Gardasil - The HPV Vaccine

Gardasil and HPV

You've most likely seen the "one less" commercials promoting Merck's new Gardasil vaccine that protects girls from HPV (genital human papillomavirus). I have had several questions regarding this vaccine and whether their daughter should receive it.

When Texas Governor pushed for HPV vaccine to be required for all 12 year old girls, the cancer preventative drew a lot of attention, even Oprah got on board with a show covering the pros and cons of the vaccine.

Let me first talk a little bit about what Gardasil protects against. The vaccine protects against HPV types 6,11,16 & 18. These types are the precursors for 70% of cervical cancers and 90% of genital warts (Merck & co). Other drug companies are attempting to manufacture similar vaccines that might include other strains, but at present, Merck is the only company with a licensed vaccine.

HPV is the most common sexually transmitted virus in the United States. The Centers for Disease Control estimate that approximately 50 % of sexually active people will have genital HPV at some time in their lives. Condoms do create a barrier for HPV transmission, however, HPV is transmitted from skin to skin contact, not through seminal or vaginal fluids. Therefore, the virus can be transmitted during foreplay, petting, and other skin to skin contact in which many do not use condoms or consider "sex". I may have already given you more information than what you anticipated to read, but I'm just giving you the facts and the reality of this issue. To add more :), the Merck representative shared some interesting information with me during his last visit. According to recent research, the most common place HPV found on young males was under the finger nails. I see that cringe, but it's a reality.

The vaccine is most effective when the complete series is administered before a female is sexually active or engaging in any of the above activities. The Gardasil vaccine requires three doses with dose one and two separated by 2 months and dose two and three separated by 6 months. When the vaccine is administered as directed, the reduction of cervical cancer (that result from the included HPV types), is nearly 100%. (CDC HPV Vaccine Information Statement)

According to the National Center for Chronic Disease Prevention and Health Promotion, in 2005, 47% of high school students had had sexual intercourse and 34% of them did not use a condom. 14% of high school students had four or more partners. Every year there are approximately, 9 MILLION new sexually transmitted disease infections among those 15 to 24 years of age. This survey included intercourse as what we older generations consider "traditional intercourse" not all of the other activities I mentioned previously. So, consider the numbers even greater that are being exposed to HPV.

Many of us may have HPV and not even know it. Most physicians only screen for HPV if you have an abnormal pap smear, and this has only been done in recent years. Only approximately 10% of people that have HPV have been diagnosed. I have been shocked at the number of girls ages 15-20 that are already having abnormal pap smears and positive HPV screens. It's alarming to me.

So back to the vaccine ... girls may start the vaccine at age nine but it is recommended by age twelve. The most common side effect of the vaccine is tenderness at the site. There has been an increased incidence of syncope or passing out. Much discussion has been raised regarding whether the occurrence is related to the vaccine or the age group vaccinated. (ACIP Report) I screen girls if they have a history of passing out, have them wait fifteen minutes before leaving the clinic and keep ice and ammonia inhalants handy. I haven't yet had anyone pass out from the vaccine.

We do have excellent cervical cancer screening rates in the United States and most precancerous cells are identified during annual pap smears. However, still cervical cancer kills 3600 women nationally and affects 10,000 each year. Even though the vaccine protects against certain precursors of cervical cancer, pap smears are still necessary for all females who are sexually active or age 21 and older.

I recommend the vaccine for all girls at age 11. My daughter will receive the vaccine when she turns 11. For me, I'm not going there with the discussion on whether or not my daughter will participate in activities that would include transmission of HPV prior to marriage or that her partner(s) will either. I'm not a fortune teller, but if I can protect my child from the devastating effects of cervical cancer, I will.

If you are interested in your daughter receiving the HPV Vaccine, it is available at all Tulsa Health Department Locations. There is no charge for those without insurance, with medicaid, and those who have insurance that does not cover the HPV vaccine. If you have private insurance that covers the vaccine, you can still get the vaccine at cost $130 and seek reimbursement from your individual insurance company.

I welcome any comments or questions regarding Gardasil. Have a great Monday!