Mandatory HPV Vaccination

[joetrisman]

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I think that vaccines definitely have their place and time, but I'm against broadly giving vaccines for diseases that do not have high mortality rates for a few reasons.

My first reason is the development of lymphoid cancers could be accelerated by every immunization you receive. Its not been proven to be a definite cause, but on paper it works out if you've studied VDJ recombination and have an understanding of genetics. http://www.plosbiology.org/article/infooi%2F10.1371%2Fjournal.pbio.0050043

Additionally, based on the principle of original antigenic sin, you could potentially make yourself worse off by getting vaccinated.

Finally, while it is potential possible to eradicate a virus through vaccination as such in the case of small pox, I think along the lines of Red Queen Theory for viruses and think that many will just change strains through evolutionary pressure. The lack of a HIV vaccine comes to mind.

 

[Pharmavixen]

lol, joetrisman. How about the White Rabbit theory, that if the vaccine isn't given in a timely fashion, you shall be too late?

From the CDC link:

As of September 30, 2010, there have been 56 U.S. reports of death among females who have received Gardasil. Thirty of these reports have been confirmed and 26 remain unconfirmed due to no identifiable patient information in the report such as a name and contact information to confirm the report. Confirmed reports are those that scientists have followed up on and have verified the claim. In the 30 reports confirmed, there was no unusual pattern or clustering to the deaths that would suggest that they were caused by the vaccine.

 

[FarscapeGirl]

It's so funny to me that people often rush to make comments like this about children. I really believe that this is a cop out. You as a parent do and should have control over the decisions your children make. The key is: don't start parenting when they become teenagers. Parenting should begin at birth. When i was a child (and I'm still in my 20s) my parents were "hands on" parents. They didn't wait for the schools or the media to raise us because they were already doing it. The result: all three of us (2 girls, 1 boy)graduated from college drugfree, std free, and baby free. I'm not saying that the vaccine is not a good option. I'm simply saying we should spend more time educating our children and instilling moral values rather than vaccinating them against STDs because "they're going to do it anyway." Our kids deserve a chance to develop into the responsible, moral adults God created them to be. We all need to stand up and be real parents again because in the end - our children are the ones who end up suffering. I KNOW how i would feel if my eleven yr old came home with some other STD or pregnant because I decided to leave the decision regarding premarital sex up to them.

Newsflash: you can have sex without your parents knowing about it! You can also have safer sex and have very little change of getting STDs, becoming pregnant, etc. You can also get HPV without having vaginal intercourse.

The idea is to give the vaccine to your child before they have sex. Before you have any idea your precious child is getting it on with a member of the opposite sex or even thinking about it. Think of it this way, too. Your child can grow up, get married, only have sex with her husband, and end up with HPV because he's screwing around on her. Wouldn't you have wanted to protect her?

 

[FarscapeGirl]

Okay, so I went and did a little more research on this issue and have revised my stance on Gardasil. While I feel it is acceptible to have on the market, I feel it is unacceptable to have this drug required by any state agency or school due to a myriad of reasons. It should be up to parents to decide if they want to vaccinate their children with this particular drug. Please note I am not calling for the abolishment of required vaccines. Any law forcing this particular vaccination on school aged children is ridiculous. We are going to force parents (because states certainly don't have the money to give it away for free thru their health departments) to spend $360 bucks (which is not a drop in the bucket for most people) to vaccinate against a disease that effects about 2% of the population? Is it me or is it more than coincidence Merck is pushing this drug so hard after its fall from grace with the Vioxx fiasco or more recently the failure to bring Vioxx's replacement Arcoxia to the market? We currently have about 30,000,000 school aged girls in the country and at $360 bucks a pop, thats $10,800,000,000 right into Merck's pocket. (thats 10.8 billion with a B!!) As far as the "opt out" clause is concerned, it is total crap thanks to the media and a country full of people that believe what they hear from their neighbor and read in the paper rather than the facts. When everyone else call’s the signed law “mandatory,” perception becomes reality and in effect it does become mandatory.

On top of that, I wouldn't give this vaccine to my daughter. Reguardless of the "it will make are cute daughters ******" rhetoric (rhetoric garbage from the right wing extreme machine I may add) , my reasoning is more from a safety/benefit stand point. I don't feel comfortable yet with this drug's findings because the risk assessment is still inconclusive for long term effects. What if we find out 10 years from now that it causes sterility? (Then Merck will go sell it in China, right?) In the drug trials, women were only followed for an average of 3-4 years. Big whoop! So not only do we NOT know about long term complications, we have NO idea how long immunity lasts. None. Zilch. Zippo!

Another bone of contention with Merck's advertising is the whole 50% transmission rate of HPV. What a load of horse crap. Jama not too long ago said that HPV's xmission rate is more like 33% and top that off, serotype HPV 16 & 18 (the ones that cause 2/3 of cervical cancer that Gardasil works on) transmission is about 1%. So who's kidding who here? I'm looking forward to reading the studies about this drug 10 years from now and seeing how successful it really is.

Okay, long-term effects. The flu vaccine changes every single year, and I've never seen a long-term effect study on any of them. What if it causes sterility 20 years down the line??!!

My point is that vaccines are pretty standard. They're made pretty much in the same way using the same concepts (vaccines against prostate cancer not withstanding). I'd feel safe enough giving this to my daughter, and I would have gotten it myself when I was under 26 if I hadn't been in a vaccine clinical trial at the time.

 

[FarscapeGirl]

I think that vaccines definitely have their place and time, but I'm against broadly giving vaccines for diseases that do not have high mortality rates for a few reasons.

My first reason is the development of lymphoid cancers could be accelerated by every immunization you receive. Its not been proven to be a definite cause, but on paper it works out if you've studied VDJ recombination and have an understanding of genetics. http://www.plosbiology.org/article/infooi%2F10.1371%2Fjournal.pbio.0050043

Additionally, based on the principle of original antigenic sin, you could potentially make yourself worse off by getting vaccinated.

Finally, while it is potential possible to eradicate a virus through vaccination as such in the case of small pox, I think along the lines of Red Queen Theory for viruses and think that many will just change strains through evolutionary pressure. The lack of a HIV vaccine comes to mind.

Okay, if a vaccine can increase your risk of lymphoid cancer (and your in vitro paper does not lead me to any real consideration of that risk), then each infection you get would also cause that risk to go up. And infections have many more fold of antigen than vaccine, so you'd actually want to get the vaccine to prevent the disease.

And the fact there isn't an HIV vaccine is not due to the fact that it keeps changing strains. If that were the case, we'd just have to get several HIV vaccines every once in awhile, like we get an annual flu vaccine. HIV is a disease of the immune system, and so it's been hard to figure out a mechanism to make a vaccine that actually protects against it.

 

[joetrisman]

Okay, if a vaccine can increase your risk of lymphoid cancer (and your in vitro paper does not lead me to any real consideration of that risk), then each infection you get would also cause that risk to go up.

Apologies if the paper was bad. I was just trying to quickly grab a primary literature source that showed VDJ recombination results in episomes that we once thought not to recombine back into the genome at other locations, but has recently been shown to recombine back in - previously I wrote a paper on VDJ recombination but I couldn't find it for proper sources. As with any recombination event, there are possibilities of inserting to convert a protoncogene into an oncogene. Therefore, yes to your statement, for each adaptive immune response that occurs, you are in essence rolling the dice for cancer. Evolutionarily it makes sense as an acute infection is more hazardous than the eventual rise of cancer towards an animal's fitness.

And infections have many more fold of antigen than vaccine, so you'd actually want to get the vaccine to prevent the disease.

Live attenuated vaccines would have the same. Additionally, live attenuated vaccines would have proteins coded for that aren't that same as the actual infectious virus. You'd be having an adaptive response to stuff that doesn't even matter in terms of preventing infection. I'd take my chances with whether or not I get the real infection rather than taking the vaccine. Once again though, I do not say this as a blanket statement. I do think some vaccination is ok for things that are highly pathogenic and fatal, but things like the seasonal flu vaccine are just careless imo.

And the fact there isn't an HIV vaccine is not due to the fact that it keeps changing strains. If that were the case, we'd just have to get several HIV vaccines every once in awhile, like we get an annual flu vaccine. HIV is a disease of the immune system, and so it's been hard to figure out a mechanism to make a vaccine that actually protects against it.

HIV does in fact create substrains within an individual. http://www.pnas.org/content/96/19/10559.full This paper talks about the diversity. Due to the nature of viruses (high replication of genetic material) substrains often occur due to replication errors. HIV is divided into a fairly complex phylogenetic tree that starts with HIV1 &2. HIV1 is divided into M, O , and N based off nucleotide sequences. Additionaly sub categories of A-K exist. And additionally, within a host, a surprising amount of variability occurs due to the aforementioned mechanisms of copying errors.

I will note however that I'm not up to date on trends in primary literature concerning a lot that is going on in immunology. Pharmacy school is taking too much of my time to really keep up.

 

[charmacist]

I'm a 24 year-old male pharmacist, and I decided to get the Gardasil vaccine. I'll be getting the last vaccine this coming March.

Except for Gardasil's unusually high cost, I see no other reason why Gardasil shouldn't be used almost universally for everyone in the appropriate age range.

Most of the arguments against vaccination are comical and have little or no science-, evidence-based foundation.

However, where access to government services (e.g., public education) is concerned, I disapprove of all mandatory vaccination programs--not just for Gardasil, but for all vaccines. The health consequences are a consideration, but they do not justify forcing someone to be vaccinated. That is simply immoral, and I will never support such an act of aggression.

If a program is going to be "mandatory" at all, it should allow for a wide range of exemptions, and the process of applying for an exemption should be easy and quick.

 

[FarscapeGirl]

I'm a 24 year-old male pharmacist, and I decided to get the Gardasil vaccine. I'll be getting the last vaccine this coming March.

Except for Gardasil's unusually high cost, I see no other reason why Gardasil shouldn't be used almost universally for everyone in the appropriate age range.

Most of the arguments against vaccination are comical and have little or no science-, evidence-based foundation.

However, where access to government services (e.g., public education) is concerned, I disapprove of all mandatory vaccination programs--not just for Gardasil, but for all vaccines. The health consequences are a consideration, but they do not justify forcing someone to be vaccinated. That is simply immoral, and I will never support such an act of aggression.

If a program is going to be "mandatory" at all, it should allow for a wide range of exemptions, and the process of applying for an exemption should be easy and quick.

When people refuse vaccination, they then are benefitting from being a free-loader (taking the benefit of herd immunity without any of the very minor risk and effort) and also putting other people who legitimately can't be vaccinated at rather large risk.

Measles is extremely infectious, but babies can't be vaccinated against it. Pertussis is not a big deal in you or me, but it's horribly bad for infants, and they die from it.

When people suggest get vaccination for hospital workers, the rate hovers around 50%, at least for flu, even when it's highly available. When it's required, it's almost 100%. Not everyone understands or cares that they're putting other people at risk.

I'm fine if you have a legitimate medical reason for not getting a vaccine. But if you don't get them, you're putting my family and community at risk. And frankly, when I have kids, I'll do as much as I can to prevent them from being around unvaccinated kids until my kids are fully vaccinated.

 

[FarscapeGirl]

Apologies if the paper was bad. I was just trying to quickly grab a primary literature source that showed VDJ recombination results in episomes that we once thought not to recombine back into the genome at other locations, but has recently been shown to recombine back in - previously I wrote a paper on VDJ recombination but I couldn't find it for proper sources. As with any recombination event, there are possibilities of inserting to convert a protoncogene into an oncogene. Therefore, yes to your statement, for each adaptive immune response that occurs, you are in essence rolling the dice for cancer. Evolutionarily it makes sense as an acute infection is more hazardous than the eventual rise of cancer towards an animal's fitness.


Live attenuated vaccines would have the same. Additionally, live attenuated vaccines would have proteins coded for that aren't that same as the actual infectious virus. You'd be having an adaptive response to stuff that doesn't even matter in terms of preventing infection. I'd take my chances with whether or not I get the real infection rather than taking the vaccine. Once again though, I do not say this as a blanket statement. I do think some vaccination is ok for things that are highly pathogenic and fatal, but things like the seasonal flu vaccine are just careless imo.



HIV does in fact create substrains within an individual. http://www.pnas.org/content/96/19/10559.full This paper talks about the diversity. Due to the nature of viruses (high replication of genetic material) substrains often occur due to replication errors. HIV is divided into a fairly complex phylogenetic tree that starts with HIV1 &2. HIV1 is divided into M, O , and N based off nucleotide sequences. Additionaly sub categories of A-K exist. And additionally, within a host, a surprising amount of variability occurs due to the aforementioned mechanisms of copying errors.

I will note however that I'm not up to date on trends in primary literature concerning a lot that is going on in immunology. Pharmacy school is taking too much of my time to really keep up.

I'm not trying to be rude here, but what in the world are you talking about? I don't even know where to begin. Where have you been learning immunology? My husband and I are both molecular biologists (I switched to pharmacy after finishing my PhD), and neither one of us can make head or tail of where you're getting these rather wacky ideas.

You do not appear to understand the immune system. VDJ recombination happens throughout your life, but it does not happen in response to a specific antigen. It's a process that proceeds by chance, and your body just happens to have the right combo to make an antibody against a specific disease. Plus, I will point this out again, but your article does not link vaccines to cancer. There's not even a conceptual link by any respected scientist that I could find by a quick search on PubMed that links or even suggests a process by how getting a vaccine would increase your risk of cancer.

See my post above on why getting the flu vaccine is important. Any babies, very ill people, or elderly in your life? Get the vaccine so you don't pass the flu onto them and cause them to die.

As well, I was not asking about whether HIV changes substrains in the individual. That is not relevant to the discussion (by the way, neither was your article choice, as you basically didn't link to a specific journal article but a letter by an editor of what's in store for that issue). You said that the reason we can't make an HIV vaccine is because HIV mutates. That is not the only nor main reason. The flu vaccine mutates every year, but we're able to make a vaccine to it just fine. Rather, the HIV virus evades the immune system in a very sneaky way, which makes it hard to make a vaccine for it. A very good friend of mine worked many years on trying to make a vaccine for HIV to no avail. We can't follow the same rules that we do for other vaccines, so this process is requiring many minds working on it over many years.

 

[joetrisman]

I'm not trying to be rude here, but what in the world are you talking about? I don't even know where to begin. Where have you been learning immunology? My husband and I are both molecular biologists (I switched to pharmacy after finishing my PhD), and neither one of us can make head or tail of where you're getting these rather wacky ideas.

You do not appear to understand the immune system. VDJ recombination happens throughout your life, but it does not happen in response to a specific antigen. It's a process that proceeds by chance, and your body just happens to have the right combo to make an antibody against a specific disease. Plus, I will point this out again, but your article does not link vaccines to cancer. There's not even a conceptual link by any respected scientist that I could find by a quick search on PubMed that links or even suggests a process by how getting a vaccine would increase your risk of cancer.

See my post above on why getting the flu vaccine is important. Any babies, very ill people, or elderly in your life? Get the vaccine so you don't pass the flu onto them and cause them to die.

As well, I was not asking about whether HIV changes substrains in the individual. That is not relevant to the discussion (by the way, neither was your article choice, as you basically didn't link to a specific journal article but a letter by an editor of what's in store for that issue). You said that the reason we can't make an HIV vaccine is because HIV mutates. That is not the only nor main reason. The flu vaccine mutates every year, but we're able to make a vaccine to it just fine. Rather, the HIV virus evades the immune system in a very sneaky way, which makes it hard to make a vaccine for it. A very good friend of mine worked many years on trying to make a vaccine for HIV to no avail. We can't follow the same rules that we do for other vaccines, so this process is requiring many minds working on it over many years.

Why is that before anyone is rude, they always throw out a disclaimer 😛 In any event, I knew that SCID often resulted from a defect in IL7 gene. I thought that the IL was secreted at a basal level by innate immune cells due to the basal level of pathogens that are encountered. Once again, I wrote a paper about VDJ in my undergrad genetics class, so I came across a few abstracts during my research that mentioned VDJ being dependent of IL7 signaling. So it seemed logical that an adaptive immune response would confer to an increase in VDJ recombination events. But after your response which lead to my subsequent researching IL7 production this am, I found that while it is produced by dendritic cells, the majority is constitutively produced by stromal cells. So apparently I was wrong in thinking that an introduction of an antigen would increase VDJ. Apologies.

After starting pharmacy school, I envy those who pursued Phds as I find the pharmacy curriculum lacking in basic science and I'm forgetting a lot. Seeing as you mentioned you came from there, do you have any recommendations as to pursuing a phd after pharm school? Any info would be appreciated 🙂

 

[rph3664]

I collect old medical books, and one book from the 1930s described a vaccine for - hang onto your seats - ACNE.

Someone made an extract of zit bacteria and gave it to teenagers in the hopes of relieving that scourge of adolescence. Didn't last long.

 

[owlegrad]

I collect old medical books, and one book from the 1930s described a vaccine for - hang onto your seats - ACNE.

Someone made an extract of zit bacteria and gave it to teenagers in the hopes of relieving that scourge of adolescence. Didn't last long.

That would be pure gold, the schools wouldn't even need to make it mandatory, the market would take care of that on it's own.

 

[Momus]

I'm a 24 year-old male pharmacist, and I decided to get the Gardasil vaccine. I'll be getting the last vaccine this coming March.

Did you pay out of pocket ~$400+?

 

[FarscapeGirl]

Why is that before anyone is rude, they always throw out a disclaimer 😛 In any event, I knew that SCID often resulted from a defect in IL7 gene. I thought that the IL was secreted at a basal level by innate immune cells due to the basal level of pathogens that are encountered. Once again, I wrote a paper about VDJ in my undergrad genetics class, so I came across a few abstracts during my research that mentioned VDJ being dependent of IL7 signaling. So it seemed logical that an adaptive immune response would confer to an increase in VDJ recombination events. But after your response which lead to my subsequent researching IL7 production this am, I found that while it is produced by dendritic cells, the majority is constitutively produced by stromal cells. So apparently I was wrong in thinking that an introduction of an antigen would increase VDJ. Apologies.

After starting pharmacy school, I envy those who pursued Phds as I find the pharmacy curriculum lacking in basic science and I'm forgetting a lot. Seeing as you mentioned you came from there, do you have any recommendations as to pursuing a phd after pharm school? Any info would be appreciated 🙂

The reason I come across as strong as I do in the topic of vaccines is that I'm pretty passionate about vaccines and frustrated at some of the dis-information that's out there on them (not that your post had anything to do with this, but for instance that vaccines are bad because they're made from aborted fetuses...). I'm concerned for public health and where it's heading.

Just be careful when reading about in vitro stuff and expanding it to actual clinical results. Not that I'm familiar enough with the areas you posted in, but it's also a good idea even when just reading one or two in vitro papers. There's a lot of research papers with ideas that don't hold up over the long run. It took me a bit in grad school to realize both of these things after the 'memorize and spit back up' mentality of undergrad, even though I did do some research in undergrad, too. One of the both cool and frustrating thing about research is that there's this library of possible theories about an area that keeps updating and changing. Once one of them becomes pretty much validated, the science moves to a new, more intimate subset in that area.

The idea of making a vaccine against acne that rph3664 brought up is one of the many bad ideas over the years that have been studied in science without someone understanding much about what they were doing, but they still do "experiments" and get published. There's plenty of the same level of improper science still being published now; it's just often hard to tell if you're not in that field (although I can still pick out stuff like not having proper controls, not understanding molecular biology, etc.). There are plenty of papers that are good, too, but that in hindsight could be even better (described often in the discussion sections).

You've got several options as a pharmacy student to get involved in research. For one, if you're really interested in research, you may be able to volunteer right now in a professor's lab and possibly even get class credit for doing a research problem. Once you're out, you can do a fellowship or head for a PhD. Some PharmD programs offer a joint PhD program, too, but you might be too far in your studies to start that. Still, it'd be good to look into.

What area of science are you interested in?

 

[Samus2008]

Well I don't know why it would be mandatory for only girls. Meningitis isn't. I'm a guy and would not let someone force this vaccine on me. I'm not in pharmacy school yet (but accepted), but forcing doesn't sound legal.

 

[rph3664]

Well I don't know why it would be mandatory for only girls. Meningitis isn't. I'm a guy and would not let someone force this vaccine on me. I'm not in pharmacy school yet (but accepted), but forcing doesn't sound legal.

It's not mandatory for anybody, anywhere. When this thread was started (look at the date), there was a proposal in Texas to make immunization of girls mandatory for school attendance, and it was rapidly shot down for numerous reasons, one of them being that HPV is not a disease that is transmissible through casual contact and potentially rapidly fatal.

It was initially recommended only for use in females because women are more likely to contract cancer from HPV. Much more recently, it has been approved for use in boys.

 

[charmacist]

Did you pay out of pocket ~$400+?

No. My insurance pays for the full cost of the vaccine.

However, the physician I see for the vaccine charges me (and bills my insurance) for a full office visit. This seems outlandish to me because he provides no real service other than to vaccinate me. To make the office visit fee seem justified, he'll idly take my blood pressure.

But I don't complain. I live in a ****ty, poor, rural area, and he's the only doctor I could find who was willing to vaccinate males. I have to travel over an hour to get to his office.