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Friday
Feb242012

So your friend asks, Can younger children get the HPV vaccine?

 

Preface: Since there are a billion and one sources and data that approach this question, I will stick to the most recently published data (within the last few years).

Let us start out with the basics (skip if you’re ahead of the class).

What is the HPV vaccine?

The HPV vaccine, also known as Gardasil (made by Merck & Co. Inc.), is a quadrivalent vaccine against human papillomavirus (HPV).

It is quadrivalent because it protects against 4 types of HPV including: 2 types of HPV that cause nearly 75% of cervical cancer cases (HPV 16 &18), and 2 more types that cause ~90% of genital wart cases (HPV 6 & 11). It is an empty viral protein shell (or virus-like particle, pictured below), with no DNA; therefore, there is no possible way of contracting HPV by the vaccine. Additionally to the virus-like particle, there is an aluminum adjuvant (aluminum hydroxyphosphate sulfate) in the vaccine used to stimulate Th2 response in human T cells that is responsible for long-term immunity.

ahh, beautiful HPV virus-like particle

Why is the HPV vaccine important?

Unlike most cancers, cervical cancer can be prevented. Human papillomavirus (HPV) infection is necessary, although might be one of many reasons, to cause cervical cancer. Virtually all (93-100%) of 3-dose vaccinates protect against HPV. Simple as pie?

Here are some statistics:

- Most individuals (~75%) who engage in sexual activity will become infected with HPV at some point in their lifetime (most being asymptomatic).

- HPV infection accounts for an estimated 530,000 cervical cancer causes (~270,000 deaths), with the majority occurring in developing countries (~88%).

- 90% of anal cancers are due to HPV (in both genders)

- ~50% of other cancers (oropharyngeal, penile, vaginal, vulvar) are due to HPV
HPV accounts for 5.2% of the worldwide cancer burden.

- HPVs 16 and 18 (or high-oncogenic HPV types – HR-HPV) are responsible for 70% of cervical cancer cases (especially HPV 16)

- Worldwide, there is a peak of HPV infection for women under 25 years of age.

What ages should take this vaccine?

For the reported “best immunization response”, vaccination at ages 11-12 years for girls and boys is recommended. The Center for Disease Control (CDC) and Morbidity and Mortality Weekly Review (MMWR) reports, 9 years of age is the minimum for girls and 11 years old for boys to receive the vaccine. Additionally, 26 years of age is the maximum. This is based on efficacy of the vaccine, and to my knowledge is not based on safety issues.

Aside from immunologically significant timing, it is also important to get in all 3 doses before the first sexual encounter.

So what are the statistics like in developed countries?

According to data from the National Health Interview Survey, only 27% of preadolescent girls (aged 9-17) in the US had completed the 3-dose regimen in 2009, however this data fluctuates with region in the US. This is considerably lower than the numbers observed in many other developing countries (Sheinfeld, 2011).

Other interesting facts about HPV vaccination in the US:

- There is an inverse relationship between income and vaccination in adolescent girls.

- Parent’s attitudes, beliefs, and knowledge are linked to vaccine rates, showing that parents with more knowledgeable and positive views towards vaccines were more likely to vaccinate their daughters (surprise). Additionally, parents who believe the vaccine is safe are more likely to vaccinate their daughters.

- Interestingly, being born-again Christian correlates with lower vaccine rates.

(Meanwhile...) In Australia, with help of an ongoing school based government funded HPV vaccination program in April 2007 for adolescent females aged 12-13 years there has been a reduction in new cases of genital warts of 73% and a reduction of 44% of new cases in young males due to herd immunity (Garland et al., 2011).

In a country that can afford prevention of a cancer-causing viral infection, why are there not mandatory vaccinations?

That’s a great question, and we’re going to stay away from the polarized religious views of vaccinating 9 year-olds against a sexually transmitted disease. Straight to the facts, I believe I speak for everyone when I say, we should want to vaccinate our children against a cancer-causing viral infection when given the chance, social context aside.

 

ResearchBlogging.org






Garland, S., Skinner, S., & Brotherton, J. (2011). Adolescent and young adult HPV vaccination in Australia: Achievements and challenges. Preventive Medicine, 53 DOI: 10.1016/j.ypmed.2011.08.015

 

Wong CA, Berkowitz Z, Dorell CG, Anhang Price R, Lee J, & Saraiya M (2011). Human papillomavirus vaccine uptake among 9- to 17-year-old girls: National Health Interview Survey, 2008. Cancer, 117 (24), 5612-20 PMID: 21692069

Sheinfeld Gorin SN, Glenn BA, & Perkins RB (2011). The human papillomavirus (HPV) vaccine and cervical cancer: uptake and next steps. Advances in therapy, 28 (8), 615-39 PMID: 21818672

 

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