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Ault Appointed to Federal Immunization Committee

March 19, 2019

Kevin Ault, MD
Kevin Ault, MD

Kevin Ault, MD, member of The University of Kansas Cancer Center and professor and division director in the Department of Obstetrics and Gynecology, has been appointed to the Advisory Committee on Immunization Practices (ACIP) by Health and Human Services Secretary Alex M. Azar II. This federal committee is part of the Centers for Disease Control and Prevention and formulates vaccine policy for the United States. Dr. Ault will serve a four-year term.

“It’s an incredible honor to be appointed to this committee, which has an important role providing advice and guidance on the control of diseases preventable by vaccines,” Dr. Ault said.

Individuals comprising ACIP’s 15-member committee are experts in a variety of fields including vaccinology, immunology, pediatrics and internal medicine. Dr. Ault’s career has centered around the human papillomavirus (HPV) vaccine, which protects against HPV-related cancers, including cervical, anal, oropharyngeal (middle throat) and other genital cancers. About 14 million people, including teens, become infected with HPV each year.

“Over the last 10 to 12 years, cervical cancer rates have slowly gone down. That is partially due to uptake of the HPV vaccination,” Dr. Ault said. “In recent years, however, the incidence of another HPV-related cancer has increased – head and neck cancers, particularly among men.”

Dr. Ault anticipates that ACIP will explore the epidemiologic factors affecting this phenomenon, as well as evaluate new HPV vaccine data. Research data on a possible new vaccination for RSV (respiratory syncytial virus) will be another area of focus.

Previously, Dr. Ault had been the liaison member from the American College of Obstetricians and Gynecologists to the ACIP. He is the second OB-GYN to be appointed to this committee in the past 50 years.

HPV Related Cancers

Roy Jensen, MD, talks with Kevin Ault, MD, about recent advances with the HPV vaccine and HPV-related cancers.

Dr. Roy Jensen: Welcome to #BenchToBedside, a weekly series of live conversations about recent advances in cancer from the research bench to treatment at the patient's bedside. I'm Dr. Roy Jensen, Director of the University of Kansas Cancer Center and with me, is Dr. Kevin Ault, Division Director of General Obstetrics and Gynecology and a liaison member of the advisory committee on immunization practices for the CDC. Kansas and Missouri hold a fairly dubious distinction, which is costing people lives. Both states have among the lowest vaccination rates in the country for Human Papillomavirus or HPV, but there is new research to talk about that should make all parents feel more empowered to protect their kids. We'll get to that in a moment. But first, hear what one mom and patient had to say about her HPV-related cancer.

Tina Hillhouse: I ended up doing radiation, no chemotherapy. It was the worst year of my life. I had the horrible burn and then ended up ... the radiation blew a hole right through my jawbone under a back molar. Course, the tooth died. The worst was after they pulled the tooth and I was left with exposed bone, which turned into a bone infection and that is the most horrific thing I've ever been through in my life. I just thank my lucky stars that I'm here and that I get to live life cancer-free and I get to be here for my daughter. I certainly don't have the energy and strength that I did before, but I'm here. I can't believe that it's out there. I mean, that we actually have a vaccine to prevent a cancer. It's a dream come true and why a parent would not prevent against a cancer is beyond me.

Dr. Roy Jensen: HPV infection does not discriminate. But, how common is it in the population?

Dr. Kevin Ault: Think the best data from some of the people at the CDC is that about 80 or 90% of us are going to get an HPV infection sometime during our adult life. It is a sexually transmitted infection, but it's really spread by skin-to-skin contact. It doesn't take intercourse to spread it. It's incredibly common. Most people get infected in their teens and 20s.

Dr. Roy Jensen: What types of cancers are caused by this virus?

Dr. Kevin Ault: Well, there's four or five cancers. I'm a gynecologist, as you said during the introduction, so I always think of cervical cancer. Cervical cancer is about 12,000 cases a year in the United States. It's almost exclusively caused by human papillomavirus infection. There are other gynecological cancers that are much rarer; vulvar and vaginal cancer. There's a rare male cancer; penile cancer, but the cancer that's gonna be number one in the next few years is the head and neck cancer and that disproportionately affects males. Anal cancer is both genders. It's about equal between males and females, but the story is gonna change in the next two or three years. Cervical cancer rates are slowly drifting down and ENT head and neck cancers are going up, HPV-related. It's gonna change.

Dr. Roy Jensen: So there is a cancer vaccine to guard against HPV-related cancers and new research is showing that the vaccine really works. Could you tell us about that research?

Dr. Kevin Ault: There's some brand new, preliminary research from Finland. In that country, was involved 10 or 15 years ago in the very beginning of the clinical trials that led to the vaccine we have now. What they've done is linked their national cancer registry to the people who got involved in the trial and have been following them for 10 or 15 years. Based on this preliminary data, there are zero head and neck, anal, HPV-related cancers, cervical cancers, in the women that got vaccinated. They're following about 4000 women who are vaccinated and about 15,000 people who didn't. They're beginning to have HPV-related cancers in the unvaccinated group, but in the vaccinated group, the number is zero. It's a pretty amazing number. I think that's the first data we have that HPV vaccine prevents cancer, and I think it's also the first data we have that the HPV vaccine prevents head and neck cancer.

Dr. Roy Jensen: That's amazingly effective. If you're just joining us, we're talking about HPV and why it is important to have your children vaccinated. Pauline is here in the studio to take your questions, and remember to share this link with people you think might benefit from our discussion and use the hashtag #BenchToBedside. Exactly how the HPV vaccine work?

Dr. Kevin Ault: It is a surface protein. It's what's on the outside of the virus. We manufacture that in a factory basically. There are multiple types of HPV. The current one that's in the United States, the second generation vaccine protects against nine different types. If you're lucky and you get this vaccine on time when you're an 11-year-old, you only need two shots. Those shots can be given a year apart. That's a relatively new recommendation. When I've talked to our colleagues in pediatrics, they love that recommendation, 'cause they can see them for a pre-school physical two years in a row and get that vaccine in. The older dosing; the dosing for people who are older than 15 when they start their series is three doses. It's been proven to cause antibodies is how we think it works and be very effective.

Dr. Roy Jensen: Exactly how effective is it?

Dr. Kevin Ault: Well, since this is #BenchToBedside, I've been involved in this research for a couple of decades. The most recent study that we published looked at this new version of the vaccine and it was about 97% effective against diseases caused by the types that were in the newer version of the vaccine. We think we could prevent more than 90% of cervical cancers. Most of the head and neck, anal cancers, other cancers I mentioned, are due to a specific type of HPV called HPV 16. There's less variety in the non-cervical disease so we're guessing more than 90% of these HPV-related cancers are gonna be prevented.

Dr. Roy Jensen: Who should receive the HPV vaccine?

Dr. Kevin Ault: Well, there's a recommendation for young teenagers, young adolescents, 11 to 12-year-olds get a series of vaccines. One of them is a whooping cough booster. The other one is a meningococcal meningitis vaccine, flu vaccine of course is recommended universally in that age group, and then the other vaccine is the human papillomavirus vaccine.

Dr. Roy Jensen: Do children really need to be vaccinated especially when they're not sexually active yet?

Dr. Kevin Ault: Well, I mean, I got my flu shot back in August. I don't know when you got your flu shot, but now we're here three or four months later in the middle of a horrible flu season. We usually try to give vaccines before the exposure starts. Certainly, 11 and 12-year-olds are not going to be exposed to a sexually transmitted infection, but as I said previously, 80 or 90% of them are. You're also lucky when you're 11 or 12 years old. Not only can you get the two doses, you have a great immune response to those two doses and it'll probably carry you for at least a decade based on the research that we've done.

Dr. Roy Jensen: Some parents have a fear that by providing HPV vaccine to their kids, that will essentially be a green light to engage in sexual activity. What do studies show about that issue?

Dr. Kevin Ault: There's at least eight or 10 well-done studies. We did one when I still lived in Atlanta that looked at that. I think the short answer is there's no difference. The study we did was small, and we followed women forward from an early age from 11 to 12 years old, but there are larger and better done studies that look at a wider age range, different countries, different cultures, but they all have a very consistent result that that's not what happens.

Dr. Roy Jensen: If you're just joining us, we're talking about HPV because 79 million Americans are infected. Every year, 14 million more are newly infected. The CDC says HPV is the most common sexually transmitted infection. Every year in the United States, 39,800 people will get a cancer caused by HPV. By 2020, HPV-related head and neck cancers will outnumber cervical cancer cases. That is why it is important to have your children vaccinated. Pauline, do we have a question from our audience yet?

Pauline: We do. We have one question from Lindsey [Leaseman 00:09:42], who just joined the conversation. She is asking, "When will the series officially go from three shots to two?"

Dr. Kevin Ault: Well, it already has for the target population that we're aiming at, the 11-year-olds. You can give the two series. That was maybe about two years ago. I think it was the beginning of the year or two years ago, so that's a brand new recommendation that should be implemented in family doctors' offices, pediatricians' offices.

Dr. Roy Jensen: Is HPV vaccination safe and effective, and are there any long-term side effects that result from this vaccine?

Dr. Kevin Ault: We've talked about the effectiveness, but the safety data is very good as well. There is a nice study in a journal called Drug Safety done by an Australian group that's been looking at this for a long time. There are 109 studies that look at vaccine safety that they did in this big review article, and very consistently found that HPV vaccine was safe. It wasn't related to autoimmune problems or neurological problems. January was cervical cancer awareness month, so last year there was a lot of stuff on social media and in publications. Forbes magazine had a very nice publication just a week ago at the end of January. There's a lot of bad information on social media, that this causes problems as far as autoimmune and neurological diseases, and the research just doesn't bear that out.

Dr. Roy Jensen: Any final questions from our audience?

Pauline: We do. We actually have three questions. The first question is from

Rachel: "If a child missed the optimal timeframe for receiving the vaccine, should they receive the vaccination now? How old is too old to get it?"

Dr. Kevin Ault: That is a very good question and the answer is 26. The vaccine is approved up to age 26. I give this vaccine pretty routinely and that's a population that comes to see a gynecologist. We can get insurance to pay for it up to age 26 'cause that's been the recommendation since the vaccine's been around for about 10 years, that women and men in their 20s and late teens have to get three doses is the only bad part of that.

Dr. Roy Jensen: A question I had, Kevin, is do we have any idea how long the vaccine is effective for?

Dr. Kevin Ault: I've done a little bit of research in that, and that finished study I think it's probably gonna be the best data. At least a decade, so I think the encouraging thing about that too, is the other two vaccines I mentioned a little bit earlier, the whooping cough and the meningitis vaccine; we figured out that they were gonna need boosters within about five years of that, but the HPV vaccine doesn't look like it's that way. It looks like it carries forward at least 10 or 15 years. We first started giving this vaccine to humans 10 or 15 years ago, so we don't have any data beyond that, but I think the news is good. If you're giving it to 11-year-olds, you're getting them through the peak years that they might get infected and then the pre-cancerous condition ... I'm thinking like a gynecologist here, but the pre-cancerous condition is late 20s and early 30s and then cervical cancer is really a young woman's disease. The peak age would be in the early 40s in the United States.

Dr. Roy Jensen: Any more questions, Pauline?

Pauline: Yes, we have a few more. You've already touched on the stigma associated with the vaccine. Can you lend some advice on best practices in talking with patients who have this stigma about why their child should be vaccinated?

Dr. Kevin Ault: That is another very good question. I speak to the medical students here about this and to a certain extent, I said this in on us. This is on providers 'cause you really need to make it clear that you recommend this vaccine. I usually tell people I give it to my own daughters if it comes up, and it's cancer prevention. That's really what parents relate to when they're in that pre-adolescent year. There's very good research on that and the women who are older who come and see me, they've had friends who've had abnormal pap smears or pre-cancerous disease, so cancer is really what we need to emphasize is what it boils down to.

Pauline: I have one more question from

Stacy: "Do I understand correctly that young adults may carry HPV without symptoms, risking unknowingly spreading it to others?"

Dr. Kevin Ault: Absolutely. Of women that get HPV 16, the one I mentioned previously that's the worst type; only about 10 or 15% of women are gonna have an abnormal pap smear, so men of course, are not getting pap smears, so they were spreading around asymptomatically all the time. Really a very small minority of people will get a clinical disease, something that will come to the attention of a gynecologist.

Dr. Roy Jensen: Dr. Ault, do you have any final thoughts for our audience before we close out?

Dr. Kevin Ault: Well, I wanted to go back to that last question about the way doctors talk to patients about this, and I think since you're the director of our cancer institute, we really need to emphasize that this is a cancer vaccine. Tina, the woman that talked at the beginning, and I have done some programs together. Her daughters are the same age as my daughters. A few years ago when we saw that the vaccine rates were flattening out, we figured there would be about 57,000 more cancers in that cohort of a group of people like my daughters, who are the peak of their health, at the peak of their abilities, but we're gonna lose tens of thousands of those young men and women to cancer that we could've prevented by raising our vaccine rates now.

Dr. Roy Jensen: Thank you, Dr. Ault. Thank you for watching. Please join us next week when we were gonna have a team talking about our Cardio Oncology program at the KU Cancer Center and how we're working to minimize the damage that chemotherapy can have on a cancer patient's heart. Please join us Wednesday at 10:00 a.m. to learn about cardio oncology. Thank you and goodbye.

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