Qre:us
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- Nov 21, 2008
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I remain undecided on the HPV vaccine for my daughter who is approaching the age when they recommend it. Her pediatrician is neutral on it. What do you know about it Q?
The "biased" source(s):
Well, a group of us had an intense discussion about this HPV vaccination program in Canada. One even works for the Public Health Agency of Canada as part of the vaccination program, while the rest of us, ranging from 2 doctors to us, the epidemiology crew (6 of us, w/ 2 of us whose focus are on cancer, 1 who is in public policy who had an axe to grind about the $ injected into this program), hashed out the possible pros and cons of this vaccination program. So, again, it's just over-dinner conversation...I'd suggest going to actual studies to get properly informed.
A few really relevant studies were cited, and I can't for the life of me, remember what all those specific ones were. There's a few in the New England Journal of Medicine.
Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, Markowitz LE.Prevalence of HPV infection among females in the United States.JAMA. 2007 Feb 28;297(8):813-9.
Garland SM, Hernandez-Avila M, Wheeler CM, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med 2007, 356, 1928-43.
The FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 2007, 356, 1915-27.
Sawaya GF and Smith-McCune K. HPV vaccination – more answers, more questions. New Engl J Med 2007, 356, 1991-3. (editorial)
Haug CJ. Human papillomavirus vaccination – reason for caution. New Engl J Med 2008, 359, 861-2.
Setting set - conclusions drawn -
A few points of consideration:
- there has been no trials focusing on the effectiveness of the vaccines for girls under 16, I believe.
- the duration of immunity provided by the vaccines is unknown (it has not been out long enough to know long-term)
- those girls that are currently getting vaccinated as part of the programs, are actually serving as part of the large-scale sample of subjects for prospective cohort studies of this vaccination program (nothing inherently wrong with that, as some people have to be the guinea pigs, the firsts)
- Two types of vaccination: Gardasil and Cervarix
- Gardasil: protects against high-risk (aka, said to be responsible for 70%
of cervical cancer) HPV types, 16, 18 and, low-risk (e.g., genital warts)
HPV types, 11, and 6.
- Cervarix: protects against only the high-risk HPV types, 16 and 18.
- there is well over 100 types of HPVs.....the vaccines target 4 (2 of the
most common high risk ones).....
- prevalence study (the above reference, JAMA, in 2007) found that the
four types of HPV to be quite low, with the high-risk types (16, 18)
making up around 2% of the cases of all female population in USA,
between 12-59. Also, there's a decline in prevalence of HPV after a
certain "high risk" age, for girls. So, the pretty low prevalence rates kinda
calls into question the effectiveness of nationwide vaccination program,
and given that, of the 2 high risk types of HPV, they're only implicated in
70% of cervical cancers.
- no long-terms effects have been studied; as mentioned earlier, the girls
entering the program are serving as the subjects.
- awareness of knowledge about sexual behaviours, and, evaluating the
likelihood if whether one will be, or does belong, in the high risk groups,
such as age, number of sexual partners, marital status, should help in
making a more informed decision about one's personal need of the
vaccine. One size does not fit all, in this case.