But many people question the safety of a novel immunization for a novel virus, especially parents with young children. Moderna recently announced plans to begin testing its coronavirus vaccine in children between the ages of 12 and 17, while Pfizer and AstraZeneca began their pediatric trials in October.

We were able to talk to Jason Terk, M.D., physician at Cook Children’s Pediatrics Keller Parkway and a nationally known advocate for vaccines, who answered a few questions about the COVID-19 vaccine.

Tell us about the COVID-19 vaccine and why people should feel safe receiving it.

The vaccine is really showing a lot of promise because we've gotten data that shows that the efficacy (that's how well the vaccine works at protecting against COVID-19 disease), is much more effective than what we might've expected. We were hoping to get something around 70% and the two vaccinations that are being considered for emergency use authorization have efficacy of about 95%, which is really fantastic. I think that that bodes well for the potential of these vaccinations to make a real difference for us.

While trials in children are just beginning, should parents go ahead and get the vaccine?

Well, the quantity of vaccinations that we have available is going to be limited initially. The CDC, FDA and the state health departments are all working together to determine what priority groups need to be getting it first. The elderly nursing home population, healthcare workers, and first responders are going to be the first individuals recommended to get the vaccination. Obviously we need to protect the health care workers so that we can continue to do our jobs providing care to our patients. Unless you have some serious underlying health condition that makes you high risk for complications from COVID-19, you will not as a parent be among the first groups of individuals  recommended to get the vaccination. But once we have plenty of supply, I certainly encourage parents to get the vaccination for themselves.

When is the vaccine going to be available for children?

Trials in children are only just beginning. We need to prove that the vaccine is just as effective and just as safe in children because children are not little adults. We also need to make sure that it works as well for them too. I have no reason to expect that it will not be as effective for children. It's going to be important to stay tuned for that. Once the vaccine is available for myself, I'm definitely going to be in line to get it. And I am unreservedly optimistic about its impact for myself and for the rest of us.

What gives you that confidence that it is a safe choice for you to get the vaccine?

In medicine, we're data driven and we have really good data that shows its effectiveness, as well as what the safety profile is with the 30-40,000 individuals who were involved in the Phase 3 trials. Right now, what we've seen from a safety point of view, is that it is producing some side effects that are very similar to other vaccinations out there that are routinely recommended and they're fairly mild for most people. The two vaccinations that are currently under consideration for emergency use authorization require two doses. One of them requires two doses separated by 21 days. The other one requires two doses that are separated by 28 days. It appears that after that second injection, that maybe about half of the individuals have some side effects like achiness and, and maybe sore joints and, and some injection site soreness and things like that, but it doesn't last very long. It's generally gone after a few days. We've had the pandemic going on now for about a year. And we've had these vaccines that are under consideration now for about six months in the clinical trials. People in those clinical trials will be followed for at least 2 years to monitor for any problems. I have no reason to expect that there will be safety concerns.

Will children receive the same vaccine as adults?

Very good question. We won't really know the answer to that until the clinical trials are completed in children. Sometimes kids require lower doses of the same vaccination that we need to get as adults. And sometimes they get the same dose. What you're looking for is to get the desired therapeutic point of protecting against the disease at the lowest dose to minimize side effects. So that's what they'll be working on for kids too.

Should people who have already had COVID-19 get the vaccine?

So the current recommendations coming from the CDC is that prior COVID-19 disease should not be a determining factor about whether you should get the vaccine, because we do not know how long natural disease will give you immunity. It certainly gives you some protection for a period of time, but how long that lasts? We really don't know. Probably because of limited supply, individuals who were shown to definitely have had COVID-19 will probably not be the first ones that will be recommended to get the vaccination. That’s getting kind of ironed out right now and we'll get more specific information on those recommendations in the next several weeks I expect.

Where should people look for more information as they make the decision on getting the vaccine?

I think that it's important to talk about information and how people get information. Unfortunately, there is organized resistance against vaccinations generally, and against efforts to try to vaccinate the population against COVID-19 specifically. Consumers of this information need to know that that those sorts of agenda-driven organizations are working to prevent the end of the pandemic. We really need to be very careful and make sure that the things that we're reading or watching on social media are evidence-based. These vaccinations are going through the same – and even greater – rigorous processes and scrutiny that all the other vaccinations that we have gone through. I have every confidence that this is going to be a game changer for the human population. We all need to get vaccinated and support this challenging effort.

Are you hopeful that a COVID-19 vaccine can help end the pandemic?

Absolutely. This is our way forward to try to get back to normal. It's not going to be an immediate thing, but it's going to be a lot quicker now that we have such effective vaccinations. It will take some time for us to really get back to normal as we know it, but we're getting there.

For more information about vaccines and COVID-19, visit https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines.

For the latest on how COVID-19 is impacting kids and Cook Children’s work to protect them, visit the medical center’s newsroom at checkupnewsroom.com.

And only time will tell for sure, but some indicators lean toward a potentially severe influenza season.

Clinical experts in the U.S. watch the Southern Hemisphere of the world for signs of what might be in store for us in the north.

In Australia, where winter recently ended, the Department of Health reported the flu season arrived earlier than normal. Of special concern to the experts is the type of flu season seen in Australia – Influenza A (H3N2). H3N2 is a more dominant strain of the flu and causes more illnesses.

How effective the flu vaccine is depends on how well experts predict what strains of the flu will be circulating the globe that year.

“The vaccine strains are chosen about nine months before flu season, based on circulating strains from around the world by epidemiologists who are geniuses and do this for a living,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases.

Locally, the first case of flu (Flu B) was reported at Cook Children’s Medical Center two weeks ago. Last week, no one tested positive for either strain.

NBC News reports that one pediatric flu death has already been recorded in the U.S. – a 4 year old in California who had underlying health problems.

Jason Terk, M.D., a Cook Children’s pediatrician and a national expert on immunizations, adds his voice to other pediatricians and global health experts who say the flu vaccine remains the best way to prevent influenza.

“The great news about the vaccine is that even when it’s not always a perfect match for prevention, the flu vaccine can reduce the severity of the illness, even if you do catch the flu that season,” Dr. Terk said.

To make an appointment for your child’s flu shot, contact your Cook Children’s pediatrician. The vaccine is currently available in many offices and a second shipment will be delivered next week.

“It takes two weeks for the shot to become most effective. Because flu can hit as early as late October or early November, we recommend getting the flu shot as soon as possible and definitely before the end of October,” said Justin Smith, M.D., a Cook Children’s pediatrician.

More On This Topic:

• Flu Shot Appointments
• Influenza/Flu Information
• Let's Learn About ... The Flu
• How To Tell If It's Strep, Flu, Rotavirus Or Norovirus
• Comfort Menu to Ease Pain, Anxiety for Children Getting a Shot
• Is It a Cold or The Flu?
• Pediatricians Say Kids with Egg Allergies Should Now Get The Flu Shot

To identify the hot spots, researchers from the University of Texas at Austin and Johns Hopkins University looked at each area’s volume of international travel from foreign countries with large measles outbreaks and the prevalence of nonmedical exemptions from childhood vaccinations.

The same researchers previously predicted outbreaks in Washington, Oregon and New York which are all experiencing an influx of measles cases.

“For measles, most experts believe that there will be one to two deaths per 1,000 cases, most likely infants. We are set to see over 1,000 cases in the U.S. in 2019. So, for the first time since the 1980s, we may expect infant deaths from measles in the U.S.,” said the study’s lead author, Sahotra Sarkar, a philosophy and integrative biology professor at UT Austin and an expert on public health, in UT news. “We have long known that vaccine avoidance is a critical public health issue in the U.S. and Europe. Our results show how travel from regions elsewhere compounds this risk.”

The Texas Department of Public Safety has confirmed 15 measles cases in Texas this year, including one in each: Tarrant, Dallas and Denton counties and two in Collin County. Comparatively, Texas had nine measles cases in 2018 and only one in 2017.

Already this year, more than 760 cases of measles have been confirmed in the United States, the highest number in decades.

Physicians at Cook Children’s call this news frustrating because measles is a disease once thought to be all but gone from the planet. Texas has one of the highest rates of unvaccinated children in the U.S., partly due to a 2003 state law allowing parents to opt out of getting their children immunized for reasons of conscience.

“It’s not a coincidence that as we have seen more people hesitant to receive the vaccine, we have seen the number of measles cases increase nationwide,” said Justin Smith, M.D., a pediatrician at Cook Children’s. “The numbers are very concerning.”

Measles is a highly contagious respiratory illness spread by contact with an infected person through coughing and sneezing. Measles is so contagious that if someone has it, 90 percent of the people around that person who are not immune will become infected.

The Centers for Disease Control and Prevention (CDC) recommends children who are older than 12 months get two doses of MMR vaccine, starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age. Teens and adults should also be up to date on their MMR vaccination.

Two doses of the MMR vaccine are about 97% effective at preventing measles; one dose is about 93% effective.

"Populations who choose to not follow the recommended vaccine schedule are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," said Jason Terk, M.D., a Cook Children's pediatrician.

Other Texas counties to make the Top 25 were Harris at No. 9 and Travis at No. 22.

To learn more about where you can receive vaccines in the Tarrant County area, visit the Immunization Collaboration of Tarrant County website.

For More on This Topic:

• 25 U.S. Counties Identified as Most at Risk for Measles Outbreaks
• Vaccines and Immunizations
• Immunization Collaboration of Tarrant County
• Common Questions About Immunizations
• Why Children Like Olivia Need You to Immunize
• From Vaccine Hesitant to Pro Vaccines. Why This Mom Changed Her Mind.
• Pediatricians Remember Experiences with Measles
• What The First Measles Case in Tarrant County Means for Your Child
• 'Vaccines Are Safe and Effective'
• When It Comes to Your Kids It's Never Just a Virus
• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles In the Classroom
• MMR/thimerosal/mercury: What you should know

DCPH says no further information will be released to protect private patient confidentiality.

“Vaccination is the most effective way to prevent measles,” stated Dr. Matt Richardson, Director of Public Health in Denton. “Unfortunately, people think that measles is just a rash and fever but measles can cause serious health concerns, especially in young children, and is highly contagious. Vaccination is incredibly effective at protecting those we love from this infection."

This information comes only days after a national study published in the Public Library of Science, names Fort Worth as a hot spot for the anti-vaccine movement. Texas is one of 18 states that allows kids to opt out of vaccines as a philosophical exemption.

In the year 2000, the CDC declared that measles had been eliminated in North America and we thought we were well on our way to relegating measles to the trash heap of history. Now, thanks to declining vaccination rates, measles is making a comeback. Along with the cases in Texas, 55 people in Washington and neighboring Oregon have gotten sick with the virus.

So, since we are starting to see measles again, we thought it would be important for people to know a few things about this incredibly contagious disease from Jason Terk, M.D., a Cook Children's pediatrician in Keller and a nationally known advocate for vaccines:

1. Measles starts out looking like a bad cold with runny nose, cough, red and watery eyes, and high fever.
2. Two or three days after the initial symptoms begin, tiny white spots may appear in the mouth that are only seen with measles called Koplik spots.
3. Three to five days after the initial symptoms begin, a rash will appear as flat red spots on the face at the hairline and spread downward to the neck, torso, arms, legs and then feet. Small raised bumps may appear on top of the flat red spots.
4. The spots may become so numerous that they combine to create an overall red appearance to the entire body.
5. Fevers as high as 104° F will be present when the rash appears.
6. Measles is the most contagious infectious disease known and is spread by coughing and sneezing. The virus particles are suspended in the air for up to two hours where an infected person has coughed or sneezed.
7. If you are exposed to the measles and have not been vaccinated, you have a 90% chance of getting the measles.
8. A person with measles is contagious from 4 days before through 4 days after the rash appears.
9. One out of every 4 people with measles will be hospitalized.
10. One out of every 1000 people with the measles will develop swelling of the brain which can lead to brain damage and death.
11. One out of every 20 children with measles gets pneumonia which is the most common cause of death from measles in children.
12. For every 1000 children who get measles, one to two will die from it.

So, if you don’t want any of the above, get yourself and your child vaccinated! Tarrant County has been identified as a location where a measles outbreak is considered likely. Only we can change that!

Learn more on this topic:

• Measles Outbreaks Increase as Vaccination Rates Decrease
• Measles
• Vaccines and Immunizations
• Frequently Asked Questions About Immunizations
• Immunization Schedule
• Information for parents
• Talking to your child about immunizations
• What teens should know about immunizations

According to The Washington Post, the number of confirmed cases have been steadily rising from a handful last week to 23 cases on Tuesday, Jan. 22.

“The vast majority of those who had have fallen ill had not been immunized,” the Washington Post wrote.

While this news is alarming to health care officials, it does not come as a surprise. The World Health Organization (WHO) says the number of measles cases has grown 30 percent worldwide and that “vaccine hesitancy” is one of the top 10 threats to global health in 2019.

The WHO defines vaccine hesitancy as “the reluctance or refusal to vaccinate despite the availability of vaccines.”

The organization says vaccine hesitancy threatens to reverse progress made in tackling vaccine-preventable diseases that currently prevents 2-3 million deaths a year. But the WHO states a further 1.5 million could be avoided if global coverage of vaccines improved.

In New York, NBC News reports that an outbreak among Orthodox Jews has led to 177 cases. The Centers for Disease Control and Prevention states that 349 cases of measles were confirmed in 26 states in 2018, making last year the second-worst year for measles since 2000.

“Almost none of the cases had been vaccinated against measles,” NBC reports.

Measles is one of the most infectious viruses known to man and will infect 90 percent of unimmunized people who breathe it in. What frustrates health care providers is that the spread of this highly contagious disease can be contained.

And while the vaccine has been found to provide about 95 percent protection, a recent poll of Texas parents found 13 percent say they believe the risks of vaccines outweigh the benefits and 16 percent say they should be able to opt out of vaccinating their children.

Texas has one of the highest rates of unvaccinated children in the U.S., partly due to a 2003 state law allowing parents to opt out of getting their children immunized for medical reasons or conscientious and religious beliefs.

In an editorial in the Fort Worth Star-Telegram, Peter Hotez, M.D., director of the Texas Children’s Hospital Center for Vaccine Development, urged parents to provide immunization for their children, Dr. Hotez warned that “we are extremely vulnerable to a measles outbreak in Texas.”

Dr. Hotez identified Tarrant County and Fort Worth as national “hot spots” for a potential outbreak. A study co-authored by Dr. Hotez found that parents of at least 518 kindergartners in Tarrant County schools last year opted to not get preventive shots for their children.

“This news is frustrating to physicians and other health care providers because measles is a disease once thought to be all but gone from the planet. It’s not a coincidence that as we have seen more people hesitant to receive the vaccine, we have seen the number of measles cases increase nationwide,” said Justin Smith, M.D., a pediatrician at Cook Children’s. “The numbers are very concerning. In 2000, the United States declared that measles was eliminated from this country. Now, more and more kids aren’t getting immunized and diseases like measles have returned. Measles is very serious and can cause pneumonia. Children under the age of 5 have a higher risk of hospitalization.”

Keeping vaccination rates relatively high (somewhere around 90 percent) helps protect all children (vaccinated or not) from diseases, Dr. Smith said. In addition, when outbreaks occur, even children who are vaccinated become at risk for contracting disease due to the number of possible exposures.

"Populations who choose to not follow the recommended vaccine schedule are actually setting up the perfect conditions for the diseases they are unvaccinated for to erupt into an outbreak. It is really not a question of whether these outbreaks will occur but when," Jason Terk, M.D., a Cook Children's pediatrician.

Learn more:

Measles

Vaccines and Immunizations

Frequently Asked Questions About Immunizations

Immunization Schedule

Doctors agree that nothing fights off the flu better than the vaccine, including all children 6 months and older.

And thanks to  recommendations, based on research, that includes children who are allergic to eggs.

A study by the Centers for Disease Control and Prevention (CDC) found the rate of anaphylaxis after all vaccines is 1.31 per one million doses given.

Based on guidelines from the CDC and the American Academy of Pediatrics, people with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine. It is now recommended that people with a history of severe allergic reaction to egg (any symptom other than hives) can now be vaccinated in an inpatient or outpatient medical setting, under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.

"All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines," the AAP wrote in the September 2018 edition of Pediatrics as part of its "Recommendations for Prevention and Control of Influenza in Children, 2018-2019."

Backing up the AAP and CDC, is new research in the Annals of Allergy, Asthma and Immunology, which found the flu shot to be safe and recommended its use for people who are allergic to eggs.

Jason Terk, M.D., a Cook Children’s pediatrician, said previous recommendations on egg-allergic individuals not receiving a flu vaccine were based on the fact that most of the flu vaccine currently available is created from viral cultures in chicken embryos. Experts theorized there was a risk because of the concern that small amounts of the egg that the viral cultures come from could end up in the vaccine.

“After years of study and observation, it was found that no significant increased risk for reactions occur in egg-allergic people,” Dr. Terk said. “The recommendation to avoid flu vaccine for egg-allergic people has been removed. No medical intervention is without risk. But the risk of influenza and the complications arising from it far exceed the infinitesimal risk of influenza vaccination.”

If you have concerns, Dr. Terk said your pediatrician should be happy to answer questions about your child and why the flu vaccination should be given.

A new study shows that health providers are less likely to offer the Human papillomavirus (HPV)

The research was presented at the Annual Meeting of the Society of Gynecologic Oncology in New Orleans on March 24 and was taken from NIS-Teen, a national survey which collects data from parents to adolescents aged 13 to 17 years old to track vaccination rates in the United States.

ABC News reports the most recent statistics from 2016 show about 65 percent of girls had started the HPV course, only 56 percent of boys had.

The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. The CDC recommends that 11 to 12 year olds receive two doses of HPV vaccine at least six months apart.

HPV infection can cause cervical, vaginal and vulvar cancers in women and penile cancer in men. HPV can also cause anal cancer, throat cancer and genital warts in both men and women. Boys are especially vulnerable to throat cancer.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Jason Terk, M.D., a pediatrician at Cook Children’s, says vaccination rates for HPV are comparatively lower than other adolescent vaccines primarily because parents don’t perceive that their teens' physicians strongly recommend it. And, physicians may not provide a definitive endorsement of the HPV vaccine because they incorrectly believe they will meet resistance from the parents of their teen patients.

Dr. Terk has taken steps to improve the HPV rates among Cook Children’s 27 primary care practices by providing educational sessions showing how pediatricians can improve their vaccination rates

Dr. Terk has received national attention for calling HPV vaccination rates an “epic fail.”

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

HPV is so common, in fact, that the journal JAMA Oncology reported in January that nearly half of American men may have an HPV infection known to cause cancer. This is based on a study of 1,868 men, ages 18 to 59. Among the group, only 10.7 percent were vaccinated against HPV while 45 percent reported having genital HPV.

Girls had a head start on HPV vaccinations. The vaccine was approved by the FDA for use in girls in 2006 and for boys three years later. 

The study shows that work still needs to be done to raise awareness about the dangers of HPV and how to prevent an infection with the highly effective HPV vaccine. Dr. Terk said that's one of the reasons why boys are lagging behind girls in HPV vaccine rates. He also said there's a public consciousness about HPV causing cervical cancer, but many people aren't generally aware or understand that HPV vaccination is just as important for males. He said that many haven't connected the increase in head and neck cancer is caused largely due to HPV infection.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s what Dr. Terk wants parents to know: HPV infection can be prevented.

The vaccine is most effective when given in early adolescence.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends."

So why aren’t more people getting this vaccine?

According to NPR, a new analysis from the Blue Cross Blue Shield Association found only 29 percent of the teens its members insure receive a first dose of the human papillomavirus (HPV) vaccine by their 13^th birthday. The CDC found that nationally only 43 percent of teens are up-to-date on all the recommended doses of the vaccine.

Another recent study found that Texas ranks 47^th in the cancer-preventing vaccine. Out of the 50 states and the District of Columbia, Texas only ranked higher than Utah, South Carolina, Wyoming and Mississippi for HPV vaccination coverage.

“A simple vaccination can mean the difference between getting a deadly cancer or not. Unfortunately, not enough people are getting the importance of this message,” said Jason V. Terk, a Cook Children’s pediatrician.

HPV infection can cause cervical, vaginal and vulvar cancers in women and penile cancer in men. HPV can also cause anal cancer, throat cancer and genital warts in both men and women.

The HPV vaccine is recommended for preteen boys and girls at age 11 or 12 so they are protected before ever being exposed to the virus. The CDC recommends that 11 to 12 year olds receive two doses of HPV vaccine at least six months apart.

Teens and younger adults who start the series later, at ages 15 through 26 years, will need three doses of HPV vaccine to protect against cancer-causing HPV infection.

The Texas System Offices of Health Affairs states that about 90 percent of men and 85 percent of women in the United States will contract HPV at some point in their lives. HPV is the most common sexually transmitted virus in the United States. Most sexually active people will have genital HPV at some time in their lives.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

Dr. Terk wonders if there’s a disconnect when parents think about their child receiving the HPV vaccination.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s what Dr. Terk wants parents to know: HPV infection can be prevented.

The vaccine is most effective when given in early adolescence.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends.”

More Resources:

• Vaccines and Immunizations
• HPV Vaccines: Vaccinating Your Preteen or Teen
• What is HPV?
• HPV Questions and Answers
• CDC approves 2-dose HPV vaccine schedule

Once school was back from the Christmas break, kids returned to share their germs with one another. To make things worse, the brutally cold weather when they got back ensured that everyone stayed in an enclosed environment. All a perfect storm to see our flu numbers climb higher.

“We typically see an uptick in flu a couple of weeks after kids go back to school following the winter break,” said Jason Terk, M.D., a pediatrician at Cook Children’s in Keller. “Right now, we are seeing an increase in Flu B, but still see plenty of Flu A cases. Our patient volumes are still very high.”

Last week, 403 flu cases were confirmed at Cook Children’s, up from 345 the week prior. What makes this week different is the amount of Flu B cases seen. Last week saw 104 confirmed Flu B cases, up from 60 a week earlier.

“It’s expected that Flu B will follow or peak after Flu A, but it’s still earlier than expected this season,” said Morgan A. Pence, Ph.D., clinical microbiologist at Cook Children’s. “This is the earliest we’ve seen Flu B in the last four flu seasons and it looks like Flu A and B are overlapping more this year than in the past.”

The good news is that Flu B is usually less severe than Flu A. The bad news is it means a continuation of a flu season that is already looking to be the worst since the 2014-2015 season. The Centers for Disease Control and Prevention reports the death of 30 children nationally as a result of the flu.The CDC stated that all U.S. States except Hawaii have reported widespread flu activity.

“It’s important for people to take care of themselves and others to prevent the spread of the flu as much as possible,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Disease. “The flu vaccine continues to be recommended for everyone 6 months of age and older. Make sure to practice washing your hands and please keep your children home if they are sick.”

Out of 50 states and the District of Columbia, Texas only ranked higher than Utah, South Carolina, Wyoming and Mississippi for HPV vaccination coverage, according to researchers at The University of Texas System and UT Health Northeast. HPV is the most common sexually transmitted infection and is responsible for 90 percent of cervical cancer cases as well as thousands of oral cancer cases each year.

The study found that only 39.7 percent of females and 26.5 percent of males in Texas between the ages of 13 and 17 were up-to-date with the vaccine in 2016. The national average was 43.4 percent.

“This study is particularly frustrating because a routine vaccine recommended by the CDC and other leading health organizations around the world can prevent HPV,” said Jason V. Terk, a Cook Children’s pediatrician. “A simple shot can mean the difference in life and death. Unfortunately, most Texans are not getting the importance of this message.”

The Texas System Offices of Health Affairs states that about 90 percent of men and 85 percent of women in the United States will contract HPV at some point in their lives.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Waiting until you think HPV is a risk is too late. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s the good news that Dr. Terk wants parents to know: HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9.

"This is a relevant issue for all parents,” Dr. Terk said. “We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends.”

The study, published in the journal of Annals of Internal Medicine, states 11 million (one in nine) U.S. males were found to have oral HPV. The research was done between the years 2011 and 2014.

While most people with HPV don’t develop symptoms or health problems, the Centers for Disease Control and Prevention (CDC) says HPV causes 30,700 cancers in men and women, inlcuding 6,479 cancers of the back of throat, including the base of the tongue and tonsils in both men and women.

Jason Terk, M.D., a Cook Children's pediatrician in Keller, says vaccination rates for HPV are comparatively lower than other adolescent vaccines primarily because parents don’t perceive that their teens' physicians strongly recommend it.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

HPV is so common, in fact, that the journal JAMA Oncology reported in January that nearly half of American men may have an HPV infection known to cause cancer. This is based on a study of 1,868 men, ages 18 to 59. Among the group, only 10.7 percent were vaccinated against HPV while 45 percent reported having genital HPV.

The recent studies show that work still needs to be done to raise awareness about the dangers of HPV and how to prevent an infection with the highly effective HPV vaccine.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Unfortunately, waiting until HPV is contracted is not an option. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

That’s the good news that Dr. Terk wants parents to know: HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9.

"Only 34 percent of adolescents in the U.S. have received the HPV vaccine series. Here in Texas, that number drops to 33 percent," said Jason Terk, M.D., a pediatrician at Cook Children’s. "This is a relevant issue for all parents. We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends. "

Jason Terk, M.D., a pediatrician at Cook Children’s, has received national attention for calling HPV vaccination rates an “epic fail.” Now, he’s steering a plan to improve HPV vaccination rates for pediatricians in each of Cook Children’s 27 primary care practices.

Using the reporting capability of the electronic medical record at Cook, Dr. Terk will calculate the HPV vaccination rate of each primary care pediatrician’s and practice’s 12-14 year old patients. Then, half of those pediatricians and practices will be given an educational session showing how they can improve their vaccination rates while the other half will serve as a control group.

The goal is to get more patients between the ages of 12 and 14 vaccinated against HPV.

“We will help lay out an action plan for the practices and set a goal of increasing vaccination rates by 10 percent over six months,” Dr. Terk said.

The physicians will then be given a progress report after 3 months.

“We will compare the vaccination rates between the group who received the educational sessions and those that did not both at 3 months and 6 months to measure the effectiveness of the educational sessions and action plan,” Dr. Terk said. “If the process improves vaccination rates, we will spread the education throughout the system with the goal of providing the best care for all of our patients.”

Vaccination rates for HPV are comparatively lower than other adolescent vaccines primarily because parents don’t perceive that their teens' physicians strongly recommend it. And, physicians may not provide an unequivocally affirmative endorsement of the HPV vaccine because they erroneously believe they will meet resistance from the parents of their teen patients.

Across the country, the number of children who receive the HPV vaccine is very low compared to other vaccines they are scheduled to receive at the same time. This is despite the fact that meningitis and pertussis are much less common than HPV.

HPV is so common, in fact, that the journal JAMA Oncology reported in January that nearly half of American men may have an HPV infection known to cause cancer. This is based on a study of 1,868 men, ages 18 to 59. Among the group, only 10.7 percent were vaccinated against HPV while 45 percent reported having genital HPV.

The study shows that work still needs to be done to raise awareness about the dangers of HPV and how to prevent an infection with the highly effective HPV vaccine.

“One of the major problems with HPV is that it may be 20 or 30 years before a person develops cancer due to an infection that happens in the teen years,” Dr. Terk said. “Unfortunately, waiting until HPV is contracted is not an option. We have to make every effort to provide our patients the HPV vaccine so we can put an end to the thousands of teens who move through Cook Children’s without ever gaining this indispensable protection.”

New recommendations from the Centers for Disease Control and Prevention (CDC) requires only two doses of the vaccine spread over six months for younger teens 11-14 years of age. The Advisory Committee on Immunization Practices (ACIP), the body that formulates recommendations on how the vaccines which are licensed by the FDA should be used in this country, voted for the change.

The ACIP says older teens and young adults, ages 15 to 26, will still need three doses because they don’t have as robust a response as younger teens.

“This is good news because it will mean that more younger teens can be considered fully vaccinated if they complete their series of two doses over six months prior to their 15th birthday,” said Jason V. Terk, a Cook Children’s pediatrician in Keller and someone who has been at the forefront of HPV vaccination efforts. “Fewer doses means better compliance with this important cancer-preventing vaccine.”

Under the new schedule, the first of two doses of the HPV vaccine should be administered at 11 or 12, although it could be given as early as 9, as under the previous guidance. The second dose would be administered six to 12 months after the first dose.

According to the CDC, about 80 million Americans are infected with HPV; in most cases, the immune system clears the infection. Still, more than 38,000 cases of HPV-associated cancers occur in the United States every year.

Related Articles

• Early evidence HPV vaccine is working
• HPV Raises Risk of Head and Neck Cancer Sevenfold
• 'Epic fail
• Cook Children's Keller Clinic
• What is unique about pediatric leadership?

About the Source

Jason Terk, M.D., is a Cook Children's pediatrician in Keller. He earned his medical degree from University of Texas Medical Branch in Galveston, Texas. He completed his residency in pediatrics at Mayo Graduate School of Medicine (Mayo Clinic) in Rochester, Minnesota. His interests include public policy advocacy for children's health issues, focusing primarily on vaccines. Dr. Terk is board-certified in pediatrics.

Listen to episode 2 of Cook Children's podcast - Pediatric Leadership: The New Medicine.

Questions addressed:

1. Have you noticed differences in leading in or advancing pediatric issues?
2. What are some particular challenges in pediatric leadership?
3. Moving forward, what are some particular issues in pediatrics where we need strong leaders to step in and lead?

Important links:

Texas Pediatric Society

Texas Medical Association

“Future pediatric leaders are waiting to step forward and it’s a matter of responding to the tap on the shoulder, the encouragement of a colleague to get involved.” – Jason Terk, M.D.

Jason Terk, MD-Cook Children’s Keller

Read Dr. Terk’s article about low HPV vaccination rates-Epic fail

Subscribe for series on iTunes

Download/Listen to MP3

Listen to episode 1 here. 

In a study that was released early online from the journal Pediatrics, researchers looked at the percentage of girls aged 14-19 years were infected with the types of human papillomavirus (HPV) contained in the HPV vaccine in the years 2003-2006 and compared that to the percentage of 14-19 year old girls infected with the types of human papillomavirus (HPV) contained in the HPV vaccine in the years 2009-2012.

They found that the rate of infection in the years prior to routine vaccination in this group of girls was 11.5 percent. That percentage dropped to 4.3 percent in the years following routine recommendation of a vaccine. This is a rather remarkable finding given the relatively small numbers of girls who had received the full 3-dose series of the HPV vaccine.

It further illustrates how well this vaccine protects against such an important infection that can cause cancer in later years. This evidence of early success will likely lead to even more important measures of success with decreased numbers of women having abnormal pap smears that indicate cervical dysplasia and ultimately decreased numbers of cancers.

Imagine how much better it will be when we improve the numbers of teens getting this important vaccine!

Jason V. Terk, M.D.

According to researchers at Albert Einstein College of Medicine in New York, HPV raises the chances someone will get head and neck cancer by at least sevenfold.

For their study, 96,000 people took a mouthwash test for oral HPV infection. Four years later, 132 of them developed some form of head and neck cancer. People infected with a strain called HPV-16 were between two and 22 times as likely to be in the cancer group.

"This study backs up knowledge we already have about how common HPV is and how significant its association with cancer is," said Jason Terk, M.D., a pediatrician at Cook Children's primary care location on Keller Parkway. "HPV is an infectious disease and we all need to be concerned."

By the year 2020, experts believe head and neck cancer will surpass cervical cancer as the most common cancer caused by HPV.

But there is good news. HPV can be prevented.

The FDA has approved vaccines that prevent the HPV strains that are associated with cancers of the cervix and head and neck. Boys and girls can begin the vaccination process as early as age 9. And a new version of HPV vaccine, approved earlier this year, has even more cancer protection.

"Only 39 percent of adolescents in the U.S. have received the HPV vaccine. Here in Texas, that number drops to 33 percent," said Dr. Terk. "This is a relevant issue for all parents. We have a vaccine that can prevent cancer. Parents should start the vaccination process as soon as their pediatrician recommends. "

Some parents may feel uncomfortable talking to their children about the HPV vaccine. For those parents, here's Dr. Terk's advice:

• Explain that the vaccine protects against a very common infection that causes cancer

• · Most people (80%) will get infected with the types of HPV that can cause cancer

• · HPV vaccination equals cancer protection

• · It is best to get the vaccine at 11-12 years of age with the other adolescent vaccine; it works best at this age.

Also good to remember, research shows that youth who receive the HPV vaccine are not more likely to have sex. 

About the Source 

Jason Terk, M.D., earned his medical degree from University of Texas Medical Branch in Galveston, Texas. He completed his residency in pediatrics at Mayo Graduate School of Medicine (Mayo Clinic) in Rochester, Minnesota. His interests include public policy advocacy for children's health issues, focusing primarily on vaccines. Dr. Terk is board-certified in pediatrics.

“Epic fail.”

A couple of years ago, this was the phrase that my teenage son used as I unsuccessfully attempted to beat him in a game we were playing. At the time, I thought to myself that it was a harsh but accurate assessment of my performance. And, I was certainly motivated to practice on my own so that the next time, things would be different.

That same phrase came to mind as I read through an alarming article of interest to physicians. The article, published in Cancer Epidemiology, Biomarkers & Prevention is titled Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey.

Bottom line: Physicians (primarily pediatricians and family physicians) do poorly in providing the Human Papillomavirus (HPV) vaccine to patients.

Another source, the most recent National Immunization Survey-Teen for the year 2014, reports another alarming trend. The survey shows the number of patients who start the shots – and also complete them – lags far behind what it should be. (The HPV vaccine is given as a series of shots.)

So, it came as no surprise to me that the first article clearly showed what I have suspected for some time and which has been hinted at by previous studies. The epic failure in providing what is essentially a cancer-prevention vaccine to the recommended population of 11-12 year old boys and girls lies not at the feet of the anti-vaccine movement or hesitant parents. Rather, the failure belongs to we physicians!

The article describes findings from an online survey sent to 2368 pediatricians and family physicians in 2014. The 776 respondents self-reported their own performance on strength of four criteria: Endorsement (how strongly they recommend the vaccine); timeliness (whether they recommend it at 11-12 years of age, which is the most beneficial age); consistency (recommending it routinely vs using a risk-based approach); and urgency (whether they recommend the patient receive the vaccination that day). More than a quarter stated they did not strongly endorse the HPV vaccine, and a similar number reported that they did not recommend it be given at 11-12 years of age. Amazingly, 59 percent said they used a risk-based approach versus a routine approach to recommending the HPV vaccine, and only half of the respondents recommended giving the vaccine then and there, while the doctor discussed the HPV vaccine with the patient and parent. And these results represent a best-case scenario because respondents would be unlikely to paint an unflattering picture of their own performance.

Clearly, we have a major problem with physicians struggling with their own discomfort in talking about the HPV vaccine and who erroneously believe parents do not value it. Physicians who can’t communicate the importance of this cancer-preventing vaccine in turn fail to recommend it, which is so important to protect our patients. We are at risk of being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. Only we physicians can fix what it wrong with us: Only we can reverse this epic failure!