- Hi, I'm Dr. Jon Hallberg, an associate professor
in the department of Family Medicine and Community Health
at the University of Minnesota Medical School.
I'm also a practicing physician and the father of two teenagers.
The purpose of this program is to learn how to deal effectively
with one adolescent immunization.
But before we show you how to do that the right way,
we're going to start by showing you a few examples
that are a little less than ideal.
Let's take a look at the first scenario.
- Kayla looks fantastic.
Before you go, there are a few vaccines
we give at the two-month visit:
rotavirus, Hib, polio,
the second dose of hepatitis B,
and the DTaP vaccine
against diphtheria, tetanus, and pertussis.
Also, there is one other vaccine you could consider.
- What's that? - The pneumococcal vaccine.
If you're interested, we could add it to the list,
but it's up to you.
- Of course this is silly.
You know no provider would ever be so nonchalant
about the pneumococcal vaccine.
It's a safe, effective, lifesaving immunization.
But what if the patient is a preteen
and the safe, effective, lifesaving immunization
we're talking about is the human papillomavirus,
or HPV, vaccine?
Is it possible that we present that one
as somehow less important?
Let's check in on another scenario.
- Adrian is growing well
and meeting all her developmental milestones.
That's great.
Now, I'd like to open what might be
an uncomfortable conversation.
- About what?
- Well, since Adrian's a year old now,
she'll soon be interacting closely
with children her own age.
Diseases like measles, mumps, and chicken pox
are transmitted by...
contact with sick people.
- Okay.
- If she hasn't already, she will start
to reach out and touch other children
who, in return, will be touching her.
I don't think there's anything you can do to really stop it.
It's just natural.
Keeping that in mind, I wanted to educate you
about the vaccines that can prevent these diseases
and especially the diseases' relationships
to social behaviors
so you can make a choice that's right for your child.
- Well, most vaccine-preventable diseases
are spread by contact with other people,
but just don't dwell on how people get infected.
Yes, the HPV infections we're concerned about
are transmitted through sexual activity,
but we shouldn't treat the vaccine any different
from the others we give.
The whole point is to prevent disease,
so adolescents need to be immunized
before they become sexually active.
- Well, I'm glad that Jack now knows
that skunks don't like it when you try to cuddle them.
- I do not think we need to remind him.
- Just keep the wound clean, and if it starts to swell up,
bring him back into the clinic, okay?
- Okay. - All right.
Oh, also, if you want,
we could give him a rabies vaccine.
It's your call. You're the parent.
- Nah, you know, he's such a healthy kid.
I think his body can fight it.
- Frankly, I don't think he's the type to get it.
He's not like those kids in other countries
where they actually die from rabies.
I wouldn't worry about it.
- Okay. All right, thank you.
- No need for a rabies vaccine
after exposure to a wild skunk?
Of course that's ridiculous.
And as you know, there's no type of person to get rabies,
just as there's no type of person
to get an HPV infection.
Most Americans will be exposed
to the HPV viruses that we're concerned about
through sexual activity,
and 22,000 of them every year will go on to develop
a form of cancer that could have been prevented by the vaccine.
It's well documented
that a health care professional's recommendation
is the single most important factor
in a parent accepting the HPV vaccine for their child.
We just need to be calm and up-front
about letting them know
how important it is to receive it.
- I told you this hockey is just not a good idea.
[sighs]
Well...
- Oh, so that's gonna be sore for a few days,
but it should get better by the end of the week.
Let us know if it doesn't, okay?
All right?
Now, I see that you turned 12, so since you're here,
this would be a great time for those vaccines
which are recommended at this age,
which are HPV, Tdap,
meningococcal.
Are there any questions about that?
- Yeah, the HPV, that seems like something that could wait
until she's a little older, don't you think?
- I think I get your drift,
and I know it seems kind of soon,
but the thing is, the vaccine are recommended
at the youngest age
for which they've been proven safe and effective.
No matter what the disease, you want to make sure
that immunity is in place before the exposure happens.
A bonus is that at Isabella's age,
kids respond much more vigorously to the vaccine
than older kids and adults,
and that might make even better protection.
It's also convenient because, well,
there are two other vaccines due at the same age,
and, well, those two and the first dose of HPV
can all be given at the same appointment.
- Okay, but I just wonder
what we might be opening the door to.
- Okay.
Some people have had that worry.
There's research been done that has studied that question,
and they found no more sexual activity among girls
that have had that vaccine compared to those that hadn't.
So that may have eased some minds,
especially considering what you get in exchange.
I think it's pretty amazing that there's
a safe and effective way of preventing cancer.
I'd feel a lot better if we got her protected today.
- Okay.
- All right, Brady, I think the doctor
is going to want to do a throat culture on you,
so I'll bring back a tray of supplies for that.
Also, looking at your chart, it looks like you're due
for some vaccines: Tdap, meningococcal, and HPV.
We have some vaccine information statements
that you'll want to read, but do you have any questions?
- I hate to see him get three shots at once.
And I've read that the HPV vaccination
doesn't necessarily prevent all types of HPV.
So I think we'll just skip that one.
- It's true that there are many different types of HPV,
so it's great that you're aware of that.
We're really happy that the vaccine
we use in this office
protects against two cancer-causing types of HPV
and two types that cause genital warts.
We actually had a continuing education service on this
and learned that the four types of HPV the vaccine prevents
are responsible for by far the biggest share
of a whole variety of cancers,
including anal cancer in men.
Plus, they also account for 90% of genital warts.
And the vaccine's nearly 100% effective
against those four virus types,
so it really does knock out
a lot of the health threats from HPV.
And there's no evidence that the vaccine wears off
even years after you've had it.
- So you'd recommend it pretty strongly, then.
- I do.
The pediatricians and the family doctors
in our office do.
And actually, the oncologists here in town--
those are the cancer specialists--
are big fans of the HPV vaccine.
The cancer doctors in particular
would love to have fewer patients coming to them
who could have avoided cancer if they'd had the HPV vaccine.
- Well, looks like you're getting that shot.
- Totally okay with that.
- Okay, everything looks great,
and you can pick up your forms for the soccer tryouts
on your way out.
I noticed in your chart here that we haven't
given you the HPV vaccine, though.
We should do that today.
Do you have any questions for me
before we bring your mom back in?
- Well, like, we've talked about it,
and I'm not having sex.
When I do, it won't be
with the kind of person that's been around a lot.
I just don't feel like I need it.
- Well, it makes me really happy to know
that you've made the decision to not have sex for now
and see yourself being careful about it in the future.
That's gonna protect your health in a lot of different ways.
The thing that most people don't know about HPV, though,
is that it's incredibly common.
It turns out that four out of five of us
will have at least one HPV infection during our lives.
So it's not something that just circulates
in people who have a lot of partners.
Almost all of us will be exposed to it sooner or later.
In your case, later.
The vaccine gets your natural immune processes going
so you're ready and able to fight off an infection
if you are exposed in the future.
- I've never heard anybody I know that has HPV.
- Well, it's not exactly
the kind of thing people talk about.
And really, people your age wouldn't have any way to know
if they did have HPV.
We usually don't test for it until you're an adult.
And the cancers that it causes
generally don't show up for years.
Now, the virus can just come and go
without causing any trouble
if it's the type that doesn't cause warts or cancer.
And even if it is a dangerous type,
sometimes the body can clear it before it can do any damage.
It's just that there's no way to control
which type or types you'll get
and no way to guarantee
that if you do get a cancer-causing type,
it'll go away on its own.
I'd hate for you to count on luck
when you could protect yourself by getting vaccinated.
If we get the first one done today,
you can schedule the next two on your way out
and be done in six months.
- Okay.
- Sean, you're in great health.
It's wonderful to see you making so many healthy choices.
Shannon, everything looks good.
The last thing we need to do today
is to get you the vaccines
that are recommended at this age:
meningococcal, HPV, and Tdap.
I know the nurse gave you these vaccine information statements
to look at before.
Do either of you have any questions
about the three vaccines?
- Well, I'm okay with the meningococcal and the Tdap,
but I've heard some bad things about the HPV,
so I think we'll just skip that today.
- Can you say some more about what you've heard?
- Well, it's a relatively new vaccine,
and I've heard that some people
have had some pretty bad reactions to it,
and I'm just not worried enough about HPV
to take a chance that the vaccine's
gonna do something bad to Sean.
- I know it's been in the news a lot lately,
and actually, because I've had so many questions
from my patients about it, I made it a special point
to really look into the safety studies behind it.
Vaccines go through a lot of testing
before they ever get to a doctor's office.
These tests make sure that the vaccines
work at preventing diseases
and that they're very safe.
There's also ongoing monitoring for safety
all the time that they're being used with the general public.
I have a chart on the wall that we can look at
that explains the process in more detail,
but the HPV vaccine has been recommended and licensed
since 2006,
and we don't have any serious safety concerns.
- But I know I've heard about people fainting
after getting it.
- Adults and adolescents sometimes do faint
after certain medical procedures,
including vaccinations,
so it's not specific to the HPV vaccine.
In fact, we ask all big kids and adults to stay seated
in the office for 15 minutes after every vaccination
for that very reason.
Now, I'm very comfortable
with the safety of the HPV vaccine,
and I do think it's important for Sean to have it today.
My nieces and nephews went through
the same vaccination series when they were Sean's age,
and I wouldn't want anything different for him.
- Well, what do you think?
Yeah.
Okay.
- We now have a way to prevent today's adolescents
from developing certain forms of cancer tomorrow,
and all we have to do is treat the HPV vaccine
just like any other.
Take every opportunity to recommend it,
give the doses on schedule,
and be prepared to answer any question
just as you would for any other vaccine.
No drama needed.