By: Christina Paulson, M.D.
January 1, 2011
As parents, we have many important decisions to make concerning our children’s health, and one of them is whether or not our child should receive Gardasil®, a vaccine developed to help prevent cervical cancer and other conditions caused by the human papilloma virus (HPV). The vaccine protects against four types of HPV (6, 11, 16 and 18), two that cause cervical cancer and two that cause genital warts (flesh colored growths that may appear around the vagina or anus). In rare cases, a HPV infection can lead to other types of cancers of the vulva, vagina and anus in girls, and the anus and penis in males. The four types of HPV covered in the vaccine account for 75% of cervical cancers and 90% of genital warts.
Infection with HPV is very common, especially among young people. About 70-80% of all people in the United States will be affected by HPV in their lifetime. However, most people never know they have the virus, because it often goes away on its own and may not cause any symptoms. According to for the Centers for Disease Control (CDC) about 6 million new cases of genital HPV are diagnosed in the United States each year. Of this number, it is estimated that 74% of them occur in 15-24 year olds. This means that any sexually active person can get HPV. In fact, at least 1 in every 2 young women has had a genital HPV infection. This leads to over 10,000 cases of cervical cancer each year in the United States resulting in approximately 3,900 deaths
Gardasil® is the first vaccine developed in the United States to prevent cancer. It is taken over the course of six months in a series of three shots (the second shot is given 2 months after the first, and the third shot is given 4 months after that). Gardasil® was approved by the Food and Drug Administration in June of 2006. It does not contain a live virus (which means the vaccine cannot cause a HPV infection), and it does not contain mercury or thimerosal. Mild side effects have been reported, such as discomfort at the injection site, low-grade fever and flu like symptoms. Early reports suggested fainting was more common after vaccination, but people of this age group are more likely to have fainting episodes and the recent evidence indicates someone is no more likely to faint after Gardasil®.
Gardasil® is approved for both males and females age 9-26. It is commonly offered at the 11-12 year old check-up along with other regular booster shots for tetanus, whooping cough and meningitis. The vaccine needs to be given BEFORE a person is exposed to the virus to get the most benefit. Even if your child is not planning on having sex for many, many years – vaccinating at a young age provides them with protection when the time comes. Research studies have followed girls for more than five years after they received all three shots of the HPV vaccine, and they are still protected. The levels of antibodies are very high, so protection is likely to last for a long time. According to Dr. Bobbie Gostout, MD, a gynecologic surgeon at Mayo Clinic, “[vaccinating at a young age] allows a girl’s immune system to be activated before she’s likely to encounter HPV. Vaccinating at this age also allows for the highest antibody levels. The higher the antibody levels, the greater the protection” against the HPV. Although the vaccine is not designed to protect women who have already been exposed to the virus, it certainly would not be harmful for a sexually active young woman to receive it.
Gardasil® quickly earned the support of an advisory panel of the CDC and an endorsement from the Advisory Committee on Immunization Practices. It has been placed on the routine childhood vaccine schedule. Clearly, the medical community is in support of this life-saving vaccine. The question then becomes why the vaccine has not been universally accepted by parents. Well, the controversies are over multiple issues.
- The cost of $400 for the series of injections can be prohibitive (most insurances, including Medicaid, cover the cost of the vaccine for girls. Medicaid / VFC insurances cover the vaccine for boys and soon private insurances will too.) When compared with the cost for cervical precancer/cancer treatment $400 is a bargain.
- Some parents wonder if the vaccine is too new to evaluate long-term safety. This is always a concern for the CDC with all vaccines. Like all vaccines, safety is being continuously monitored and all the available data continue to show the vaccine to be safe and effective.
- There has been an unprecedented rush to make it mandatory for young women to receive the vaccine as part of their routine check up. Historically, such steps have been taken over the course of many years rather than within a year, as is the case with Gardasil. That’s because the vaccine can make such a big difference in the life of a young person – preventing morbidity and in some cases, preventing death.
- Some parents wonder if young adolescents are more likely to engage in risky sexual behavior if they know they are protected from HPV. Others are reluctant to discuss sexuality with 11-12 year olds, the age group for which the vaccine is first recommended. First and foremost, it is a parent’s responsibility to instill values in their children, this includes teaching our children to respect themselves and wait until they are physically and emotionally mature enough to engage in sexual activity. All parents are encouraged to discuss puberty and sexuality with their children. You might not think so, but your adolescent is listening to you!
Having a vaccine that protects against the types of HPV that cause serious problems (including warts and cervical cancer) is significant as it can prevent grave health problems and may even save lives. It is important to keep in mind that the HPV vaccine will protect your child from a few kinds of the virus, but it won’t provide protection from all of them. Help your adolescent understand it is still very important to see their health care providers for regular check-ups and for women to have regular gynecological exams and Pap tests.
Your decision whether to have your child receive the HPV vaccine will ultimately depend on your personal feelings and the medical facts. All parents are encouraged to discuss their concerns with their child’s health care provider so that they feel comfortable having them immunized.
For more information please visit http://www.cdc.gov/hpv.