Wednesday, May 18, 2011

HPV Vaccination: Prevent Cancer!

Yes, it’s time to talk about another vaccine. I guess I really love this topic, or perhaps it’s just that I think it’s really important. The one I’m referring to this time is the Human Papilloma Virus (HPV) Vaccine. The purpose of this vaccine is to prevent genital (including cervical) and anal cancers, and genital warts. I recommend this vaccine for all middle school students. My oldest child started the series at age 12 and was fully vaccinated at 13.

One commonly recognized brand of this vaccine is Gardisil, which prevents four types of HPV: HPV 6 and 11, which cause genital warts, and HPV 16 and 18, which cause anal and genital cancer and precancer. A more newly released vaccine is Cervarix. It covers HPV 16 and 18. Neither vaccine covers all forms of cancer-causing HPV, but HPV 16 and 18 cause approximately 2/3 of cervical cancers.

Have you heard of Human Papilloma Virus? Did you know that the lifetime risk of becoming infected with this virus is 80%? Are you aware that approximately 20 million people in the USA are infected with the virus? And 18% of 14 to 19 year-old girls are infected? Did you know the virus causes cervical cancer, anorectal cancer, and genital warts? Yuck, right? It’s a sexually transmitted disease (STD) that causes cancer and is PREVENTABLE.

The vaccine was introduced to the general public in 2006. By 2009 44.3% of adolescent girls in the United States had received at least one dose of HPV vaccine, and 26.7% had received all three recommended doses. In Australia, during the first year of a national HPV vaccination program, 75 to 80% of targeted girls had received all three doses! The vaccine is now recommended for girls AND boys, ages 9 to 26.

The vaccine has a good track record when it comes to side effects. Adverse effects shown to be caused by the vaccine are headaches, low-grade fevers, and a sore arm. Adolescents have been known to faint after receiving the vaccine. This reaction can be seen after any vaccine given to an adolescent, and is not limited to the HPV vaccine. Claims of more serious adverse effects have not been substantiated or shown scientifically to be more common in vaccine recipients than in the general public. You can find complaints about the vaccine on the internet, of course, but much of this is hearsay or linked to attempts at legal action.

Why is the vaccination rate so low? The vaccine prevents CANCER! What I hear from my patients’ parents are comments such as these: “We’re not going to give THAT vaccine.” “It’s too new.” “My daughter doesn’t need it because she isn’t going to have sex before marriage.” “If we give the vaccine then my child will think it’s ok to have sex.” “It hasn’t been around long enough for me to feel comfortable.” “I don’t know how long the immunity will last, so I want to wait until my child is older.”

I would like to respond to these comments.

1. First of all, scientific studies have shown that a fairly high percentage of kids ages 14 to 19 are already infected with the HPV virus (18% of girls in one study), so it is quite possible your child could be exposed to the virus during his or her teen years. Waiting until they are older could mean they become infected with the virus before they receive the vaccine. And you don’t have to have sexual intercourse to become infected. HPV can be transmitted via oral sex (among other ways) too! Also, there is evidence that there is more long-lasting immunity when the vaccine is given at a younger age.

2. Studies that have examined the rate of sexual activity among teenagers have shown that providing information about STD and pregnancy prevention, and even handing out condoms, has not led to an increased number of teenagers having sex. To me, therefore, it seems unlikely that giving the HPV vaccine will cause teenagers to become promiscuous.

3. Millions of doses of HPV vaccine have been administered to date, with proven safety. The vaccine is not new; it has been given to the general public since 2006.

4. Perhaps your child will wait to become sexually active until they are married. After all, you waited, right? But you don’t get to control the sexual activity of your child’s potential spouse. HPV infection (except in the case of genital warts) is not visible to the naked eye, and there is no test that can tell you if someone is infected with it.

5. I don’t want to offend anyone, here. But you should know that it is fairly common for me to see teenagers in my office who are having sex, and I don’t think most of their parents know they are sexually active. Don’t be naive. A 2002 study showed that by ages 15, 16, and 17 30-50% of teenagers were already having sexual intercourse! Talk about relationships, values and expectations with your child. But protect their health. I, too, don’t want my daughters (and I would say sons, if I had a son!) to become sexually active at such a tender age—but I will take a practical approach when it comes to preventing such a serious disease as cancer.

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