Like politics, human papillomavirus, or HPV, is a very interesting topic to bring up at parties. Conversations run the gamut from “Are we talking about sex!?” to “I heard the vaccine is really dangerous.” Being an educator, I find myself faced with the dilemma of putting on my “teacher hat” or just listening to comments. It all depends on how much alcohol has been consumed by those involved in the conversation.
At this particular moment however, I am sitting in my kitchen, looking at the wintry landscape before my eyes, and pondering how to write this piece without putting my personal opinion front and center. Let me give the facts, and let readers come to their own conclusion.
What is Human Papillomavirus?
HPV, on the other hand, is a virus that is also spread through sexual contact, but not necessarily sexual intercourse. The virus is happy with a little skin contact, therefore it is very easily spread, even when using a condom. In fact, 80% of all people have been infected with this virus at some point. If you have had sex, you probably have had HPV at some point. Yes, you likely have had a sexually transmitted infection (STI) and did not even know it - it typically does not present any symptoms.
There are over 170 types of HPV. Fortunately for most people, our body’s immune system is able to deal with HPV; after about 6 months to a couple of years the body naturally rids itself of the virus.
However, there are certain strains that have been identified as troublemakers for some people. These particular strains may cause cervical cancer, anal cancer, penile cancer, vulvar cancer, vaginal cancer and a variety of oral cancers (mouth, throat). Other strains may cause genital warts.
Please note that different strains cause different infections: Strains that cause cancer do not typically cause warts, and vice-versa.
Currently, there is no way to predict if:
- a daughter is going to be one of the 120,000 women diagnosed with cervical cancer each year.
- a child will be one of the growing number of individuals diagnosed with other cancers such as penile, oral, or anal. Currently the number is almost 35,000 a year.
- a child will be one of 355,000 people diagnosed each year with genital warts.
- a child will ever have any diseases caused by HPV infection.
One mother wrote and asked,
“As a mom to a 9 year old girl, the topic of HPV vaccines will be quickly approaching my radar. I don’t necessarily understand the vaccine itself. Does it completely prevent the virus? Are boosters required down the road if my daughter gets the initial vaccine?”
Excellent question, and one that every parent of a youngster should be evaluating.
The vaccine is given to boys and girls around ages 11 or 12. The doses are given as a three-part series over a six month period. The vaccine should be given before the child is sexually experimenting to benefit from its intended purpose of preventing HPV infection.
There are three vaccines currently available; Cervarex, Gardasil, and Gardasil-9. The difference between the three lies in the number of strains it fights. Gardasil-9 is the newest of the trio; it is effective against 9 strains of HPV rather than 2 or 4.
According to the American Sexual Health Association, Gardasil “….is approximately 100% effective in preventing infection with HPV 6 and 11, which together are responsible for nearly all instances of genital warts.” So yes, it works.
As far as boosters, once your child receives the series of three injections over six months, there is no need for a booster at this point. If your child only had one or two of the three doses, it is recommended that they receive the missed doses even if the six months have passed. They have until age 26 to do so.
The vaccine costs about $120 per dose for a total of $360. Most insurance companies cover the cost. However if one’s insurance does not cover this, or if you do not have insurance, Gardasil participates in the Vaccine For Children (VFC) program. The VFC program will enable your child to receive the vaccine at no cost if your family meets certain requirements.
Safety of Vaccines
Another mother wrote with concerns about safety. She stated,
“I never gave my girls the vaccine because I was very afraid of the long term effects. Because the vaccine was new, I didn't feel comfortable giving it them. Years later, I have heard some sad stories of side effects that some girls developed because of the Gardasil vaccine (deregulates the immune system and causes viruses). It's scary to give your children vaccines and not knowing if you are helping them or making it worse.”
Concerns over vaccine safety is common and understandable - after all, we are talking about the health of our children. I respect parents who take the time to find out all they can about vaccines.
According to a study released by the CDC’s Morbidity and Mortality Weekly Report (Markowitz LE, Dunne EF, Saraiya M, et al. Human Papillomavirus Vaccination: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep. 2014;65(RR05):1-30.), the most common side effect is tenderness, swelling, and bruising at the injection site, dizziness after the injection is given, and skin infection at the injection site. I remember my daughters experiencing tenderness at the injection site which lasted a couple of days. If you have a big event in which a child is, say, pitching in a big game, you may want to schedule around that. Otherwise, the side effects for the general population are no different than any other immunization that is typically given to children.
If your child has had a previous allergic reaction to Gardasil or any other immunization, has an autoimmune disease, has a latex or yeast sensitivity, or is pregnant it is best to talk to your healthcare provider to assess the risk/benefit to your child. It is likely the vaccine will not be given, depending on the circumstance. Keep in mind that anyone at anytime can have a reaction to any immunization, but it is quite rare. Sort of like peanut butter or shellfish allergies; you do not withhold peanut butter from your child because you heard your neighbor’s child reacted to peanut butter. Everyone is different.
Physicians are to report any adverse reactions of immunizations to the Vaccine Adverse Event Reporting System (VAERS), so anything unusual is documented and reported. For more information about the safety of the HPV vaccine, click on this link to the CDC about safety facts.
There are many scientific, well-researched reports of the safety of the HPV vaccine that conclude there are no severe side effects, even long-term. Click here and here and here for more detailed information.
What is the Global Perspective regarding HPV Vaccination?
I asked my daughter who has a graduate degree in infectious disease to offer her thoughts. She suggested I look at Australia’s HPV prevention program - they are hugely successful in immunizing their population against HPV, unlike the United States. In the United States, only 37.6% of girls and 13.9% of boys completed their series of three immunizations in 2013. In contrast, in the Land Down Under, 73.1% of girls and 60% of boys have completed their series, according to 2014 data. The difference? Australian government felt the repercussions of HPV infection warranted a national program to offer free vaccines to all their 12-13 year old students … in school…at no cost. I’m not kidding. All students. Voluntary program. In school. Free. And parents said, “Heck, yes!” (Well, I’m not really sure anyone said that.)
There is currently a worldwide effort to vaccinate as many women as possible against HPV. The World Health Organization (WHO) supports global immunization. An organization called GAVI is currently introducing HPV vaccination programs worldwide. However, other countries such as Hong Kong have a very low compliance rate.
- HPV is a virus that is primarily transmitted through sexual contact.
- HPV is spread by skin-to-skin contact, therefore a condom will not prevent the disease from spreading, but it may decrease the odds.
- Most adults will have HPV at some point in their lives.
- Most healthy immune systems naturally fight the virus off within two years.
- There are over 170 strains of HPV.
- Certain strains have been found to be the primary causes of genital warts and certain cancers. The cancers include cervical, penile, anal, vaginal, throat, and oral cancer.
- Oropharyngeal (throat, mouth) cancers rose 225% between 1998 and 2004 due to HPV according to the American Sexual Health Association.
- Vaccines are available for children starting at age 11 or 12.
- 99% of cervical cancer is caused by HPV.
- Since 2007, when the vaccine was first given, the HPV infection rate has decreased 56%.
- 170,000,000 doses have been given worldwide according to the World Health Organization.
- Always discuss any concerns about HPV and other vaccines with your healthcare provider.
Parents have the option to allow their child to be vaccinated against HPV. The best way to make an informed decision is to base your conclusions on research and evaluation and a consult with your healthcare provider. Use the links provided in this blog to read further. Next time you are discussing the pros and cons of vaccinating children against HPV at a party, take a sip of wine, smile and nod, and share your knowledge. Or change the topic to the upcoming election; certainly there are no conflicts on that topic, right?
For a personal perspective on cervical cancer, click on the link to "A Moment with Marcy: A Cervical Cancer Survivor's Thoughtful Reflection."