18,000 Waterloo region students need to be vaccinated against HPV, hep B after pandemic delays

Waterloo's public health unit is more than a year behind on its standard vaccinations — part of the province's program for Ontario students — with a backlog of about 18,000 Grade 7, 8 and 9 students in the region who now need to get caught up, CBC News has learned. 

The province's school-based program inoculates Grade 7 students against three infections:

• Human papillomavirus (HPV).
• Hepatitis B.
• Meningococcal meningitis. 

In a typical year, students are given two shots: one in the fall and one the following spring. The last time the shots were administered was in 2019, said Kristy Wright, manager of vaccine preventable disease for Region of Waterloo Public Health. 

"We estimate that it's approximately 18,000 students — so that's a lot of students," Wright told CBC Kitchener-Waterloo. 

"The program was interrupted in 2020 as a result of the COVID pandemic," she said. "Public health resources were redeployed to the COVID response, so that's where we've been for the last two and a half years."

Catch-up clinics to start in November

Waterloo region isn't alone.

The City of Hamilton's public health unit also suspended its school-based vaccine program in March 2020, due to the COVID-19 pandemic response.

According to Public Health Sudbury and Districts, it administered just 1,237 doses in 2020, down from 3,325 doses in 2019 — a drop of more than 60 per cent. 

Wright said she's met with public health units across the province during the pandemic and many are in the same position.

"We do talk to other health units as vaccine managers, so I do know that other health units are in the same position where they'll need to catch these students up," said Wright.

In Waterloo region, because public health staff are still busy managing the region's COVID-19 response, it won't be able to offer in-school vaccination. Instead, the plan is to offer mass clinics at the two primary public health offices: 99 Regina St. in Waterloo and 150 Main St. in Cambridge, said Wright.

Appointments will be available as of Nov. 1 and they expect the catch-up clinics will continue well into 2022, she said. 

Despite the lapse, there haven't been any outbreaks of hepatitis B or meningococcal meningitis in the Region of Waterloo Public Health unit. Outbreaks of HPV are harder to track, however. 

75% of sexually active adults contract HPV

An estimated three out of four sexually active Canadians will have at least one HPV infection over their lifetime.

"HPV is actually sort of a silent virus," said Wright. "And oftentimes people don't develop symptoms and can infect others, unknowingly.

"So it's hard to detect an outbreak of HPV because so many Canadians experience HPV infection."

A rise in cancers caused by HPV infections has been noted in Nova Scotia young adults, and that's why Toronto family Dr. Vivien Brown said it's crucial to catch up on these missed vaccinations — and get back that momentum.

"We've seen the power of vaccine with COVID," said Brown. "With the HPV vaccine, we're not just reducing infection — we're actually changing the paradigm in terms of the risk of cancer.

"It reduces your risk of six different kinds of cancer," said Brown, who also chairs HPV week for the Federation of Medical Women of Canada. "When you're immunized, that reduction of cancer is with you for life."

Those cancers are:

• Cervical.
• Throat.
• Anal.
• Vulvar.
• Vaginal.
• Penile.

In 2018, and again in 2020, the World Health Organization issued a global call to eliminate cervical cancer, which is considered less than four per 100,000 cases. It's something Australia has already done, said Brown, and if Canada keeps on track with pre-pandemic rates of vaccination, this country could be next.

In Australia, no more Pap tests

The two countries started immunizing against HPV at around the same time, but Australia had much higher uptake, said Brown. Now, more than 85 per cent of that country's population is immunized.

"In Australia, they no longer do Pap tests. They do HPV screening. If you're HPV negative, you don't even need a Pap test. So our whole way of screening and what we look at as preventative options are going to be changing in the next couple of years, as we immunize more and more of the population."

While Canada's national guidelines recommend HPV vaccines for all people between ages 9 and 26, Brown points out there is no upper age limit to receiving the vaccine. 

She said that means no matter how old you are, if you are with a new partner, it is worth talking to your doctor about getting the HPV shot.