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HPV Controversy

HPV Basics

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Updated May 10, 2007

Vaccines have always been a bit controversial, especially in some circles, with some people opposing them for religious reasons or because they fear an autism link.

Gardasil, the HPV vaccine that protects girls against four types of HPV, or human papillomavirus, including the two types that cause most cervical cancers and the two types that cause the most genital warts, has been especially controversial...

According to the CDC, genital HPV "is the most common sexually transmitted infection in the United States" and "persistent genital HPV infection can cause cervical cancer in women," some of which can be prevented by Gardasil, the HPV vaccine.

Why all the controversy about Gardasil?

Most of it seems to revolve around that some people don't like the idea of their child being "forced" to get a "new" vaccine that protects against an STD, especially since they don't believe that their child is going to be sexually active...

The controversy over getting Gardasil is especially loud in Texas, where a fight to overturn the governor's executive order mandating the HPV vaccine for all 11- or 12-year-old girls has now been successful.

Some things to think about as you consider which side of the HPV vaccine debate you are on include:

1) Choice

Even if the HPV vaccine becomes mandated in your state, you can likely opt out so that your child doesn't get the vaccine.

Gardasil is a part of the current recommended childhood immunization schedule that is approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians, and most of the other vaccines in the schedule, like the tetanus shot, MMR, and hepatitis B vaccine, are already required for school.

The timing of the mandate to get the HPV vaccine was a little fast in Texas, but then most kids don't get a vaccine until it is required for school. This was seen when the hepatitis B and chickenpox vaccine were introduced, so requiring Gardasil for school would be a good way to make sure kids quickly get protected against cervical cancer.

Still, even if it isn't required for school, since it is on the childhood immunization schedule, it is likely that your pediatrician may recommend that your child get Gardasil starting at her 11- or 12-year-old well child visit.

Surprisingly to some parents, not all experts are in favor of HPV vaccine mandates, even those experts that are generally in favor of kids getting all of their vaccines. This is not because they believe that there is anything wrong with the new HPV vaccine. Instead, they think that the focus should be on the vaccine, and not on the mandates, and they would prefer a slower roll-out.

And some think that making the making the HPV vaccine compulsory, as Dr. Catherine D. DeAngelis states in an editorial in the Journal of the American Medical Association, "could have the unintended consequence of heightening parental and public apprehensions about childhood vaccinations" and can create "a backlash among parents."

2) Necessity

Although some parents don't think that their kids will need a vaccine that protects against a sexually transmitted disease, especially at such an early age, statistics don't support that.

Consider that according to the CDC 2005 Youth Risk Behavior Survey, 47 percent of high school students report having had sexual intercourse, and 34 percent of sexually active students said that they didn't use a condom the last time they had sex, which puts them at great risk for STDs such as HPV. And 34 percent of students in the ninth grade, increasing to 63 percent by 12th grade, reported having had sexual intercourse.

So some parents who think that their child isn't sexually active are in denial about their child's sexual activity and risk of HPV.

And even if your child isn't sexually active and is abstinent until marriage, there is no guarantee that her partner will have been too. The CDC reports that over 14 percent of women who were 18 to 25 with only one lifetime sex partner still had HPV infections.

3) Safety

Is the HPV vaccine "too new" for general use?

While Gardasil is a new vaccine, it is important to remember that it has been formally FDA approved, is recommended by the AAP, and will undergo continued safety monitoring as it begins to be used, just like other new vaccines and medications.

4) Duration of Protection

Doesn't the vaccine only last for five years?

No one knows how long the vaccine lasts, which is common with all new vaccines. The CDC reports that studies show good protection up to five years after vaccination, which is how long the studies currently go. The women in the studies will continue to be monitored to see how long the protection from the vaccine really lasts and if it is lifelong.

What if it doesn't provide lifelong protection? Then like some other vaccines, maybe a booster dose might be considered.

5) Risks

Will a vaccine against a sexually transmitted disease encourage promiscuity?

Well, if you look at the above statistics about how many high school students are having sex, it doesn't seem like they need a reason to have sex or be promiscuous. Taking steps to encourage abstinence should definitely be encouraged, but there is no research that a vaccine will encourage more teens to have sex or have more partners.

Instead, as they discuss the HPV vaccine, it might actually give pediatricians and parents an opportunity to talk to teens about STDs, teen pregnancy, safe sex, and the benefits of being abstinent.



Sources:

Quadrivalent Human Papillomavirus Vaccine. Recommendations of the Advisory Committee on Immunization Practices. MMWR. March 12, 2007 / 56(Early Release);1-24.

CDC. Youth Risk Behavior Surveillance—United States, 2005. Morbidity & Mortality Weekly Report 2006;55(SS-5):1–108.

Doctors, Legislators Differ On HPV Vaccine Mandates. DIXON BK. Pediatric News. February 2007 (Vol. 41, Issue 2, Page 1,12)

HPV vaccine mandate stirs controversy in USA. Larkin M - Lancet Infect Dis - April 2007; 7(4); 251

Mandatory HPV Vaccination: Public Health vs Private Wealth. Lawrence O. Gostin; Catherine D. DeAngelis. JAMA. 2007;297:1921-1923.

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