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What does everyone think about the introduction of the papillomavirus vaccine and/or its use in younger children?
HPV vaccine approval
- Thread starter 2Bsure
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If parents do not want their daughters to receive the vaccine then I say no problem. I will be happy to forward the cervical biopsy results to them in coming years (I've been on a run lately with cases of CIN III/CIS).
Student health centers at colleges and universities will likely be handing this vaccine out like candy. My question is if it will obviate the need for annual or biannual Paps, and how the OB/GYNs would react to this loss of regular patient contact.
Student health centers at colleges and universities will likely be handing this vaccine out like candy. My question is if it will obviate the need for annual or biannual Paps, and how the OB/GYNs would react to this loss of regular patient contact.
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Havarti666 said:
My understanding is that the vaccine that has been developed is to HPV-16 only, and though this sub-type is responsible for a large number of cervical dysplasia, there are other high risk subtypes of HPV that the vaccine does not provide protection against. I doubt that screening recommendations will change for that reason.
I wonder if all managed care health plans will pay for it for that reason, since there is little cost incentive for them. (added cost of vaccination without reduction in annual/biannual OB/GYN visits). Certainly the vaccine should reduce the number of colposcopy's and LEEP/cone biopsy with a reduction in cost for insurance companies, but they rarely show this much insight.
As far as parents not wanting their children to have the vaccine, I'm not sure that will be a big issue. There will always be some parents distrustful of all vaccinations, probably no more so for HPV vaccine. As far as it being a vaccine for a STD, we already provide Hep B vaccine (Hep B being a bloodborne pathogen historically primarily transmitted through sexual contact and IV drug use) without much fanfare.
I would probably encourage parents and young adults to garner as much info as possible. BTW, one could recieve the vaccine and still develop CIN for the reason stated above, do you also send these parents their daughter's cervical biopsy results?
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McDoctor said:
Only with written consent.
Good post, BTW. I'm also hoping this will be a non-issue, but it will be interesting to watch it play out (especially if the other 4-5 major types have vaccines developed against them).
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Havarti666 said:
That would certainly have a huge impact.
Do you think males should also recieve the vaccine? I think it would have a broader impact as a public health measure in eradicating the disease if we vaccinated both sexes, since men clearly carry and transmit the virus. This would be a challenge to convince parents of young boys that they should also be vaccinated for HPV. I suppose that it would reduce incidence of genital warts in men, but this would be a much, much harder sell. And again we would hit alot of resistance from managed care.
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Is there any word about whether or not this will become a recommeneded childhood vaccine?
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bananaface said:
the phase III trials of Glaxo-SmithKline's vaccine showed a much higher seroconversion response (and theoretically longer lasting immunity?) in children vaccinated age 10-14 so one would think that the AAP would make a recommendation statement based on this in the upcoming months.
Doing a quick google search, I'm surprised to see significant resistance to HPV vaccination in adolescents from some conservative christian groups. What is the rationale for this? Is there really concern that this enormous public health benefit will somehow lead to widespread moral decay? Can anyone enlighten me as to why there would be any objection to this based on moral/ethical grounds?
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Personally, I think this is absolutely fabulous. I've been keeping track of the development of this vaccine as best I can. There's a research lab near my campus where they are doing human testing with this, and I want to sign up. (free HPV vaccine? I'm there!)
That said, the reason why conservative groups are against the vaccine is more than a little ridiculous. They think that promoting the vaccine is promoting unprotected promiscuous sex (and we all know promiscuity is immoral and wrong... sex is dirty and sinful and should be reserved for the person you marry). And we all know that only dirty harlots get HPV (sarcasm intended).
That said, the reason why conservative groups are against the vaccine is more than a little ridiculous. They think that promoting the vaccine is promoting unprotected promiscuous sex (and we all know promiscuity is immoral and wrong... sex is dirty and sinful and should be reserved for the person you marry). And we all know that only dirty harlots get HPV (sarcasm intended).
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st.cronin said:
It appears that the efficacy diminishes somewhat if taken later, but it's still better than nothing. I had several med school classmates who participated in one of the trials, and they were all in their early-mid 20's.
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McDoctor said:
I'll second Larch's comment on this matter. One objection is the old "it'll give people a license to have sex, more sex, more unsafe sex, etc." I find this patently absurd, but they're welcome to their opinions.
The vaccine also forces parents to confront some rather uncomfortable facts:
1. Cute little 10-14 year-old girls are someday going to have sex
2. Some of this sex will likely occur before marriage
3. Some of this sex will likely occur with non-virgin males
Part of the fundamentalist mindset involves difficulty in reconciling what should be with what is, so it doesn't surprise me at all that some folks are up in arms about this.
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Its amazing that these people that have such strong convictions about what they percieve as absolute and moral have such little confidence in their ability to pass these morals on to their children that they perceive this vaccine as a threat. To me, it shows a complete lack of confidence that they have raised their children to make smart decisions and a desire to project blame for their children's mistakes (which is a normal part of growing up) in misguided directions.
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I think part of the reason the vaccine is less effective is that if it were administered at age 20, a significant portion of the population has already been infected with one of HPV serotypes.
I just get the feeling that, from a public health perspective, the arguments against vaccination are extraordinarily dangerous. While the numbers of US HPV related cervical cancer are low (though by no means insignificant), what would the reaction be if an HIV vaccine is developed? Would religious conservatives block approval since it suddenly makes intercourse and intravenous drug use much less threatening activities?
I just get the feeling that, from a public health perspective, the arguments against vaccination are extraordinarily dangerous. While the numbers of US HPV related cervical cancer are low (though by no means insignificant), what would the reaction be if an HIV vaccine is developed? Would religious conservatives block approval since it suddenly makes intercourse and intravenous drug use much less threatening activities?
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For the longest time, the head of an important FDA advisory panel was a wife-beating right wing religious conservative whack-job. What do you expect ?
CDC is afraid to put the HPV vaccine into the block of recommended vaccinations out of fear of getting targeted by the religious zealots running the current administration.
CDC is afraid to put the HPV vaccine into the block of recommended vaccinations out of fear of getting targeted by the religious zealots running the current administration.
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2Bsure said:
This is what I have heard too. It's most effective if given before you are sexually active, because it won't work if you already have HPV. This is why it's being recommended for younger girls, but I'm not sure what the average age of a first sexual experience is today. 😕
I think it's a great idea, but I'm biased because my mom has had cervical cancer twice, most likely caused by HPV. I know if I ever have daughters (and even sons) I will make sure they are vaccinated. So what's the vaccine like? Is it one shot, a series of shots over a period of time etc.?
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mustangsally65 said:
My school is participating in one of the clinical trials, the one with GlaxoSmithKline. it is a series of 3 vaccines over a few months. It makes the muscle a little sore, but nothing worse than a typical shot (at least that I've experienced).
As for the age of first sexual intercourse in girls, I just read in the New Yorker that it's about 17 years old. There was an article in the March 13 (I believe) new yorker that talked about the HPV vaccine in an article about how this administration views science. I can't find a link, but if you get a chance to read it, it's pretty interesting.
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OK, in case anyone is interested in the article, I found it... Here's an excerpt from the beginning. And if anyone wants to read the rest I can PM the pdf to you. I could only find it on lexisnexis, so can't post a link that would work.
POLITICAL SCIENCE , By: Specter, Michael, New Yorker, 0028792X, 3/13/2006, Vol. 82, Issue 4
POLITICAL SCIENCE
The Bush Administration's war on the laboratory.
On December 1st, Merck & Company applied to the Food and Drug Administration for a license to sell a vaccine that it has developed to protect women against the human papillomavirus. HPV is the most common sexually transmitted disease in the United States; more than half of all Americans become infected at some point in their lives. The virus is also the primary cause of cervical cancer, which kills nearly five thousand American women every year and hundreds of thousands more in the developing world. There are at least a hundred strains of HPV, but just two are responsible for most of the cancer. Two others cause genital warts, which afflict millions of people. Merck's vaccine, designed to protect against those four strains, has been tested in thirteen countries, including the United States. More than twelve thousand women between the ages of sixteen and twenty-six were monitored for an average of two years. The results were conclusive: twenty-one of the women who received a placebo during the trial developed the cellular abnormalities that are associated with cancer and other illnesses. Not one of those in the vaccinated group did. Another vaccine, which is being developed by GlaxoSmithKline, promises to be just as effective.
Even in the age of molecular medicine, such unqualified successes are rare. "This is a cancer vaccine, and an immensely effective one," the Nobel laureate David Baltimore, who has served for the past eight years as president of the California Institute of Technology, told me. "We should be proud and excited. It has the potential to save hundreds of thousands of lives every year."
The vaccine is now under review by the F.D.A. and could be approved for use in the United States by June; what happens after that will depend largely on the Bush Administration's Advisory Committee on Immunization Practices. The committee's recommendations are not binding, but most states rely on them in determining which vaccines a child must receive in order to attend public school. To prevent infection with HPV, and to minimize the risk of cervical cancer, girls would need inoculations before becoming sexually active. The average age of first intercourse in America is under seventeen; to insure the broadest possible coverage, the vaccines would have to be administered much earlier.
Vaccinations for contagious diseases like measles and mumps are required before a child can enter public school. That won't be the case with the HPV vaccine, however. The Bush Administration, its allies on Capitol Hill, and the religious base of the Republican Party are opposed to mandatory HPV vaccinations. They prefer to rely on education programs that promote abstinence from sexual activity, and see the HPV vaccine as a threat to that policy. For years, conservatives have regarded the human papillomavirus as a kind of index of promiscuity. Many abstinence supporters argue that eliminating the threat of infection would only encourage teenagers to have sex. "I personally object to vaccinating children when they don't need vaccinations, particularly against a disease that is one hundred per cent preventable with proper sexual behavior," Leslee J. Unruh, the founder and president of the Abstinence Clearinghouse, said. "Premarital sex is dangerous, even deadly. Let's not encourage it by vaccinating ten-year-olds so they think they're safe." Senator Tom Coburn, Republican of Oklahoma, a family physician and a prominent leader among those who believe that abortion should be illegal, has argued repeatedly in Congress that since condoms can fail, the nation should stop relying on them so heavily. In 2004, he made his position clear when he testified about his experience treating patients who have been infected with HPV: "Studies have indicated for years that promiscuity was associated with cervical cancer."
POLITICAL SCIENCE , By: Specter, Michael, New Yorker, 0028792X, 3/13/2006, Vol. 82, Issue 4
POLITICAL SCIENCE
The Bush Administration's war on the laboratory.
On December 1st, Merck & Company applied to the Food and Drug Administration for a license to sell a vaccine that it has developed to protect women against the human papillomavirus. HPV is the most common sexually transmitted disease in the United States; more than half of all Americans become infected at some point in their lives. The virus is also the primary cause of cervical cancer, which kills nearly five thousand American women every year and hundreds of thousands more in the developing world. There are at least a hundred strains of HPV, but just two are responsible for most of the cancer. Two others cause genital warts, which afflict millions of people. Merck's vaccine, designed to protect against those four strains, has been tested in thirteen countries, including the United States. More than twelve thousand women between the ages of sixteen and twenty-six were monitored for an average of two years. The results were conclusive: twenty-one of the women who received a placebo during the trial developed the cellular abnormalities that are associated with cancer and other illnesses. Not one of those in the vaccinated group did. Another vaccine, which is being developed by GlaxoSmithKline, promises to be just as effective.
Even in the age of molecular medicine, such unqualified successes are rare. "This is a cancer vaccine, and an immensely effective one," the Nobel laureate David Baltimore, who has served for the past eight years as president of the California Institute of Technology, told me. "We should be proud and excited. It has the potential to save hundreds of thousands of lives every year."
The vaccine is now under review by the F.D.A. and could be approved for use in the United States by June; what happens after that will depend largely on the Bush Administration's Advisory Committee on Immunization Practices. The committee's recommendations are not binding, but most states rely on them in determining which vaccines a child must receive in order to attend public school. To prevent infection with HPV, and to minimize the risk of cervical cancer, girls would need inoculations before becoming sexually active. The average age of first intercourse in America is under seventeen; to insure the broadest possible coverage, the vaccines would have to be administered much earlier.
Vaccinations for contagious diseases like measles and mumps are required before a child can enter public school. That won't be the case with the HPV vaccine, however. The Bush Administration, its allies on Capitol Hill, and the religious base of the Republican Party are opposed to mandatory HPV vaccinations. They prefer to rely on education programs that promote abstinence from sexual activity, and see the HPV vaccine as a threat to that policy. For years, conservatives have regarded the human papillomavirus as a kind of index of promiscuity. Many abstinence supporters argue that eliminating the threat of infection would only encourage teenagers to have sex. "I personally object to vaccinating children when they don't need vaccinations, particularly against a disease that is one hundred per cent preventable with proper sexual behavior," Leslee J. Unruh, the founder and president of the Abstinence Clearinghouse, said. "Premarital sex is dangerous, even deadly. Let's not encourage it by vaccinating ten-year-olds so they think they're safe." Senator Tom Coburn, Republican of Oklahoma, a family physician and a prominent leader among those who believe that abortion should be illegal, has argued repeatedly in Congress that since condoms can fail, the nation should stop relying on them so heavily. In 2004, he made his position clear when he testified about his experience treating patients who have been infected with HPV: "Studies have indicated for years that promiscuity was associated with cervical cancer."
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McDoctor said:
I've read about adding it into recommended boosters 👍 .
McDoctor said:
The argument is supposed to be: If the risk for contracting HPV declines, younger women will think they don't have to use birth control and it will contribute to increases in younger women having intercourse.
Obviously it's a mad-hatter argument.
And to put it in perspective, how many of you worried about HPV when you lost your virginity? I was worried about many things that fateful night - and HPV was not one of them.
W
Wizard of Oz
I'd like to bump this thread now that the vaccine has been out a while.
Just to throw this out there, I think that there is a company that is making a vaccine that covers a wart-associated strain or two.
I think that the vaccines cover several strains, but I agree that screening will still continue.
I know a doc who is an OBGYN who did extra training in ID (a rare sort of specialist), and he told me that the numbers with the GSK vaccine weren't strong enough for boys.
I know a doc who recommended it to a 30-year-old married woman who started having abnormal paps after having a baby. Do you think that the doc is misinformed?
Coming from one of the biggest Bush-supporting states in the union, conservative groups will find any reason (however absurd it sounds) to try to promote abstinence only. They've already been saying that HPV transmission appears unaffected by condom use (so what, now you're telling people not to use condoms?), so I guess this vaccine would destroy their standpoint. It stands to reason that my state is second to Nevada in divorce and remains a hotbed for teenage pregnancy. Yeah, abstinence only, don't get me started.
We also have an education issue on our hands with HPV--warts vs. cervical CA, what it means to be seropositive, the fact that you can clear the virus, etc. I'm afraid that in my over-educated mind, I can't really accept HPV as a traditional STD (or perhaps more appropriately sexually-transmitted or associated infection) since the letters "STD" have such a negative stigma. To me, the virus family in itself is really just a marker for sexual activity.
I'm behind the vaccine 100% Cervical CA is a life/death matter. We don't have time to stand behind a pulpit on our moral high ground with this issue.
Just to throw this out there, I think that there is a company that is making a vaccine that covers a wart-associated strain or two.
I think that the vaccines cover several strains, but I agree that screening will still continue.
I know a doc who is an OBGYN who did extra training in ID (a rare sort of specialist), and he told me that the numbers with the GSK vaccine weren't strong enough for boys.
I know a doc who recommended it to a 30-year-old married woman who started having abnormal paps after having a baby. Do you think that the doc is misinformed?
Coming from one of the biggest Bush-supporting states in the union, conservative groups will find any reason (however absurd it sounds) to try to promote abstinence only. They've already been saying that HPV transmission appears unaffected by condom use (so what, now you're telling people not to use condoms?), so I guess this vaccine would destroy their standpoint. It stands to reason that my state is second to Nevada in divorce and remains a hotbed for teenage pregnancy. Yeah, abstinence only, don't get me started.
We also have an education issue on our hands with HPV--warts vs. cervical CA, what it means to be seropositive, the fact that you can clear the virus, etc. I'm afraid that in my over-educated mind, I can't really accept HPV as a traditional STD (or perhaps more appropriately sexually-transmitted or associated infection) since the letters "STD" have such a negative stigma. To me, the virus family in itself is really just a marker for sexual activity.
I'm behind the vaccine 100% Cervical CA is a life/death matter. We don't have time to stand behind a pulpit on our moral high ground with this issue.
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I'm actually kinda shocked by this:
So what about the long term effects?
So what about the long term effects?
