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Testimony in SUPPORT of HB-7199: an Act Concerning Immunizations Against the Meningococcal Virus and Human Papillomavirus Hannah G

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Testimony in SUPPORT of HB-7199: an Act Concerning Immunizations Against the Meningococcal Virus and Human Papillomavirus Hannah G Testimony in SUPPORT of HB-7199: An Act Concerning Immunizations Against the Meningococcal Virus and Human Papillomavirus Hannah G. Rosenblum, MD March 13, 2019 Dear Co-Chairs Representative Steinberg, Senator Abrams and Distinguished Members of the Public Health Committee: As an internist and a pediatrician at Yale-New Haven Hospital and St. Mary's Hospital, I care for both adults and children in the hospital and in the office. My patients are all ages, from newborns to the elderly, and I also care for patients affected by cancer in my regular practice. I am a resident of New Haven, Connecticut and I am writing to testify about why I strongly SUPPORT HB-7199, an act that concerns prevention of cancer and prevention of meningitis. My testimony focuses on the critical public health issue of disease prevention, and addressing misinformation about vaccinations. Please see the attached addendum for several rigorous scientific studies in reputable high-impact journals that support the safety, efficacy and impact of the life-saving immunization against human papilloma virus (HPV). We Connecticut pediatricians are familiar with the routine schedule of vaccinations and with counseling parents about protecting their kids against illnesses that used to harm children early in life (to name a few: diseases like diphtheria, polio, haemophilus influenza, and measles). Because these critical immunizations given in early childhood are required to enter Connecticut public schools, I have not seen children harmed, maimed or killed by those infectious diseases of the past. However, human papilloma virus (HPV) is a widespread infectious disease of our time and I am all too familiar with HPV’s effect on my patient’s health. Transmitted through skin-to-skin contact, nearly all men and women are exposed to HPV at some point in their lives. High risk types cause cervical, other genital cancers and head and neck cancer. One young primary care patient of mine was diagnosed with oropharyngeal cancer; were the vaccine available in her youth, her life would have been drastically different. Admitted to Smilow Cancer Center for debilitating jaw and mouth pain, she was on a strictly liquid diet. The HPV-positive tumor that had started in her sinus and nose had eroded into her sensitive facial bones. Multiple rounds of chemotherapy, radiation and surgeries left her with profound difficulty chewing and swallowing, not to mention constant pain and social anxiety due to disfigurement. Her speech was barely intelligible to her daughter, who remained faithful at her bedside all day and night. She is one of the lucky ones- her malignancy has not taken her life! As an internist, I have cared for countless adult patients who have died from cancers that were not preventable. But for patients with cervical cancer, some head and neck, and many genital cancers, prevention is now the reality! The essential vaccine that was explicitly developed to prevent cancer: the vaccine against human papilloma virus (HPV) has been greatly underutilized in our state of Connecticut. Though recommended by the ACIP and CDC, this is because the HPV vaccine has not made it to the list of immunizations required for public school and therefore, the burden is currently on parents to make sure their children receive it. In my practice, parents frequently interpret this vaccine as “not important” because it is not expected for school entry. This bill will not Testimony in SUPPORT of HB-7199: An Act Concerning Immunizations Against the Meningococcal Virus and Human Papillomavirus Hannah G. Rosenblum, MD March 13, 2019 remove parental consent in decision-making about their children- it will eradicate HPV, just as we’ve eradicated polio and other deadly diseases. This bill is so critical to the health of our state’s children and adults because it makes concordant the medical recommendations for nationwide vaccination, pediatrician recommendations and school requirements. We internists recommend regular mammograms to detect early breast cancer, regular colonoscopies to detect colon cancer, regular Pap smears to detect early abnormalities in the cervix. Rarely do we have the opportunity to actually prevent cancer. And just as we recommend patients use seatbelts to protect against injury or death in the case of a car accident, the HPV vaccine protects a patient in the case of exposure to HPV virus. Let’s make the next generation of physicians and patients unfamiliar with HPV-related cancers. As data from Australia shows, this can be even be done in one-generation! As a doctor that counsels patients, and an advocate for protecting children, I know that there is a lot of misinformation circulating about vaccinations. In fact, the WHO (World Health Organization) has named “vaccine hesitancy” a top ten threat to global health in 2019, joining such public health crises such as the Ebola epidemic and climate change. There is also an ongoing national conversation about the role of social media in promoting anti-science lies, prompting Google, Facebook and Pinterest to take action. Key FACTs about the HPV vaccine are addressed in the attached articles: 1. It is safe & effective! 2. It is for BOTH boys and girls, and protects both against cancers of the cervix, vulva, vagina, penis, anus and oropharynx (back of the throat including base of the tongue and tonsils). 3. It does not promote earlier onset of sexual behavior in adolescents. 4. School-entry requirements are impactful in decreasing burden of HPV and cervical dysplasia. Legislators: Thank you for using your position on the public health committee to address cancer prevention. I urge you to protect Connecticut's children and adults against cancer with this immunization against human papilloma virus. SUPPORT HB-7199. Sincerely, Hannah G. Rosenblum, MD Testimony in SUPPORT of HB-7199: An Act Concerning Immunizations Against the Meningococcal Virus and Human Papillomavirus Hannah G. Rosenblum, MD March 13, 2019 Table of Contents for References Attached Below <CDC and ACIP Guidelines > 1. Petrosky E, Bocchini Jr JA, Hariri S, Chesson H, Curtis CR, Saraiya M, Unger E, Markowitz L. Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices. Morbidity and Mortality Weekly Report 2015; 64(11): 300-304. 2. Centers for Disease Control and Prevention: https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html <Efficacy and Population Level Impact> 3. D’Addario M, Redmond S, Scott P, Egli-Gany D, Riveros-Balta AX, Henao Restrepo AM, Low N. Two-dose schedules for human papillomavirus vaccine: Systematic review and meta-analysis. Vaccine 2017; 35, 2892-2901. 4. Luna J, Plata M, Gonzalez M, Correa A, Maldonado I, Nossa C, Radley D, Vuocolo S, Haupt RM, Saah A. Long-term Follow-up Observation of the Safety, Immunogenicity, and Effectiveness of Gardasil in Adult Women. PLoS ONE 2013; 8(12):e83431. 5. Markowitz LE, Liu G, Hariri S, Steinau M, Dunne EF, Unger ER. Prevalence of HPV After Introduction of the Vaccination Program in the United States. Pediatrics 2016; 137(2): e20151968. 6. Spinner C, Ding L, Bernstein DI, Brown DR, Franco EL, Covert C, Kahn JA. Human Papillomavirus Vaccine Effectiveness and Herd Protection in Young Women. Pediatrics. 2019; 143(2):e20181902. 7. Niccolai L, Meek JI, Brackney M, Hadler JL, Sosa LE, Weinberger DM. Declines in Human Papillomavirus (HPV)-Associated High-Grade Cervical Lesions After Introduction of HPV Vaccines in Connecticut, United States, 2008-2015. Clinical Infectious Diseases 2017; 65(6):884-9. 8. Brisson M, Benard E, et al. Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models. Lancet Public Health 2016; 1:e8-17. <Safety of HPV Vaccination, also International Data> 9. Arnheim-Dahlstrom L, Pasternak B, Svanstrom H, Sparen P, Hviid A. Autoimmune, neurological, and venous thromboembolic adverse events after immunization of adolescent girls with quadrivalent human papillomavirus vaccine in Denmark and Sweden: cohort study. BMJ 2013; 347:f5906. 10. Brotherton JML, Fridman M, May C, Chappell G, Saville AM, Gertig DM. Early effect of the HPV vaccination programme on cervical abnormalities in Victoria, Australia: an ecological study. Lancet. 2011; 377: 2085-92. Testimony in SUPPORT of HB-7199: An Act Concerning Immunizations Against the Meningococcal Virus and Human Papillomavirus Hannah G. Rosenblum, MD March 13, 2019 11. Machalek DM, Garland SM, et al. Very Low Prevalence of Vaccine Human Papillomavirus Types Among 18-35 Year Old Australian Women 9 Years Following Implementation of Vaccination. The Journal of Infectious Diseases. 2018; 217: 1590-600. 12. Arana JE, Harrington T et al. Post-licensure safety monitoring of quadrivalent human papillomavirus vaccine in the Vaccine Adverse Event Reporting System (VAERS), 2009- 2015. Vaccine. 2018; 36: 1781-1788. 13. Naleway AL, Mittendorf KF, Irving SA, et al. Primary Ovarian Insufficiency and Adolescent Vaccination. Pediatrics. 2018; 142(3):e20180943. <HPV Not Associated with Increased Sexual Activity> 14. Bednarczyk RA, Davis R, Ault K, Orenstein W, Omer S. Sexual Activity-Related Outcomes After Human Papillomavirus Vaccination of 11-to 12-Year Olds. Pediatrics. 2012; 130;798. <Public Health Data for Immunization School Requirements > 15. Barraza L, Weidenaar K, Campos-Outcalt D, Yang YT. Human Papillomavirus and Mandatory Immunization Laws: What Can We Learn From Early Mandates? Public Health Reports. 2016;131(5): 728-731. 16. Daley E, Thompson E, Zimet G. Human Papillomavirus Vaccination and School Entry Requirements. JAMA Pediatrics. 2019; 173(1);3327. 17. Thompson EL, Livingston MD, Daley EM, Zimet GD. Human Papillomavirus Vaccine Initiation for Adolescents Following Rhode Island’s School-Entry Requirement, 2010- 206. Am J Public Health. 2018; 108:1421-1423. <Social Media Spread of Misinformation and Fear Tactics> 18. Broniatowski DA, Jamison AM, Qi S. Weaponized Health Communication: Twitter Bots and Russian Trolls Amplify the Vaccine Debate.
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