Gardasil, the HPV vaccine, has been in the news a lot lately. You’ve seen the commercials for it. Perhaps you’ve already gotten your daughter vaccinated. Maybe you’ve received the vaccination yourself. But what does it do? Why is it given so young? And does your daughter need to be vaccinated?
To start at the beginning, HPV is actually a group of viruses; there are over 100 strains or types. Sixty of these types are considered low risk and cause warts (or papillomas) on the non-genital areas of the body, such as your hand and feet. At least 40 strains of HPV are mucosal types and are called this because they favor moist areas of our body, such as the genital region.
HPV types 16 and 18 cause 70% of all cases of cervical cancer, and HPV types 6 and 11 cause 90% of genital warts. According to the American Cancer Society, in 2000 approximately 12,000 women in the U.S. developed invasive develop cervical cancer. Over 4,000 women died from the disease.
What is the HPV vaccine?
Gardasil, given in three injections spaced about two months apart, protects against HPV types 16, 18, 6, and 11, and has been approved for girls ages 9 to 26. The HPV vaccine was studied for five years in over 80,000 women. Clinical trials showed its efficacy at the five-year mark was still 100%. It is the only cervical cancer vaccine available right now.
The 2009 Immunization Schedule published by Maryland’s Department of Health and Mental Hygiene (DHMH) recommends vaccinations start at ages 11 to 12. The immunization is also recommended (again, starting at age 11 or 12) by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).
According to Greg Reed, program manager of the Maryland Center for Immunizations at DHMH, “we are very active in promoting the HPV vaccination.” It is included in the Maryland’s Vaccines for Children (VFC) program, which provides free vaccines to children aged 18 and younger who are uninsured or underinsured. “We send 25,000 doses of HPV every two months to participating doctors statewide,” says Mr. Reed.
“The HPV vaccine when it first came out in 2006 was truly one of the most exciting developments in public health. We are promoting it because it’s a very important vaccine for girls,” says Dr. Jinlene Chan, M.P.H., the acting deputy health officer for public health with the Anne Arundel County Department of Health.
Why does she need it?
It is estimated that at some point in time 80% of the U.S. population will contract an HPV virus. It is usually spread through sexual contact, but not exclusively. HPV should really be regarded as a skin-to-skin disease. Virgins and non-virgins can get the virus. Most of the HPV infections we get resolve on their own – usually there are no symptoms. However, women increase their risk of HPV infections by becoming sexually active at a young age, having multiple sex partners and having sex with someone who has multiple partners.
At her pediatric practice in Ellicott City, Dr. Ruth Agwuna has found most parents to be receptive to their daughters getting the HPV vaccine. While she assures parents that the vaccine is safe, Dr. Agwuna believes some parents may be reluctant to immunize their daughters out of fear that the vaccination somehow gives the girls a green light to become sexually active, but overall “less than 1% has turned it down when I’ve suggested the vaccination,” she says. Many times it has been the parents who have asked for the vaccination.
“I start giving the vaccination at 14. If there’s a high risk, I’ll give it earlier,” says Dr. Agwuna, who is also the medical director at the Woolford Infirmary Health Center at Morgan State University in Baltimore. And how have her patients reacted to getting yet another shot? “The kids are very accepting and ready for it. They all know about it, and have heard about it at school.”
According to Merck, maker of Gardasil, the most common side effects were pain, itching, bruising, swelling and redness at the injection site, headache, fever, dizziness, nausea, vomiting and fainting. In June the Food and Drug Administration required Gardasil labeling to include a warning for physicians to watch out for fainting (syncope), and to urge patients to sit or lie down for 15 minutes after being vaccinated. Dr. Agwuna and other pediatricians I spoke with were already practicing this with their adolescent patients. Evidently, they’re always on the lookout for fainters.
Additionally, Gardasil should not be given to pregnant women or to anyone who is severely allergic to yeast (one of its ingredients).
Why is the vaccine given to such young girls?
The highest prevalence of HPV infections is seen during adolescence — that’s why the vaccine is specifically targeted to this age group. In a news conference last October, Dr. Lance Rodewald, director of the Division of Immunization Services at the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC) explained that the recommendation extends down to such a young age because “you always want to vaccinate before the period where there could be disease. And so it’s very important to vaccinate before the onset of sexual activity and 11 and 12 years old, is before the onset of sexual activity.” Some research also suggests younger women may be biologically more vulnerable to the HPV virus, and that may explain why infections spread faster in this age group.
Like Dr. Agwuna, Dr. Chan wants parents to know that “the vaccine has been shown to be very safe. It’s a very effective vaccine against cervical cancer and genital warts.”
An ounce of prevention
It’s important to remember that the HPV vaccine isn’t a cure for cervical cancer; it’s a preventative measure. Plan on regular (every three years is the typical recommendation) pelvic exams and pap tests, even in women who have received Gardasil. For the uninitiated, a pap test involves a quick swab to collect cells from the cervix – the lower tip of the uterus. These cells are examined for any abnormalities that might lead to cervical cancer. The pap test can also detect infection or inflammation. Cervical cancer tends to develop slowly and is very rare in women under 25. Before the pap test, cervical cancer was once one of the most common causes of cancer death in America.
Cervical cancer is curable and preventable. And this is important so it bears repeating: even if you have gotten the HPV vaccine, you should still get regular pap tests and pelvic exams. Other HPV types, not covered by the vaccination, can still cause genital warts and cervical cancer.
Most insurers will cover the cost of an HPV vaccination. It costs about $125 per dose or $375 for the full series. However, if your insurance company does not cover it, check with your county health department to see if you can get this vaccination for your child (and others) under Maryland’s VFC program.
What about boys?
While adolescent boys and young men are also at high risk for HPV infections there is no reliable test for HPV in males, so the virus is rarely detected. Currently, vaccination with Gardasil is not approved for boys. But research is ongoing. Which is good — because HPV types 16 and 18 cause 90% of anal cancers in men, and 50% of penile cancers.
Giving your daughter the HPV vaccine does not mean you’ve given her a green light to engage in sexual activity. Have a frank talk with her about why you’re giving her the vaccine—because you love her and you want to protect her and her sexual health. Both HPV and cervical cancer can have devastating consequences for a woman’s fertility, in particular — if you want to bounce grandchildren on your knees in the future, then protect their mother now.
For more information on Gardasil, visit Merck’s web site at.gardasil.com, and visit the CDC’s web site on the vaccine at cdc.gov/std/hpv/STDFact-HPV-vaccine-young-women.htm.
Deanna Franklin Campbell is Chesapeake Family’s medical columnist.
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