new book on HPV vaccine in historical context

hmprescott

speaking of HPV vaccines

I just received my contributor’s copy of Three Shots of Prevention: The HPV Vaccine and the Politics of Medicine’s Simple Solutions edited by Keith Wailoo, Julie Livingston, Steven Epstein, and Robert Aronowitz (Johns Hopkins, 2010).

News Abortion

New HPV Vaccine Protects Teens From at Least Four Kinds of Cancer

Martha Kempner

A study released Monday found that Gardasil 9, the newest version of the vaccine that protects against HPV, remains effective for years after it’s given to pre-teen and teen boys and girls.

A study released Monday in Pediatrics found that Gardasil 9, the newest version of the vaccine protecting against the human papilloma virus (HPV), remains effective for years after it’s given to pre-teen and teen girls and boys.

The study confirms that results found during clinical trials in adult women are applicable for young people as well, which is important because the Centers for Disease Control and Prevention (CDC) recommends these shots be given as part of routine vaccinations at age 11 or 12.

Dr. Stanley Block, co-author of the study, had conducted research on the earlier version of Gardasil and found that its protection lasted as long as eight years after the final dose of the vaccine had been given to teens and pre-teens. But similar research had not yet been done on Gardisil 9, which was just released in January.

“With little kids, preteens and teens, you have to show that the antibodies are as good or better than in adult women, whom we know efficacy data in,” Block told Forbes.

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To test the continued efficacy of the latest vaccine, Block and his team gave 3,066 girls and boys ages 9-to-15 three doses of Gardasil 9. Just like with the previous vaccines, participants in the study got the second dose a month after the first and received the final dose six months later.

The researchers then checked the levels of antibodies for each of the nine strains of HPV that the vaccine covers. They found that more than 99 percent of the participants had sufficient antibody levels for all nine strains one month after the final dose.

Researchers continued to test the antibody levels for two and a half years and found the anti-HPV responses were persistent.

HPV is a group of more than 200 related viruses that can infect various parts of the body. There are 40 strains of the virus that are known to be spread through sexual activity, but not all are equally dangerous. Some will be cleared by the body without ever causing symptoms or health issues, but some cause genital warts and others lead to cancer of the cervix, vulva, anus, penis, or throat.

When Gardasil was first introduced in 2006, it provided protection against four strains of the virus: 6, 11, 16, and 18. Strains 6 and 11 cause almost all cases of genital warts, and 16 and 18 are thought to cause 70 percent of cervical cancer cases. Cases of cervical cancer are lower in the United States than elsewhere in the world thanks to widespread early screening methods (such as the Pap test) and the ability to treat changes to cells on the cervix before they become cancer.

Still, cervical cancer strikes about 12,000 women and kills about 4,000 in this country every year.

There are an estimated 3,000 new cases of HPV-associated anal cancers diagnosed in women and about 1,700 in men each year. And cases of head and neck cancers are thought to be on the rise because of HPV infections.

By adding protection against five additional cancer-causing strains (31, 33, 45, 52, and 58), Gardasil 9 has the potential to prevent 90 percent of cases of all cervical, vulvar, vaginal, and anal cancer. And there is reason to believe that it will help prevent oral cancers caused by HPV as well.

“We have four cancers we know this vaccine is going to prevent and one cancer we know it should prevent. You’re preventing five cancers for your child,” Block told Forbes. “Do I need to say anything more?”

The study also had good news for parents who might be reluctant to get their children vaccinated because of reports of adverse reactions. It found the shots were well tolerated by both boys and girls. Minor reactions can include pain, redness and swelling at the injection site, a mild fever, headache, and fainting.

News Sexual Health

New Study: HPV Vaccine Prevents Host of Teen Health Issues

Martha Kempner

A new study finds that the HPV vaccine prevents genital warts and precancerous changes to the cervix in young women ages 14 to 17. Not only does this provide further evidence of the vaccine's efficacy; it suggests that early vaccination is important.

A study published in this month’s Pediatrics adds to the growing body of evidence showing the HPV vaccine is working to prevent cervical cancer and other health issues that can be caused by the human papillomavirus (HPV).

The study followed high school girls in Canada and found that those who had received the vaccine were much less likely to be diagnosed with genital warts or cervical dysplasia than their unvaccinated peers. These results show that the protective effects of the vaccine kick in quickly and confirm the importance of having young people vaccinated at an early age.

HPV is a highly contagious sexually transmitted disease (STD) that is spread from infected skin to uninfected skin. About 79 million Americans are infected with HPV, and about 14 million people become newly infected each year. The majority of HPV cases are cleared by the body without ever causing symptoms or health problems.

Some strains of the virus, however, can cause genital warts, cervical cancer, and cancers of the penis, anus, head, neck, and throat. Approximately 12,000 women in the United States are diagnosed with cervical cancer each year, and about 4,000 die.

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Condoms can prevent HPV transmission, but only if the infected skin is in an area covered by the condom. If it’s on an area outside of the condom, such as a man’s scrotum, condoms cannot help reduce transmission.

A vaccine has been available to prevent HPV transmission since 2006. Gardasil, that vaccine, protected against four stains of the virus—the two that account for 70 percent of cervical cancers and the two that account for 90 percent of genital warts.

A newly approved version of Gardasil now protects against nine strains of the virus and has the potential to prevent 90 percent of cases of all cervical, vulvar, vaginal, and anal cancer, as Rewire has reported. A second vaccine, called Cervarix, was approved in 2009 but only protects against the two strains that cause most cervical cancer.

The vaccine is given as a series of three shots and is approved for young people—both men and women—between the ages of 9 and 26. The Centers for Disease Control and Prevention (CDC) recommends that HPV vaccines become part of the routine vaccinations for girls who are 11 or 12 years old because in order to ensure that it works, it has to be given before they become sexually active.

Though not recommended as part of the routine vaccinations for boys, health-care providers suggest that they receive the vaccine at the same age.

There have been studies that suggest that the introduction of these vaccines has had a dramatic impact. A 2013 study conducted by the CDC, for example, found that the proportion of girls infected with the four strains covered by the original Gardasil vaccine dropped among all girls (vaccinated or not) from about 12 percent before the vaccine was available to 5 percent, a drop of 56 percent.

When researchers looked at those girls who had been vaccinated, the decrease was even higher, at 88 percent.

That study looked at infections rates rather than cervical cancer rates because cervical cancer grows very slowly. The median age of cervical cancer diagnosis is 48 and even higher for other HPV-related cancers, which means it may be many years before the first generation of young women who received the vaccine would have been facing cancer diagnoses.

The new study adds to the expectation that rates of cervical cancer will come down. It followed more than 26,000 teen girls in Ontario, Canada and found that those who had received all three doses of Gardasil (the original 4-strain version) were 44 percent less likely to be diagnosed with cervical dysplasia and 43 percent less likely to be diagnosed with genital warts during their high school years than their unvaccinated peers.

Genital warts are small painless bumps that can appear on the penis, vulva, vagina, cervix, or anus, as well as in the mouth or throat. They may go away on their own or they may need to be removed by a health care provider. Cervical dysplasia is one name for abnormal changes to the cells on the surface of the cervix considered pre-cancerous and usually detected through a pap test.

These changes put women at a higher risk of cervical cancer, but there are treatments available that can prevent them from becoming cancer.

Linda Levesque, one of the senior authors of the newly published study, explained that cervical dysplasia is “not yet cancer, but over time, if it’s left untreated and unchecked runs the risk of becoming cancer later in a girl’s life.” She told HealthDay News:

“I don’t think we were surprised the vaccine works. … What I was surprised by was the magnitude of benefits in such a young age group. I expected we would see some reductions. I didn’t think they would be so large and of such significance.”

The findings suggest that the CDC and other health agencies are right to recommend that the vaccine be given to young women before their sexual debut.

Some parents have objected to vaccinating kids for an STD at the age of 11, arguing that it is too young to even discuss sexual behavior. The authors disagree. Lead author Leah Smith told HealthDay News:

“Cervical dysplasia and genital warts can happen as soon as a girl becomes sexually active, more or less. … Some parents have been delaying vaccination for their daughters until they’re older, because they don’t think they are sexually active. These results show this age group is sexually active and they are at risk. The vaccine really needs to be given before the girls are at risk.”

HPV vaccination rates in the United States are lower than those for other vaccines. The CDC estimated that if girls 13 to 17 had received one dose of the vaccine when they received the other recommended vaccinations, nine in ten young women would have gotten at least one dose. Instead, data shows that 57 percent of girls between the ages of 13 and 17 had received even one dose, and 38 percent got all three.

Some of this may be the result of an overall distrust of vaccines in the United States, but much of it likely stems from the misplaced fear that vaccinating young women against an STD will give them license to become promiscuous. There is now a plethora of research that show this is not the case, as Rewire has reported.

The authors of the new study emphasized that parents who believe there’s no harm in delaying or skipping the vaccine are putting their daughters’ health at risk.