The current conversation about HPV vaccine is a perfect example that anecdotes about health are powerful. My belief: anecdotes with evidence can be more powerful.
I am going to write a series of blog posts about HPV virus and HPV vaccine. Please tell me what you want to know. What questions do you have about HPV vaccine safety? What concerns do you have about HPV virus in girls and boys, women and men? What can I clarify? I plan to write stories from my own practice, interview adolescent medicine experts, and talk with pediatric vaccine researchers. Who else should I talk to?
In clinic, I recommend HPV vaccine to girls at their 11-year visit. I talk about the shot yearly thereafter with girls and their parents if they haven’t completed the series. Boys can also get HPV vaccine (HPV4) to prevent genital warts. One of the most challenging parts of protecting girls (and boys) from HPV virus is completing all 3 shots in the series. In Washington State for example, over 69% of our girls have received the first HPV shot, but only 45% have completed all three.
For starters, here is a link from the CDC summarizing questions about HPV vaccine safety: HPV Vaccine Safety
And here’s a statement from the AAP about HPV vaccine in the news:
The American Academy of Pediatrics would like to correct false statements made in the Republican presidential campaign that HPV vaccine is dangerous and can cause mental retardation. There is absolutely no scientific validity to this statement. Since the vaccine has been introduced, more than 35 million doses have been administered, and it has an excellent safety record.
The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the American Academy of Family Physicians all recommend that girls receive HPV vaccine around age 11 or 12. That’s because this is the age at which the vaccine produces the best immune response in the body, and because it’s important to protect girls well before the onset of sexual activity. In the U.S., about 6 million people, including teens, become infected with HPV each year, and 4,000 women die from cervical cancer. This is a life-saving vaccine that can protect girls from cervical cancer.
Does the HPV4 vaccines that boys receive also protect again the strains that cause cervical cancer? I wouldn’t give my son a vaccine just to spare him warts. What makes me very angry about the discussion around the vaccine is that most people seem to think that boys really have no role to play. Girls bear the risk of cervical cancer so they should bear the responsibility of completing the 3-part vaccine course. Last I checked, it wasn’t 4,000 die-hard Lesbians who died of cervical cancer each year. How do you address the sociological aspects with your patients and their parents?
Reality Check says
There are three HPV vaccines. Cervarix only protects against two strains of HPV, which cause 70% of cervical cancers and also cause anal, penile, throat (oropharyngeal), vaginal and vulvar cancers. Gardasil4 protects against those two cancer-causing strains as well as two strains that cause 90% of genital warts. Gardasil 9 protects against all of those strains mentioned before plus five more cancer-causing strains. Boys, obviously, can get penile, anal and throat cancers, so your son would benefit most from getting the Gardasil9 vaccine, but would also benefit from Gardasil4.
I do, however, disagree with your belief that girls should shoulder the burden of protecting themselves from anything that can only befall them — I can’t imagine that you want your son not to try to do everything in his power to protect the health and life of his future sexual and romantic partner.
Christine Seresun says
I have heard so many bad things about this vaccine. I have watched a video on You tube about a girl who had mental and pain issues after the HPV shot. I want to know what is truth and fact. My daughter is 11 and I held off on getting the HPV vaccine because I wanted to get more information about it. But as I look for information I get more confused than ever, on all the stuff I am finding negative and positive.
Reality Check says
Over 63 million doses of HPV vaccine have been administered over the course of nearly ten years, and no serious side effects have been observed (usually if a vaccine ends up having a serious side effect that wasn’t found in the company’s testing, it will surface within one year of the FDA approving the vaccine). The side effects that occur in few are soreness or redness at the site of the injection and very rarely, fainting after the injection. These are pretty mild side effects compared to cervical, throat, anal, vaginal, vulvar and penile cancers and genital warts! I’m pretty sure your child will get a LOT more injections with many harmful chemicals if they end up with cancer.
I am wondering when I should have my boys vaccinated and do they need the three parts too? My understanding, Viki, is that it prevents GENITAL warts which are the outbreak of the virus that then passes to the female partner and leads to cervical cancer. Innoculating boys prevents the virus from infecting them and, therefore, any unprotected partner. Is that correct Dr?
I’m so glad you’re going to do some posts on this topic! You’re perspective will be helpful for many of us I’m sure. I’d love for conversation and ideas about how we can make sure kids who start the vaccine series finish it since kids aren’t protected until they get all three doses. I think it is also important to talk about why the vaccine is recommended at age 11-12, younger kids’s immune respone, and also all the research and follow-up monitoring that has been done on the safety of this vaccine.
Liz Ditz says
I am so glad you will be writing the series. There’s so much misinformation and fear-mongering out there about the vaccine, much less about the real risks and dangers of cervical cancer.
Read the comments at Vince Ianelli’s about.pediatrics post:
I would like to learn about the evolution of finding this vaccine and the history of cervical cancer. I would think the discovery of finding out this cancer was caused by a virus was not expected! I’ve also heard that this vaccine only covers 4 of the most prevalent strains. How does this protect anyone when it doesn’t cover all the strains that are out there?
Reality Check says
Gardasil 4 prevents against the two strains that cause 70% of cervical cancer as well as many throat, penile, anal, vaginal and vulvar cancers and two strains that cause 90% of genital warts. Gardasil 9 also prevents against 5 more cancer-causing types. Most of the other strains it doesn’t prevent never or very rarely cause cancer.
Any studies in the pipeline on immune response when vaccine not administered per 6 month timeline. For teens not sexually active, it would be easier to give at the yearly check up at age 11, 12, 13 for example. If the vaccine is mandated by schools, it must be a mandate for both sexes. HPV disease is very different than whooping cough or measles in immediate fatalities and mechanism of spread. For that reason, makes sense for schools to encourage but not mandate.
I’ll answer wearing just my \mom\ hat rather than my \medical provider\ hat (which almost always align beautifully, but for this issue do not quite align yet)…
– Gardasil is still pretty darn new, which leaves me wanting to wait until some more time elapses and more definitive post-marketing info can be evaluated (easy for me to say this with a very young 10 year-old who still seems far from sex and puberty).
– As the fairly high incidence of fainting after Gardasil was increasingly reported, the CDC response was that \fainting is common after any kind of vaccination.\ That just didn’t ring true at all for me. I literally can’t think of once that an adolescent patient has fainted after a vaccination or other IM shot (although the acute care setting is obviously different than a primary care practice setitng).
It seems that now it’s more clearly recognized that there is an increased incidence of fainting with Gardasil in particular (mostly within the first 15 min) and the package insert has evolved to reflect that, but it doesn’t increase my comfort when a fairly new vaccination/med/procedure’s adverse effects (even minor or easily managed ones) are pooh-pooh’d.
– Along those lines, I want more info (that I expect to come from post-marketing studies) looking further at the incidence of thromboembolic events in relation to Gardasil. The more data that comes out, the more it seems that in patients without pre-existing risk factors for thromboembolism, Gardasil is not associated with an increased incidence of those events. Studies conducted with predictable and intentional followup for the purpose of monitoring for possible adverse events are more helpful to me (as a parent) than relying on the passive and voluntary VAERS.
– All of that being said, my own hesitation on this one and only vaccination is somewhat confusing to me because every physician and friend that I trust recommends it without reservation. But my mom instinct has served me well. I think I just need a little bit more time and your thoughtful wisdom and advice.
Hopefully, that won’t drive you too crazy when I’m the mom in your office, Wendy Sue :-).
Kelly, I asked because, I remember reading that there are over a dozen documented strains of HPV. I read that the the cancer-causing strains tend to not have outward symptoms like warts, and that the wart-causing strains were otherwise not harmful. It’s been years, though.
I have two quite specific questions that came up in conversation with my husband:
1) Is HPV the only cause of cervical cancer or can you contract cervical cancer without having had HPV, and are there statistics around this?
2) Did Michelle Bachmann state that the vaccine caused her acquaintance’s daughter’s mental development problems? If so it is either proven or unproven (that whole correlation and causation thing again). If she is stating falsehoods is it likely that the vaccine manufacturers might sue? Or even someone else, since that kind of falsehood is damaging to public health?
Thanks for this Dr Swanson – it’s so important to have evidence-based information around vaccines.
I would like you to explain this statement,
“…all recommend that girls receive HPV vaccine around age 11 or 12. That’s because this is the age at which the vaccine produces the best immune response in the body…”
Do all vaccines have a specific age range at which they are most effective for their immune response? How does this work? I don’t mind you referring me to a good immunology reference — I can handle it 😉
Jay Rosenbloom says
In the most recent Journal of the American Dental Association (JADA) there were two reviews addressing HPV and oral cancers. Despite evidence that this virus can be passes mouth-to-mouth, and is found in roughly 1/3 of mouth and throat cancers, why is everyone still talking about this as just a sexually transmitted virus? If this data is true then kissing may be a route of infection, leading to an increased risk of cancer.
Dr Melvin Koplow says
What about th deaths reported:
As of June 22, 2011 there have been a total 68 VAERS reports of death among those who have received Gardasil® . There were 54 reports among females, 3 were among males, and 11 were reports of unknown gender. Thirty two of the total death reports have been confirmed and 36 remain unconfirmed due to no identifiable patient information in the report such as a name and contact information to confirm the report. CDC reports
I spoke to the FDA about the stroke-like event following the vacinations with Gardasil.
Can you name any girl 12 years old that get a stroke ?
I stop giving Gardasil. I started to use Cervarix.
I do not trust MSD. The paid 4,700 to experts to do lectures about 3x normal WHY?
Gardasil is 70% effective 16 and 18. Cervarix 90 % effective
I do not let drug reps in my office. I am a pediatrician and former pharmacist.
Jen B says
D, I’ve given shots to many adolescents, and I have seen fainting with a number of vaccines. Many teens actually know that vaccines make them faint, will tell me beforehand, and we have them lie securely on a table before administering anything.
My understanding is that HPV vaccine is administered at age 9-11 because it’s an age where most girls are not sexually active. (Unfortunately, that is not always the case, but it’s a good bet). Once someone contracts HPV, the vaccine is less effective because it is not a novel virus to the immune system, and thus the immune system response is subpar.
How many girls 9 to 11 were in the clinical trials? None. So on what clinical evidence are you giving it to 9 and 10 year old girls? Are you telling the parents that it has never been studied in girls that age?
I would like a comparison of the benefits/risks of Cervarix vs. Gardasil. I think they are based on the same initial NIH work, but I’ve heard that Cervarix covers more strains, and there seem to be more … attacks … on Gardasil, for whatever reason. I’ve also heard that Cervarix has more evidence of length of effectiveness, but logically I don’t know why that would be so. People keep saying that Gardasil is only effective for five years, but is that only because the testing only lasted that long, and the other manufacturer tested Cervarix for a longer period? Also, is Cervarix even available here? Because it seems like countries that have reported these great results with national immunization campaigns (ex Australia) use Cervarix.
And maybe this part is more important. People keep comparing the “risks” of the HPV vaccine adverse effects to the “risks” of cervical cancer death, and concluding that the “adverse events” reported from the vaccine outweigh the risk of dying of cervical cancer in the U.S. The flaws in this reasoning enrage me. The risk of getting HPV includes all of the crappy things that happen when you try to get HPV lesions off the cervix, even before they become cancerous. That can really mess up your reproductive health and cause your babes to be born prematurely. I’d like to see someone put a number on the risk of THOSE adverse events. I’d also like to see a calculation that includes the prevention of anal cancer and oral cancer.
Looks like this isn’t really a conversation since none of the post have been answered or responded to.
Since the vast majority of cervical cancer doesn’t occur until your late 50’s and there haven’t been any long term studies on the vaccine how do we really know that it works?
Also the very very few women a year who die from cervical cancer 5,000 out of a population of 300,000,000 are also usually first generation immigrants and those who lack health care aren’t we vaccinating the wrong population?
Finally since nearly everyone has been exposed to the HPV virus and clear it on there own what is the co-factor that results in cervical cancer for the small numbers that do get it?