Candice Taylor (name changed), the mother of a teenage son and daughter, has not had her children vaccinated against the human papillomavirus (HPV). Last year when their pediatrician spoke to her about the preventative vaccination, she said she opted not to give it to her children because of the cost associated with the vaccine. Taylor said the price quoted to her multiplied by two children was just too much. Now that the HPV vaccine is being offered free of charge through a vaccination campaign offered by the Ministry of Health and through participating pediatricians, she says both her children will be vaccinated at their next visit.

HPV causes cervical cancer, vaginal cancer and genital warts. It can be easily transmitted through genital contact of any kind with someone who has HPV. Many males and females may have been exposed to the virus and not even known it because HPV often has no signs or symptoms.

The HPV vaccination is given to girls and boys ages nine to 12 years as a preventative measure, and protects against cervical cancer, vulvar and vaginal cancer and genital warts.

It is recommended that the vaccine be taken in a three-shot series given over a six-month period; no booster doses are recommended.

“Our aim is not to provide this [HPV] immunization as a means of protecting children sexually. Cervical cancer is the second leading cause of death in women in The Bahamas, and we are trying to protect our population against cervical cancer, that’s why we’re immunizing our children, before they’re exposed to the virus,” said Nurse Ruth Bastian, national immunization coordinator at the Ministry of Health.

The HPV vaccine was first recommended in the United States in 2006, and while it has been offered in the Bahamian private sector before now, the Ministry of Health has just recently gotten the vaccine.

“This is the first time it’s going to be offered in the public sector,” said Nurse Bastian. “It [HPV vaccine] wasn’t available at a reasonable cost for purchase when it first came on the market. Now that we’re able to get the vaccine, we are offering it to our young adult population.”

According to Bastian, of the two types of vaccines, one is just for females; the other is recommended for both boys and girls.

The Ministry of Health recently launched a campaign to make parents aware of the free campaign.

“We are just in our infancy stage, and have sent out information to the parents in the public sector. We’re hoping to get a good response, because we know it will protect the children later on,” said the nurse. In the future, she said the ministry’s goal is to ensure that parents are armed with the information they need so that they can allow their children to be immunized when they take their school medicals for grades six and seven.

While the push to vaccinate preteens hit the headlines at least 10 years ago, parents did not rush en masse to have their children vaccinated due to the cost in the private sector. With the ministry’s free offering, the nurse said they anticipate parents taking advantage.

“We’re not anticipating resistance at all. When we introduced the pneumococcal vaccine about three years ago for our babies to protect them against pneumonia, we didn’t have any resistance. I think once parents are informed and know why we’re giving the vaccine we should be able to provide it without much resistance.”

She said the vaccine has been distributed to the clinics.

“We’re anticipating that it will go smoothly. I think it’s just making sure we make it accessible for parents and the information is available,” said the national immunization coordinator.

Participating pediatricians include Agape Child & Adolescent Centre; Dr. Ayanna Remy; Dr. Carlos Thomas; Dr. Cherilyn Hanna-Mahase; Dr. Janet Davis-Dorsett; Dr. Maria Francis; Dr. Paul Hunt (Grand Bahama); Harbour Bay Medical; Precious Posterity Pediatric Centre and St. Luke’s Pediatrics Medical.

Participating physicians may charge an office visit and or administration fee.

Dr. Cherilyn Hanna-Mahase, medical director at Chesapeake Comprehensive Care, #7 Alexander Street, Palmdale, said the vaccination campaign is an important one. She said that it’s good that the Ministry of Health stepped in to offer the vaccine free of charge because the HPV vaccine helps to protect young girls and boys against the virus.

“It protects against vaginal cancer, cancer of the anus in both men and women, as well as the HPV virus, which is a wart; so without the public assistance with this particular vaccine, this vaccine was extremely expensive compared to all the other vaccines, and so this assistance will help many persons who could not afford it, actually now afford this vaccine,” said Dr. Hanna-Mahase.

The internist/pediatrician said pediatricians for the most part ordered the vaccine for parents who were educated about the vaccine and wanted to protect their children, but that in a lot of instances, when parents were told of the cost that became a barrier. The Ministry of Health vaccine campaign she said removes the cost barrier.

Prior to the campaign, the HPV vaccine cost $225 per shot, a three-course shot series is needed per person at $675, and that excludes an office visit or administration fee, according to the doctor.

Since the announcement of the campaign, Dr. Hanna-Mahase said she has had inquiries from the public as to when they can come in to have their children vaccinated, but that as of yesterday, she did not have the vaccine at her practice. As health ministry officials are supposed to deliver it to her, she hopes to have it in by next week Monday.

The doctor acknowledged that many people are of the belief that the vaccine encourages girls and boys to become sexually active, because risk factors that expose them to the virus include sexual activity. She said from that prospective parents have been resistant, even though their kids are in the target age group and the range is from 13 to 26. She said many parents believed that their child should not get

the vaccine until they become sexually active, which she said is not the case.

“If we give it now, when they’ve never had sexual contact is actually the best time,” said the doctor. “It’s the same thing when we had with the Hepatitis B vaccine that was also by body fluids and sexual contact, and we were able to get that into the regular vaccination program, and so it’s the same thing.”

She said initially people were resistant to the Hepatitis B vaccine, looking at it as an additional vaccine, and the long-term effects of it. She said people should look at the HPV vaccine as taking a preventative measure as opposed to actually getting the cancer that is difficult to cure once it has spread.

“There are many different HPV viruses. This particular vaccine protects against the four commonest viruses that will lead to cervical cancer. It won’t protect against all of them, but it protects against 70 percent of persons who would have gotten cancer,” said the doctor.

“We now know what causes cervical cancer, vaginal cancer, anal cancer, and if we have a vaccine to help protect us against these particular cancers, I would say it’s very important that we actually take them to keep our whole nation healthy. We don’t want to lose anyone to a disease that we know we can potentially protect against,” said Dr. Hanna-Mahase.

Measles, mumps and rubella campaign

The Ministry of Health launched the HPV vaccine at the same time that it launched a MMR (measles, mumps, rubella) catch-up vaccination campaign, due to the outbreak of measles in the United States, offering the vaccine for boys and girls ages one to 12 who may not have been vaccinated.

The MMR shot is also free. Parents only pay the office visit and administration fee at the participating pediatrician’s office. It’s a shot most insurances would actually cover the cost, and only about $30 out of pocket for the vaccine.

In the campaign, one shot is being offered to catch up, two vaccinations if a person has never had it. The shot is administered at 12 months, and again at four to five years, or in the teenage years, if you didn’t have it in the four to five year-period.

Measles is a highly contagious disease that spreads through the air when an infected person coughs and sneezes.

A child can get measles from just being in a room even up to two hours after the infected person has left.

Symptoms include fever, sore eyes, cough and runny nose. Small white spots usually develop inside the mouth. Diarrhea and vomiting is common. A red blotchy rash normally develops after three to four days, starting on the head and neck and spreading down the body. Children are usually quite unwell and miserable for three to five days.

In the worst-case scenario, Dr. Hanna-Mahase and Nurse Bastian say measles can be deadly, or that children could develop meningitis from which neurological deficits could result. In the long run, the nurse said it could cost more to care for a child when they have those diseases, versus paying pennies on the dollar to have them immunized.

“There was a scare about maybe five to 10 years ago with measles being associated with autism, and so a lot of parents have not had their children immunized against measles, mumps and rubella, and the thing about these particular viruses is that they look for the human body to perpetuate themselves. And so if your child is not immunized, they’re going to find you. And that’s what has happened with places like Disney World — people come from all over the world, and if someone comes into a situation who has measles, mumps or rubella and your child is not immunized, chances are your child is going to be the one to pick it up. So if you’re a traveler, you don’t know. And especially for The Bahamas we have tourism all year round, and we don’t know who is coming to our shores, and if you are not immunized, chances are your child will be the one to get that particular infection — and it can be deadly.”

The disease was thought to be eradicated from the U.S. in 2000 but has seen a resurgence in recent years. At the end of last month, the United States Centers for Disease Control and Prevention reported that 179 people across 19 states and the District of Columbia were diagnosed with measles in the United States.

Since then there have been outbreaks in Brazil and Latin America within the last two weeks, which Nurse Bastian said is the reason why they are encouraging parents to bring their children in to have them immunized.

According to the doctor there is a chance of an outbreak of measles in The Bahamas.

The last case of measles in The Bahamas was around 1997 according to Nurse Bastian. She said the elimination of the disease in The Bahamas was the result of the Ministry of Health’s hard work. But she said all children are not being given the MMR vaccination according to their schedule at age one year, and again between age four and five. She said the vaccine also protects the mother prior to her getting pregnant, against rubella to ensure the baby doesn’t develop congenital rubella syndrome, a disease that can cause blindness, heart disease, and pneumonia in the baby.

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