because when compared with their white counterparts, black and Hispanic females have increased rates of HPV infection, cervical intraepithelial neoplasia, and ICC and black women have the highest rates of death from cervical cancer.4 Barriers to obtaining the protective qualities of vaccination include concern over possible long-term effects of the vaccine, mothers not wanting their daughters to have vaccinations, and the cost of the vaccine.11,12 Mothers also reported that they felt their daughters were too young for such an immunization, that the vaccination was associated with an STI, and that the vaccination gave permission to have unsafe sexual activities.11,12 Much of the research has focused on the parents', in particular, the mother's perception and attitudes toward the vaccination and disease. However, women of childbearing age who are 18 to 26 years of age must be fully informed of their health risks to make educated decisions regarding risks, behavioral changes, and treatment options.


Perinatal and neonatal nurses must open a dialogue with respect to HPV vaccination and the impact the vaccine can have on cervical cancer. The perinatal nurse can provide counseling and education during well woman checkups and antenatal care. It is well known that new mothers are motivated to learning in the neonatal period, and the neonatal nurse can discuss the benefits of the vaccination for the mother so that she can be healthy to take the best care of her infant as he or she grows into childhood and beyond. Preventive care is an optimal focus for nurses to educate women and their families. Nurses, as trusted professionals, have a long history of influencing policy to improve healthcare related to women and newborns. Let's start talking about HPV infection, vaccinations, and preventing cervical cancer.


-M. Terese Verklan, PhD, CCNS, RNC, FAAN


Professor and Neonatal Clinical Nurse Specialist


University of Texas Medical Branch


School of Nursing Galveston


Graduate School of Biological Science


Galveston, Texas




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