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HPV Update – Gardisil for Girls and Boys

One of the cornerstones of Pediatrics is prevention of diseases through the use of vaccinations.  While many children are fearful of “shots”, these immunizations play a vital role in maintaining the health of both individuals and the community.  In a development that might make more children unhappy but please their parents, some new vaccines have been introduced in the past several years including vaccines that aim to prevent a type of cancer and as well as warts.

Gardisil was the first vaccine for general use that targets a virus that causes cancer. Cervirix is another HPV vaccine is another that was subsequently licensed..  Gardisil is designed to prevent infection by four strains of Human Papilloma Virus (HPV) that is a causative agent of cervical cancer in women;  Cervarix protects against two strains.  Gardisil vaccine is licensed for males and females ages 9-26 and is a three part series.  Cervarix is not yet licensed for use in males. 

HPV is a sexually transmitted virus that is extremely prevalent in society—the Centers for Disease Control and Prevention (CDC) has reported that as many as 80 percent of women will get a genital type of HPV by age 50.  In fact, one study from the United Kingdom showed that young women who had only one sexual partner had a 46% risk of contracting HPV within three years of their first sexual encounter.

In many, if not most people, HPV lies dormant and causes no problems.  In others, it can cause genital warts in both males and females.  In some women it can cause abnormal cervical pathology or cervical cancer.  The American Cancer Society estimated that in 2006, about 9710 women in the United States developed cervical cancer and about 3700 died from it.  Simply having a positive HPV test in any individual does not mean HPV will cause any of these conditions.  However, without HPV infection, cervical cancer  and genital warts will almost never occur.  Hence, an effective vaccine to prevent HPV will prevent cervical cancer and genital warts. 

Unfortunately, there are many strains of HPV and in order to prevent all cases of the infection, a vaccine would have to protect against all strains.  Neither vaccine protects against all strains, Gardisil protects against 4 strains of HPV—the two most commonly associated with cervical cancer and the two most commonly associated with genital warts.  Studies suggest that receiving this vaccine will reduce an individual’s chances of contracting cervical cancer by 65-70%.   The indication for males is to prevent genital warts since males can not get cervical cancer.  Cervarix protects against the two strains most closely associated with cervical cancer.

Some people express concerns about these vaccines.  For one thing, vaccination is very expensive—well over $100 per dose–and it requires three doses to complete a series.  Fortunately, most HMOs are covering the vaccine and the Federal Vaccines for Children program (which provides vaccines for children enrolled in Medicaid) is including the vaccines.

Another worry is that vaccines are new—Gardisil was only licensed in 2006 and Cervarix more recently.  People worry that a new vaccine might have side effects that did not appear in clinical trials before licensure.  This concern is legitimate.  There have been some reports of patients who have had neurological problems with Gardisil that first appeared during the six month time period over which the three shot series was administered.   However, there is no evidence that these problems were actually caused by the vaccination.  The CDC and the American Academy of Pediatrics strongly endorse the vaccine. 

Finally, some feel that since HPV is sexually transmitted, vaccinating against it will signal approval to girls and boys to engage in sexual activity.  Physicians counter this argument by pointing out that this vaccine in no way protects against all strains of HPV—much less the many other sexually transmitted infections—so it is hardly approval to have sex.  Giving a child an HPV vaccine is no more permission to have sex than giving someone a Tetanus vaccine is permission to step on a rusty nail.  It is simply protection.  Physicians are not advocating these vaccines to enable children to engage in any sexual activity or to encourage patients to engage in unsafe sex; we are advocating vaccination to protect them in the future from a cancer that kills women every single day in the US and from genital warts which can be life long..

If an individual has questions about these vaccines or is interested in receiving either of them for him or herself or for a child, one should contact one’s personal physician to discuss the vaccines.