Some major cancers are declining, according the recent US annual cancer report. Human Papilloma Virus related cancer is not one of them. This is in spite of the fact that we have a very effective vaccine for prevention of HPV. Overall, the report shows lower cancer rates in the U.S. among all genders and racial and ethnic groups for the most common cancers, including lung, colon, anal, breast and prostate. HPV related cancers, like cervical cancer, are increasing despite the vaccine. This disparity is blamed on the poor rates of vaccinations in young boys and girls.
What is the reason for this apparent failure? What can be done to fix it? Gardasil is a FDA approved vaccine for HPV. It protects against the HPV strains that can trigger cervical cancer and genital warts. It has been in use since 2006. In 2009 Cervarix was approved and became another vaccine option. Despite two options vaccination rates are poor. In 2010, only 48.7% of girls ages 13 through 17 received at least one dose of the three-dose HPV vaccine (Cervarix joined Gardasil as the second HPV vaccine in 2009), and only 32% received all three recommended doses. Considering the U.S. government’s Healthy People 2020 target is 80% vaccination among girls ages 13 to 15 for all three doses, those immunization rates are lagging. Comparatively, vaccination rates are much higher in Canada, the U.K. and Australia.”
Normally, I would point the finger of blame at the Anti-Vaccination movement as the primary culprit. In this case, the evidence points to other compounding factors. The anti-vax movement is alive and well in Canada, UK and Australia. Yet there are better HPV vaccination rates in those countries. So if the anti-vaccine movement is not solely responsible What other factors are involved?
In my opinion there are multiple factors contributing to the extremely poor vaccination rates. The recommended treatment age is a sensitive age for child-parent relationships. Fundamentalist religious groups regard the vaccine as indirect approval of teen sexual activity. There has been strong conservative resistance to education about the vaccine and requirement of the vaccine for children. The vaccine will also prompt a difficult discussion with children at a young age. The anti-vax rhetoric and fear mongering give parents a reasonable “out” to avoid a difficult proposition.
CDC recommendation:”Cervarix and Gardasil are licensed, safe, and effective for females ages 9 through 26 years. CDC recommends that all 11 or 12 year old girls get the 3 doses (shots) of either brand of HPV vaccine to protect against cervical cancer. Gardasil also protects against most genital warts, as well as some cancers of the vulva, vagina and anus. Girls and young women ages 13 through 26 should get HPV vaccine if they have not received any or all doses when they were younger. Gardasil is also licensed, safe, and effective for males ages 9 through 26 years. CDC recommends Gardasil for all boys aged 11 or 12 years, and for males aged 13 through 21 years, who did not get any or all of the three recommended doses when they were younger. All men may receive the vaccine through age 26, and should speak with their doctor to find out if getting vaccinated is right for them. The vaccine is also recommended for gay and bisexual men (or any man who has sex with men) and men with compromised immune systems (including HIV) through age 26, if they did not get fully vaccinated when they were younger.”
That is the sticking point for this vaccine. Making parents discuss a sexually related topic with 11-12 year old girls and boys. In the US sexuality is always an educational and political nightmare. It is a common theme in the US to avoid the topic or come up with unrealistic answers. IE: abstinence. If you add up parental hesitancy with anti-vaccination proponents fear mongering, like Michelle Bachmann, you get a medical fail.
Despite anti vax rhetoric multiple lines of good evidence show Giardasil is safe and effective. A study, published in the journal Archives of Pediatrics & Adolescent Medicine, researchers looked at the medical records of 189,629 girls and women ages 9 to 26 within the Northern and Southern California Kaiser Permanente health care systems. All the women received at least one dose of Gardasil between August 2006 and March 2008. By the end of the study period, 44,000 participants had received the recommended three doses of the vaccine. The researchers examined the rate of emergency department visits and hospitalizations for women in the two weeks following their vaccination and again a couple months later. Aside from some episodes of fainting and skin infections, the authors found no other safety concerns. There were some reports of seizures and allergic reactions, but a five-member safety committee of medical experts with no ties to the Kaiser study team or Merck and Co., which funded the study, concluded that these reactions were not related to the vaccine. Efficacy is documented in the research. Beyond that there is a strong statistical analysis demonstrating the clear benefits. In populations across differing ethnicity high vaccination rates equals low cancer rates and low vaccination rates equals high rates of HPV cancer.
If I offered a proven injection that would prevent pancreatic cancer people would line up around the block to get it. Call it a vaccine and several would get out of line. If I required people in the line to have a conversation with their pre-teen children about sex and STD’s; the 47% figure for the HPV vaccine would correlate well with my theoretical line around the block.
Cancer is a terrible disease and everyone agrees that stopping cancer is a laudable goal. Religious fundamentalism, anti-vaccine rhetoric, and societal taboo’s should not be stopping us from utilizing this vaccine. There are very few “good” trade offs in cancer treatment. Radiation, surgery chemotherapy are all risky, painful, and sometimes tortuous for cancer patients. Having a injection that prevents; lung cancer, colon cancer, breast cancer is a dream, nothing more. If we fail to take advantage of this treatment option we will be guilty of a criminal failure of the public health system for this generation. We must do everything we can to support this public health initiative. 21 states have initiated legislation for education or mandatory vaccinations, 41 states are considering similar legislation.
I would support mandatory vaccination for 9 year olds. I would love to see HPV related cancer rates fall by 85% in the next 20 years. This is easily achievable. We just have to have the will to step over the vocal minority and do what is scientifically reasonable.
I am very certain that some of the 12,000 young women with cervical cancer and the 3000 women who die from it annually wish their parents had considered it.
More Reading:
National Council for state legislature.
References:
http://seer.cancer.gov/report_to_nation/
The issue of adverse reactions is dealt with so superficially by pro-vax researchers. Just because there were no reactions within 2 weeks of the vaccine doesn’t mean that it is safe. Problems can manifest years after a vaccine… such as allergies which take 2 years to develop after exposure.
1. You can develop an allergy to any vaccine if it is given repeatedly. If by the third dose you do not develop an allergy to the HPV vaccine you will not have an allergic reaction unless someday you need a booster. The vaccine antigen does not remain in your blood long term. It is identified by your immune system destroyed and it develops a memory cell to identify and attack the antigen when it appears again. You cannot have an allergic reaction from your body’s own memory cells unless an outside factor is introduced. What is the significance of the two year figure?
2. Even if what you say is true the vaccine was released in 2006 it has been in stage IV evaluation since the release. the current figures are “As of 1 September 2009 there have been more than 26 million doses distributed in the United States, and there have been 15,037 Vaccine Adverse Event Reporting System (VAERS) reports following the vaccination.[48] Ninety-two percent were reports of events considered to be non-serious (e.g., fainting, pain and swelling at the injection site (arm), headache, nausea and fever), and 8 percent were considered to be serious (death, permanent disability, life-threatening illness and hospitalization). There is no proven causal link between the vaccine and serious adverse effects; all reports are related by time only. That is, they are only related because the effect happened some time after the vaccination.” There is no evidence of long term negative effects in 6 years. DO the math Cervical cancer is only one type of cancer prevented and it could prevent 85% of cervical cancer deaths 3000 annually. That is 2400 women that need not die every year.
I am not pro-vaccine, I am pro-science the data and the science support the vaccine.
We have a sort of “mandatory vaccine” approach here in Oz. You can opt out.
I am under the impression that its these vaccines are now being considered for young men as well.
Pro vaccine? Thats like saying Pro electricity. Its a mythological term that shouldnt even be entertained.
Its very strange that anti vaccination folk drive vehicles considering their fear of the unknown.
It is not clear to me why older people are not allowed to reap the benefits of these vaccines. I understand that if someone has engaged in sexual activity that resulted in their becoming infected with HPV, being vaccinated AFTERWARDS will not help, but it should be easy enough to check and see on a case by case basis if someone has it, and if not, let them get vaccinated regardless of age. It is ageist to simply assume that after age 26, it’s too late.
If parents have difficulty talking to youngsters about sex, they can always say “I’m taking you to the doctor to get your mandatory vaccinations,” and leave it at that! (or let the doctor or teacher or aunt or other person be designated to do the talking for them!)
It is a good question I think I have an answer for you but I am not certain. I will do a little research and get back to you. Your second statement I agree 100%. I have never explained to my child what the vaccines are for specifically.
An update on adults and the HPV vaccine. As I suspected, it is because it is not approved for people over 26 years of age. Drugs can be used off label but biologics like vaccines cannot. More than that no one older than 26 years old was studied so we have no information on older people. By 26 years old most of the population has been exposed to some strain of HPV, Which means the cancer benefit is questionable. Still I think that there is a plausible role for genital warts prevention in adults.
“It is not approved for people over 26 years of age” BECAUSE “no one older than 26 years old was studied so we have no information on older people.” It is a Catch-22 that we won’t have the info if we don’t try getting it! “Most of the population” doesn’t mean ME. E.g., 90% of the adult population of the USA has cold sores–which leaves 10% which doesn’t. The cancer benefit is hardly questionable if YOU are the person who gets cancer that might have been prevented if you could have gotten the vaccine.
Gardasil. Questions which the manufacturer and other promoters cannot answer:
Whether it prevents cancer, if it increases risk of cancer due to aluminium bound recombinant HPV DNA, if Gardasil vaccinated may donate blood without the aluminium bound recombinant HPV DNA causing serious health consequences for the recipient, if there is increased risk of autoimmune disorders, risk of genotoxicity,adverse events due to concomitant administration with other vaccines, serious longterm adverse events,if there is increased risk of blood clots when it is combined with oral contraceptives, if there is an increased risk of brain damage, if it will increase risk of infertility, whether polysorbate is carcinogenic, health consequences due to combination of polysorbate and
l-histidine, if aluminium adjuvant is safe, consequences of presence sodium borate, if it will increase risk of miscarriages, stillbirths or babies born with anomalies, if it is excreted in human milk, etc.
@ mindanoiha: TO answer your first question there is a stack of very good evidence that the HPV vaccine can prevent HPV related cancer despite your claim. It is an effective HPV vaccine. HPV is the main cause of cervical cancer in women. This is not in question. There are about 12,000 new cervical cancer cases each year in the United States. Cervical cancer causes about 4,000 deaths in women each year in the United States. There are about 15000 HPV-associated cancers in the United States that may be prevented by vaccines each year in women, including cervical, anal, vaginal, vulvar and oropharyngeal cancers.
About 7,000 HPV-associated cancers in the United States that may be prevented by vaccine each year in men, and oropharyngeal cancers are the most common.
About 1 in 100 sexually active adults in the United States have genital warts at any given time.
Please feel free to post any research demonstrating anything of what you propose about conjugate vaccine additives. 200 mcg is an exceptionaly low dose. Despite widespread use in Europe for decades the is no research demonstrating anything you propose. There is no evidence of dose dependent response.
To add credence to your comments about parental discomfort talking to their children about sexually transmitted diseases, here at PubMed, an analysis of kids who have taken “chastity/virginity pledges” and the prevalence of STDs within that population.
http://www.ncbi.nlm.nih.gov/pubmed/19117832
Pediatrics. 2009 Jan;123(1):e110-20. doi: 10.1542/peds.2008-0407.
Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched nonpledgers.
Rosenbaum JE.
“…RESULTS: Five years after the pledge, 82% of pledgers denied having ever pledged. Pledgers and matched nonpledgers did not differ in premarital sex, sexually transmitted diseases, and anal and oral sex variables. Pledgers had 0.1 fewer past-year partners but did not differ in lifetime sexual partners and age of first sex. Fewer pledgers than matched
nonpledgers used birth control and condoms in the past year and birth control at last sex.
CONCLUSIONS:
The sexual behavior of virginity pledgers does not differ from that of closely matched nonpledgers, and pledgers are less likely to protect themselves from pregnancy and disease before marriage. Virginity pledges may not affect sexual behavior but may decrease the likelihood of taking precautions during sex. Clinicians should provide birth control information to all adolescents, especially virginity pledgers.”
I think you are underestimating the activities of the notorious anti-vaccine blogs and the uptake of HPV vaccines. Here is Orac’s latest post about those activities. Make certain to follow the links to prior Respectful Insolence articles about those crank anti-vaccine blogs.
http://scienceblogs.com/insolence/2013/01/09/dr-sin-hang-lee-is-at-it-again-with-the-gardasil-fearmongering/
Thank you!
Does gardasil guard for 2 or 5 years ?.. If so, what will happen after that limited time will we get a booster dose(1 or again 3) ?
You can check the CDC link I put at the bottom it answers some of your questions. Going forward blood titres and experience will dictate the need for boosters and frequency.
Is it possible to catch HPV types 6,11,16,18 in spite of Gardasil?