Thursday, February 3, 2011

Still wary about HPV vaccine for your teens?

If so, you are not alone.  A recent study in Pediatrics which surveyed parents on this topic showed that HPV (Human Papilloma Virus) vaccine (marketed as Gardisil or Cervarix) is the most often refused vaccine in the pediatrician's arsenal against disease.  Reasons cited for refusal by parents include belief that there has not been enough research (80% of those refusing); that it "challenges their belief system"(51%); that they believe their children are not at high risk for contracting the STD (59%)  and that they do "not believe the vaccine is effective in preventing the disease" (37%). 

In my practice I have found that if I take the time to address these concerns with parents and patients, most are convinced of the benefit of the vaccine.  It's worth mentioning in my anecdotal experience that most kids are convinced of the value of the shot (probably due to intensive and teen-oriented marketing) but will usually acquiesce to parents' wishes to avoid the needles.  A number of my patients with skeptical parents have opted independently to get shots once they reached age 18.

What exactly does the vaccine prevent?

There are over 100 "types" of human papilloma virus.  The vaccines prevent over 70% of all cases of cervical cancer and Gardisil in particular also protects against the most common causes of genital warts. In addition to these dread diseases (click here for a photo of the pesky and tenacious genital wart), HPV is now linked to a number of head and neck cancers (due to more oral sex?) and of course can cause months of undue anxiety when Pap smears or biopsies show abnormalities due to HPV infection-even if they are temporary and ultimately vanquished by the body's immune system.

How do we contract HPV?

HPV is contracted through sexual intercourse for sure. But it is also contracted through intimate touching;  "third base", oral sex, fingering and other forms of "outercourse" bring risk of infection with them.  And let's remember that most teens progress through months to years of these "lower risk" activities (can't get pregnant after all) before engaging in intercourse.  Many 13, 14, and 15 year olds are there already even though parents underestimate the likelihood that such activity is going on.

Why vaccinate an 11 or 12 year old?

There is excellent data showing that the earlier we vaccinate the better the immune response.  I once heard a pediatrician say "We don't wait for them to step on a rusty nail to give them tetanus vaccine, do we?"  Vaccinating with HP, according to Pediatric News,  is "not about sexual readiness" rather about the prevention of cancer.

Is it safe?

According to the CDC on this subject, over 32 million doses of Gardisil were ditributed in the US from the time the vaccine was licensed in 2006 until September 2010.  The Vaccine Adverse Event Reporting System has investigated all serious event reports and has not found a pattern to suggest the vaccine is causing a serious problem.  True confession (that most teens will confirm): The HPV shot DOES hurt a bit more than most vaccines, but it is a brief 60 second ache.  This pain may explain a slightly higher than average incidence of post-shot fainting in the doctor's office.  Contrary to early YouTube videos, it DOES NOT make people walk backwards!

How long is it good for?

With each passing year since licensure we see strong data that extends the length of time we know the vaccine provides protection.  As of now we know it will last at least 7.5 years and most manufacturers and researchers think it will extend far beyond this as it contnues to be studied.  By the time the young vaccinees get into young adulthood, we will know whether a booster is necessary (as we have discovered for whooping cough, tetanus, meningitis, polio and many other illnesses).

What about boys?

Boys are the group getting the least extensive coverage in spite of it being approved and recommended for them as of last year.    When a parent or a young man asks me "Why should men get it?"  I just pause and look at them a little funny and say: "Let's stop and think about where the virus is coming from when girls get it through sexual activity."  And if that isn't convincing enough I say: "Would you like to see a picture of penile warts? (see above)"  It is worth noting that men having sex with men are at increased risk of warts and penile cancer and should definitely be vaccinated as early as possible.

I fully endorse vaccination against HPV.  I am also fully aware that there are political and economic issues surrounding the vaccine.  For one, most of the folks who speak about it publically are on the Merck payroll (the sole manufacturer of Gardisil).  And the steep price of this immunizaiton raises a moral quandary about whether it is really just a boutique vaccine and much less readily available in the rest of the world.  Nonetheless, insurance companies seem to have done their calculus and since they usually err on the side of withholding treatments and are not known for their support of preventive medicine I say we should be grateful for what we have.


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