Home > In the News, Parent Perspective, Preventable Diseases > HPV Vaccine: What’s Good For the Goose Is Good For the Gander

HPV Vaccine: What’s Good For the Goose Is Good For the Gander

There has certainly been a great deal of media coverage regarding yesterday’s vote from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) in favor of recommending Human Papillomavirus (HPV) vaccine for boys.

As the mother of five girls, I am happy to hear this.  Although my daughters will all receive the HPV vaccine, I’ve always wondered why females were being tasked with reducing the spread of a virus that can be transmitted through genital contact.   After all, HPV transmission often involves parties from both sexes.  So, while previous recommendations to vaccinate girls have had the potential to lower the rates of HPV transmission, unless there is a large majority of girls vaccinated (which, as of yet, there isn’t), the fact is HPV will continue to be spread among a sexually active population that includes both men and women.

So, a new decision has been made and the ACIP recommendation is to vaccinate boys as well.  But it’s wasn’t such a simple matter.  The recommendation was based on specific evidence that illustrated a cost-benefit of vaccination that will reduce the incidence of certain cancers in males.

What we know about the HPV virus.

What many people may not realize is that HPV infection is very prevalent among the sexually active population (and sexually active does not necessarily mean promiscuous).  To be honest, until I began researching the HPV vaccine, I never knew that most sexually active men and women will be infected with HPV at some point in their lives.  

It’s important that people realize that it is possible to be infected with HPV, but never suffer any symptoms, never realize you are infected and continue to pass it onto various partners.  It’s also possible for some people to clear the infection without any medical intervention.  However, because of the serious risks that HPV can present, we must recognize that this is not always the case.

In some cases, HPV can lead to various complications, such as genital warts or cancer, including cervical, vaginal, vulvar, penile, anal and throat cancers. Additionally, as more research is conducted, we’re learning that there may be a link between HPV and heart disease in women, a possibility that was suggested earlier this week and a concern that warrants additional research.

Unfortunately, a large study that covered 83% of the U.S. population during 1998–2003 estimated that about 24,900 HPV-associated cancers occur each year with more than 17,300 HPV-associated cancers occurring yearly in women, and almost 7,600 occurring yearly in men.  Shockingly, nearly all cervical cancers are caused by HPV, while 90% of anal cancers, 65% of vaginal cancers, 50% of vulvar cancers, 35% of penile cancers and about 60% of oropharyngeal cancers – which are cancers of the back of the throat, including the base of the tongue and tonsils – are all attributed to an HPV infection.

What we know about the HPV vaccine.

Given the statistics above, it is not surprising that the HPV vaccine is often hailed – and rightly so – as a cancer preventing vaccine.  The HPV vaccine has undergone rigorous testing and it’s estimated that approximately 35 million doses have been administered since the CDC first began recommending the series.

While staunch anti-vaccine critics often refer to VAERS reports suggesting incidence of death related to the vaccine, the specific investigations into these reports have not linked these incidences to vaccination, but rather death after vaccination, which is not related to the vaccine.  (For an excellent visual illustration of HPV vaccine safety I encourage you to check out this blog post on Information in Beautiful.)

This is just one of the many unfounded suggestions that have been the focus of anti-vaccine sentiment, all helping to contribute to parental hesitation regarding the HPV vaccine.  In addition to safety concerns, some parents question why they should get their children vaccinated if the vaccine only protects against some of the many HPV strains that exist.  Other parents wonder how long the vaccine will be effective and whether their will be a need for a booster. While there is currently no evidence that suggests that a booster will be necessary, some parents have expressed a preference to wait until their child is older and more likely to engage in sexual activity.  Still other parents are distracted by the fact that the HPV infection is transmitted through genital contact.  They worry what messages they could be sending their daughters if they decide to have them vaccinated at a young age and therefore some have opted avoid the vaccination entirely.

Unfortunately, all these issues have resulted in disappointing vaccination coverage and recent data indicates that only 44.3% -48.7% of adolescent girls, 13-17 years of age, have received one or more doses and only 26.7% to 32.0% have received all three of the recommended doses.

Of course, what we do know is that the vaccine is most effective if administered before a child becomes sexually active, as there is considerable risk that they may contract the virus before vaccination.  Knowing that national statistics suggest that more than one in five children are sexually active by the age of 15, it is understandable that the vaccine is recommended for well before that age and in line with other recommended vaccines that children could expect to receive at physician well-visits.

The new recommendation for boys.

Although the HPV vaccine has not been previously recommended for boys, it has been approved by the FDA for such purposes.  In our discussions on our Vaccinate Your Baby Facebook page, I’ve heard from many parents who have realized the benefits of the HPV vaccine and have since taken the initiative to vaccinate their sons prior to these official recommendations. (Just yesterday, I even heard Dr. Richard Besser, of ABC News, explain why he vaccinated his own two sons and why he anticipated yesterday’s ACIP recommendation to be voted through.)

What we need to consider now is what implications these new recommendations will have.  For instance, most private insurers will pay for vaccines that are on the CDC’s recommended schedule.  Since the HPV vaccine is rather expensive, at approximately $390 for the three dose series, this translates into a policy with monetary implications for insurance companies, while offering considerable cost advantages for parents who had planned to have their boys vaccinated regardless of the recommendations.

The official recommendation voted on yesterday states that boys, ages 11 and 12, should be vaccinated and males between the ages 13 through 21 should also receive the complete three shot series.  Additionally, the decision was made that vaccination may be given to boys as young as 9 and to men between the ages of 22 and 26.

Now that we have these recommendations to go on, all that’s left to wonder is how long it will take before the vaccination rate among boys will beat the rate we’ve had for girls. Personally, I’m curious to see if there will be similar concerns about the HPV vaccine being a suggestion of acceptable sexual behavior among the parents of boys as we have witnessed with the parents of girls.  I can only hope that this won’t be as much of an issue, but that these parents will recognize that their boys have just as much responsibility as our girls to prevent the spread of HPV.

  1. Twyla
    November 2, 2011 at 3:08 am

    re: “While staunch anti-vaccine critics often refer to VAERS reports suggesting incidence of death related to the vaccine, the specific investigations into these reports have not linked these incidences to vaccination, but rather death after vaccination, which is not related to the vaccine.”

    One doesn’t need to be a “staunch anti-vaccine critic” to have concerns about this vaccine. The reports of serious adverse reactions such as seizure disorders, physical and cognitive impairment, blood clots, and even death have exceeded such reports from other vaccines commonly given to teenagers.

    There have also been many reports of fainting after receiving Gardasil, which the CDC says is nothing to worry about and probably just due to fear of needles. Yet other shots are not followed so frequently by fainting.

    It’s odd to me that we are told vaccines can cause febrile seizures (which, we are told, are nothing to worry about) but that if someone develops a serious seizure disorder after the vaccine that’s just coincidental, no causal connection. We are told that if many are fainting after the vaccine, that is nothing to worry about, and if some are dropping dead after the vaccine that is just a coincidence, no causal connection.

    We really don’t understand much about vaccine reactions, including how to identify them, what causes them, who is susceptible, and how to prevent them. The desire to understand better is not being “anti-vaccine” but believing that our vaccine program must be made as safe as possible.

    Researcher Diane Harper raises questions about Gardasil:
    http://www.huffingtonpost.com/marcia-g-yerman/an-interview-with-dr-dian_b_405472.html

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  2. Twyla
    November 2, 2011 at 3:17 am

    I’m sure your readers will be interested to know that the movie “The Greater Good” is available to see online for free until November 5 at:

    Your very own Dr. Paul Offit is prominently featured in this movie as one of the “experts” interviewed about vaccines. This award-winning film interviews experts on both sides of these issues, and tells the stories of three families.

    Here is an interesting interview of two of the producers of “The Greater Good”. They make the point that this is not just a matter of “pro” vs. “con”.
    http://www.ustream.tv/recorded/18254194

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  3. Twyla
    November 2, 2011 at 11:33 am

    Per Diane Harper on Fox News 10/30/2011 re: HPV vaccines for boys: “I think that we don’t know enough about what happens with the vaccine. We know for sure that the antibody titers that provide protection and give the efficacy of the vaccine waning two to three years earlier than they do for girls. In the studies that we did with the Gardasil vaccine in boys, what we found is that 38 percent, or nearly two-fifths of boys, lost all detectable titers to HPV-18, which is one of the two cancer-causing types in the vaccine. So that is a concern…”
    http://www.ebcala.org/areas-of-law/vaccine-law/transcript-of-fox-friends-debate-on-hpv-for-boys

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  4. Nathan
    November 3, 2011 at 11:43 am

    One doesn’t need to be a “staunch anti-vaccine critic” to have concerns about this vaccine. The reports of serious adverse reactions such as seizure disorders, physical and cognitive impairment, blood clots, and even death have exceeded such reports from other vaccines commonly given to teenagers.

    Yet “reports” are subject to publicity and controversy. Comparing a new vaccine against and STD to an old vaccine against tetanus is obviously not appropriate. Studies of the vaccine, and indeed analysis of VAERS reports demonstrate that events after vaccination is similar to other vaccines, that is, low.

    There have also been many reports of fainting after receiving Gardasil, which the CDC says is nothing to worry about and probably just due to fear of needles. Yet other shots are not followed so frequently by fainting.”

    Other vaccines are not as painful as Gardsil. Pain is a cause of syncope. I’ve never noticed the CDC saying that fainting is “just due to fear of needles.” Can you support this claim?

    It’s odd to me that we are told vaccines can cause febrile seizures (which, we are told, are nothing to worry about) but that if someone develops a serious seizure disorder after the vaccine that’s just coincidental, no causal connection.

    Why is this odd to you? Anything that causes a fever can cause a febrile seizure, which are common in childhood and frequently occur independently of vaccinations (from infectious diseases, for example). This does not mean that anything that causes a fever can cause an afebrile seizure disorder.

    We are told that if many are fainting after the vaccine, that is nothing to worry about, and if some are dropping dead after the vaccine that is just a coincidence, no causal connection.

    We are told that deaths following vaccination are not connected to the vaccination because the deaths have been studied and no evidence of a connection has been found. I just don’t know what your resistance is to believing that they are not connected. It is not difficult to understand that there is a background rate for adverse events, including deaths, independent of vaccinations. Counting anecdotes does not tell us whether there are more than the backgroud rate. Looking at the studies on the vaccine does.

    I’m not quite sure why you connect “fainting” and “dropping dead” in your mind, anyway. I have friends who faint easily at the sight of blood. Do you think they might drop dead from the sight of blood as well?

    We really don’t understand much about vaccine reactions, including how to identify them, what causes them, who is susceptible, and how to prevent them.

    Well, you may not, but people who are experts in these things know quite a bit about them, enough that there is a 30 page guide to vaccine contraindications. You reduce vaccine reactions by not giving them to those for whom the vaccines are contraindicated. But as I said to you earlier, we don’t know a lot about imaginary vaccine reactions (that is, things that the antivaccine movement believes are reactions that have not been shown to actually be reactions), because they are not real.

    The desire to understand better is not being “anti-vaccine” but believing that our vaccine program must be made as safe as possible.

    However, the denial of the evidence is a clear “anti-vaccine” giveaway.

    Like

  5. Nathan
    November 3, 2011 at 11:45 am

    Interesting, some research I have not seen. Do you have a link to this evidence of waning immunity? I would like to read it, and I did not find such a link in the Fox News interview. I did note the response by Dr. William Shaffner, chairman of the Department of Preventative Medicine at Vanderbilt:

    It’s a point of interest, because we all get our every-10-years tetanus shots. We may indeed discover that down the road, we should get boosters with the HPV vaccine also; that would be not surprising.

    Obviously for any new vaccine there exists the potential of needing a booster. This does not seem to be a serious argument against getting the vaccine.

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  6. Twyla
    November 3, 2011 at 11:57 pm

    If the immunity wanes after 5 years, that is a serious argument against getting the vaccine at age 9.

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  7. Chris
    November 4, 2011 at 12:29 am

    You have a naive opinion of some people.

    Like

  8. Nathan
    November 4, 2011 at 12:46 am

    But the immunity does not wane at five years. The five year data showed no signs of waning, correct? Do point me to data indicating otherwise (as opposed to news reports). It seems to me that it is an antivaccine dream that suddenly, after five years the immunity abruptly ceases.

    Besides, although it is approved for age nine, it is recommended at age 11-12. And let’s just play along with this fantasy scenario and pretend that immunity wanes at five years, though it does not. So, a booster before college. As with the meningococcus vaccine. So what?

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  9. November 5, 2011 at 11:24 am

    Twylla – “One doesn’t need to be a “staunch anti-vaccine critic” to have concerns about this vaccine. ”

    This is perfectly true. But one does need to be a vaccine hater in order to continue to have concerns after they have been studied and found to be without basis in fact. One does not have to be crazy to be afraid of the bogey man in the closet. But after thorough investigation, one does have to be crazy to continue to believe in him.

    Like

  10. October 4, 2013 at 9:18 pm

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    Like

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    Like

  12. lilady
    December 1, 2013 at 4:51 pm

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    Like

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