The CDC recently reported that only about half of US teenager girls have received the safe and effective quadrivalent HPV vaccine (HPV4), a disappointing level of vaccine uptake. Moreover, this rate hasn’t changed over the past three years, despite significant efforts to increase the awareness and effectiveness of the vaccine amongst teenagers. Even worse news in this report is that only about one-third of teenage girls have been fully immunized with all three doses.
HPV quadrivalent vaccine, also known as Gardasil (or Silgard in Europe), is marketed by Merck & Co., usually for vaccination of teenage girls (with an increasing number of boys). The vaccine prevents the transmission of certain types (pdf) of human papillomavirus (HPV), specifically types 6, 11, 16 and 18.
HPV types 16 and 18 cause approximately 70% of cervical cancers, and caused most HPV-induced anal (95% linked to HPV), vulvar (50% linked), vaginal (65% linked), oropharyngeal (60% linked) and penile (35% linked) cancers. These cancers, mostly related to HPV, can be prevented as long as you can prevent the HPV infection from ever happening, which usually happens through genital contact, most often during vaginal and anal sex.
HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms. Approximately 79 million Americans, most in their late teens and early 20′s, are infected with HPV, and about 14 million people become infected each year in the USA.
According to the recent CDC article, parents have been asked why they did not intend to vaccinate their daughters in the next 12 months, and the top five responses were:
- vaccine not needed (19.1%),
- vaccine not recommended (14.2%),
- vaccine safety concerns (13.1%),
- lack of knowledge about the vaccine or the disease (12.6%), and
- daughter is not sexually active (10.1%).
Almost all of these issues can be addressed by further education about vaccines, since the uptake of other vaccines targeted at teens has increased significantly over the past few years. One of the larger part of the problem is that family doctors are not advocating HPV inoculations as forcefully as they do with other vaccines, such as those for bacterial meningitis and whooping cough, both of which strongly recommended in many states for teens. The new CDC report shows that 84 percent of the teen girls who hadn’t gotten an HPV shot had been to a clinic or doctor for another vaccine. If they had gotten an HPV shot at the same time, the rate for at least one dose could be nearly 93 percent instead of 54 percent, CDC officials estimated.
More than 20 states have considered adding HPV to the vaccines required for school attendance but only Virginia and the District of Columbia did so. Most states abandoned it after political fights triggered by funding costs of vaccinations, beliefs that the vaccine would promote promiscuity, and unfounded concerns about the safety of the vaccine. Funding problems will always be an issue, but the myth of promoting sexual behavior has been thoroughly debunked in large studies.
With respect to safety concerns, the current CDC study analyzed reports to the Vaccine Adverse Event Reporting System (VAERS), during the period of June 2006 through March 2013 after females who had received the HPV4 vaccine. A total of 21,194 adverse events were reported out of 56 million doses delivered during that same time period. In other words, despite significant pushing and gaming of the VAERS database by antivaccine activists, less than 0.04% of vaccinations resulted in a report. Furthermore, of those reports, 92.1% were classified as non serious, so around 1,674 VAERS reports (out of 56 million immunizations given during the time period) were considered serious,which included headache, nausea, vomiting, fatigue, dizziness, syncope, and generalized weakness were the most frequently reported symptoms.
The quality of the VAERS system for determining safety of vaccines is very poor at best–VAERS is a feel-good system for those who think that there’s a link between vaccines and something terrible, but without an active investigation, the data is just above the level of totally meaningless. Most epidemiologists know it is valueless. Even the VAERS system itself says that the data cannot be used to ascertain the difference between coincidence and true causality. There is a background rate for mortality, across all causes, irrespective of whether an individual is vaccinated or not, and unless you understand the background rate, the vaccine “mortality” rate has no scientific meaning. In fact, we could provide a Starbucks coffee drinking in the car “mortality rate”, which may or may not have any causality whatsoever.
But real large-scale epidemiological studies, which attempted to show a correlation between HPV4 immunizations and adverse events, concluded that there were no serious adverse effects, aside from typical soreness at injection site, fainting from the sight of being vaccinated, and other very minor issues. And given the overall effectiveness of the HPV4 vaccine in preventing HPV infections (which will prevent HPV-related cancers), the risk-benefit ratio is so far on the side of benefit, it is impossible to accurately measure the level of risk.
The HPV4 vaccine is one of the most important immunizations for teenagers since it can save lives. Some of the problem are that parents have a hard time believing that HPV is so prevalent (almost all adults are infected with the virus), and that their dear children will be good kids and will never get HPV; or they have a hard time connecting a vaccination to preventing a cancer 20 or 30 years in the future; or they buy into the lies about the safety of the vaccine.
Gardasil saves lives and it’s safe. I have a lot of evidence to support that claim.
- Bednarczyk RA, Davis R, Ault K, Orenstein W, Omer SB. Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. Pediatrics. 2012 Nov;130(5):798-805. doi: 10.1542/peds.2012-1516. Epub 2012 Oct 15. PubMed PMID: 23071201.
- Centers for Disease Control and Prevention (CDC). Human papillomavirus vaccination coverage among adolescent girls, 2007-2012, and post-licensure vaccine safety monitoring, 2006-2013 – United States. MMWR Morb Mortal Wkly Rep. 2013 Jul 26;62(29):591-5. PubMed PMID: 23884346.
- Klein NP, Hansen J, Chao C, Velicer C, Emery M, Slezak J, Lewis N, Deosaransingh K, Sy L, Ackerson B, Cheetham TC, Liaw KL, Takhar H, Jacobsen SJ. Safety of quadrivalent human papillomavirus vaccine administered routinely to females. Arch Pediatr Adolesc Med. 2012 Dec;166(12):1140-8. doi: 10.1001/archpediatrics.2012.1451. PubMed PMID: 23027469. Impact factor=4.140
- Lowy DR, Schiller JT. Prophylactic human papillomavirus vaccines. J Clin Invest. 2006 May;116(5):1167-73. Review. PubMed PMID: 16670757; PubMed Central PMCID: PMC1451224. Impact factor=13.069.
- Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, McQuillan G, Unger ER. Reduction in Human Papillomavirus (HPV) Prevalence Among YoungWomen Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 2003–2010. J Infect Dis. (2013). doi: 10.1093/infdis/jit192. Impact factor=6.410.