{"id":8581,"date":"2011-09-28T02:09:12","date_gmt":"2011-09-28T02:09:12","guid":{"rendered":"http:\/\/theredphoenixapl.org\/?p=8581"},"modified":"2011-09-28T02:09:12","modified_gmt":"2011-09-28T02:09:12","slug":"remark-on-hpv-vaccine-could-ripple-for-years","status":"publish","type":"post","link":"https:\/\/redphoenix.news\/es\/2011\/09\/remark-on-hpv-vaccine-could-ripple-for-years\/","title":{"rendered":"Remark on HPV Vaccine Could Ripple for Years"},"content":{"rendered":"
\"\"<\/span><\/a>
NO DEBATE Representative Michele Bachmann called the vaccine to prevent cervical cancer "dangerous." Experts disagreed.<\/figcaption><\/figure>\n

By DENISE GRADY<\/strong><\/span><\/p>\n

During a debate last week for Republican presidential candidates and in interviews after it, Representative Michele Bachmann called the vaccine to prevent cervical cancer \u201cdangerous.\u201d Medical experts fired back quickly. Her statements were false, they said, emphasizing that the vaccine is safe and can save lives. Mrs. Bachmann was soon on the defensive, acknowledging that she was not a doctor or a scientist.<\/span><\/p>\n

But the harm to public health may have already been done. When politicians or celebrities raise alarms about vaccines, even false alarms, vaccination rates drop.<\/span><\/p>\n

\u201cThese things always set you back about three years, which is exactly what we can\u2019t afford,\u201d said Dr. Rodney E. Willoughby, a professor of pediatrics at the Medical College of Wisconsin and a member of the committee on infectious diseases of the American Academy of Pediatrics. The academy favors use of the vaccine, as do other medical groups and the Centers for Disease Control and Prevention.<\/span><\/p>\n

The vaccine, recommended by the medical groups for 11- and 12-year-olds, protects against the human papillomavirus, or HPV, a sexually transmitted infection that can cause cancer. Use of the vaccine was disturbingly low even before the Bachmann flap, health officials say. That is partly because of the recent climate of fear about vaccines in general, and partly because some parents feel that giving the vaccine somehow implies that they are accepting or even condoning the idea that their young daughters will soon start having sex.<\/span><\/p>\n

Allegations that vaccines could cause autism have frightened some parents away from giving them to children. But the question has been studied repeatedly, and there is no evidence for such a link; the research that first promoted the idea was subsequently proved fraudulent.<\/span><\/p>\n

Indeed, a report published last month by the Institute of Medicine, which advises the government, found that the HPV vaccine was safe.<\/span><\/p>\n

It did find \u201cstrong and generally suggestive\u201d \u2014 though not conclusive \u2014 evidence that the vaccine could cause severe allergic reactions. But such reactions have been rare.<\/span><\/p>\n

Historically, Dr. Willoughby said, vaccine scares have caused vaccination rates to drop for three or four years, and have led to outbreaks of diseases that had previously been under control, like measles and whooping cough. Measles cases in the United States reached a 15-year high last spring, with more than 100 cases, most in people who had never been vaccinated.<\/span><\/p>\n

Once the disease begins to reappear, parents become worried and start vaccinating again. With cervical cancer, Dr. Willoughby said, \u201cunfortunately, the outbreak is silent and will take 20 years to manifest.\u201d<\/span><\/p>\n

This time, he said, there will be no symptoms to scare parents back into vaccinating their daughters until it is too late.<\/span><\/p>\n

HPV infection is extremely common \u2014 the most common sexually transmitted infection in the United States. More than a quarter of girls and women ages 14 to 49 have been infected, with the highest rate, 44 percent, in those ages 20 to 24.<\/span><\/p>\n

Millions of new infections occur each year, and researchers think that at least half of all adults have been infected at some point in their lives. The genital region is teeming with HPV, and any kind of intimate contact \u2014 not just intercourse \u2014 can transmit the virus. In most people, HPV is harmless: The immune system fights it off. But in some people, for unknown reasons, the viruses persist and can cause cancer.<\/span><\/p>\n

Although the HPV vaccine was initially approved in 2006 to prevent cervical cancer, more recent data has shown that HPV also causes cancers of the penis, anus, vagina, vulva and parts of the throat. Many scientists think that the vaccine can prevent those diseases as well.<\/span><\/p>\n

Last month, the Centers for Disease Control and Prevention published a report on vaccination rates in girls that was \u201ca call to action\u201d to do a better job with the HPV vaccine, according to Dr. Melinda Wharton, deputy director of the National Center for Immunization and Respiratory Diseases.<\/span><\/p>\n

\u201cWe\u2019re not meeting our goals,\u201d Dr. Wharton said. \u201cGirls are not getting an important preventive measure that they need.\u201d<\/span><\/p>\n

Nationwide, last year only 32 percent of teenage girls received all three shots needed to prevent HPV infection, the disease centers found. Rates of vaccination were much higher (at least 45 percent) in a few states \u2014 Massachusetts, Rhode Island, Washington and South Dakota. Those furthest below average (20 percent or less) included Idaho, Mississippi, Arkansas and Alabama.<\/span><\/p>\n

The report was particularly troubling, Dr. Wharton said, because it showed use of the HPV vaccine lagging far behind that of two other vaccines that were licensed around the same time, one for meningitis and a combination shot against tetanus, diphtheria and whooping cough.<\/span><\/p>\n

\u201cThis vaccine has been portrayed as \u2018the sex vaccine,\u2019 \u201d said Dr. Mary Anne Jackson, a professor of pediatrics at the University of Missouri-Kansas City and a member of the infectious disease committee of the American Academy of Pediatrics. \u201cTalking about sexuality for pediatricians and other providers is often difficult.\u201d<\/span><\/p>\n

Dr. William Schaffner, an infectious diseases expert at Vanderbilt University, acknowledged that 11 or 12 is \u201ca pretty tender age, and parents are having a hard time getting used to this concept.\u201d<\/span><\/p>\n

But like the measles vaccine and others, this one must be given before a person is exposed to the virus or it will not work.<\/span><\/p>\n

\u201cHere we\u2019d like to get it completed before the young woman initiates her sex life,\u201d Dr. Schaffner said. \u201cOf course parents, particularly fathers, think that\u2019s going to happen at around age 34.\u201d<\/span><\/p>\n

The average age of first intercourse in the United States is about 17 for both boys and girls, according to the Kinsey Institute. About 25 percent have had sex by age 15.<\/span><\/p>\n

Even before Mrs. Bachmann\u2019s comments, family doctors were negotiating with reluctant, confused parents. Dr. Schaffner said he knew a pediatrician who postponed the HPV shots until most patients turned 15 specifically to avoid parents\u2019 objections at the younger age.<\/span><\/p>\n

\u201cHe thinks he can pick out the early adventurers because he knows them so well,\u201d Dr. Schaffner said. \u201cThose, he vaccinates earlier. Personally, I\u2019m dubious about the success of this strategy. He may be no better than the parents figuring out who is doing what when.\u201d<\/span><\/p>\n

Dr. Willoughby said he thought the HPV vaccine might be more acceptable to parents if it were recommended even earlier in life, at a less fraught time than the cusp of puberty. Then it could be given, as most vaccines are, without parents\u2019 or doctors\u2019 feeling a need to give the child a detailed explanation. And there would not be the unspoken implication that sex was imminent.<\/span><\/p>\n

\u201cThere\u2019s probably no reason why it should be 11 or 12, as opposed to 5 or 6 or even birth,\u201d Dr. Willoughby said. \u201cIf it were being given in kindergarten, I don\u2019t think would be an adherence problem.\u201d<\/span><\/p>\n

So far, there is no evidence that the vaccine wears off over time, but if that does occur, Dr. Willoughby said, booster shots could be given.<\/span><\/p>\n

There are many strains of HPV, but two of them, known as Type 16 and Type 18, cause 70 percent of all cervical cancers. Other strains can cause genital warts.<\/span><\/p>\n

One version of the vaccine, Gardasil, made by Merck, works against the two cancer-causing strains and two other strains that are the most common causes of genital warts. Gardasil was approved for use in boys in 2009 to prevent genital warts, but medical groups like the pediatrics academy have not recommended it; that could change within the next few months.<\/span><\/p>\n

Another version, Cervarix, made by GlaxoSmithKline, protects against only the cancer-causing strains, and is approved only for girls and women.<\/span><\/p>\n

In studies comparing women who were vaccinated with those who were not, the vaccines were 93 to 100 percent effective at preventing infection with HPV Type 16 and Type 18, according to Dr. Deborah Saslow, the director for breast and gynecological cancer at the American Cancer Society.<\/span><\/p>\n

Some critics of the vaccine have said it is not needed in the United States, arguing that cervical cancer is no longer common here: Pap tests are finding precancerous growths early enough to remove them before they turn into cancer. There are about 12,000 cases of cervical cancer and 4,000 deaths a year in the United States. (In developing countries, infection rates are much higher, and the disease is a leading cause of death in women.)<\/span><\/p>\n

But deaths are only a small part of the trouble caused by HPV. Several hundred thousand women a year in the United States need surgery for precancerous lesions caused by the virus, and many more are treated for other cervical abnormalities linked to the infection.<\/span><\/p>\n

The vaccines could prevent many of those cases and spare women the surgery, which can be painful and nerve-racking, and may impair a woman\u2019s ability to carry a pregnancy to full term, Dr. Saslow said.<\/span><\/p>\n

By June 2011, more than 35 million doses of the two cervical cancer vaccines had been distributed in the United States, according to the Centers for Disease Control and Prevention. The most common side effect is a sore arm from the shot. Though fainting has been reported, Dr. Jackson said that teenagers were more likely than younger children to faint after any injection.<\/span><\/p>\n

When pediatricians recommend the vaccine, many parents still hesitate. Michele Boettiger, the mother of three daughters in Missouri City, Tex., said she struggled with the decision about whether to vaccinate them against HPV. She worried about whether the vaccine was safe.<\/span><\/p>\n

As a Roman Catholic who believes in abstinence until marriage, she also wondered whether the vaccine would somehow send the wrong message, and act as \u201ca gateway for young women to think they have sexual freedom.\u201d<\/span><\/p>\n

Ms. Boettiger, a nursing student, found reassurance in the endorsement of the vaccine by the disease centers and other medical groups, and in its acceptance by the National Catholic Bioethics Center.<\/span><\/p>\n

Her father and her husband, the girls\u2019 father, both died of cancer. \u201cOur family suffered a loss from cancer,\u201d she said. \u201cIt is not a battle I want to fight anytime soon.\u201d<\/span><\/p>\n

She has had her two older daughters vaccinated, and will do the same for the youngest.<\/span><\/p>\n

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