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Genital human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the USA. There are more than 40 HPV sub-types that can infect the genital areas of males and females. These same HPV types can also infect the mouth and throat. They are transmitted from personal contact during vaginal, anal or oral sex.

Some HPV subtypes, such as HPV-6 and HPV-11, can cause warts around the genitals or anus, but have low (but not 0) risk of causing cancers. However, the higher risk subtypes, such as HPV 16 and 18, not only cause approximately 70% of cervical cancers, but they cause most HPV-induced anal (95% linked to HPV), vulvar (50% linked), vaginal (65% linked), oropharyngeal (60% linked) and penile (35% linked) cancers. HPV is estimated to be the cause of nearly 5% of all new cancers across the world.

According to the CDC, roughly 79 million Americans are infected with HPV–approximately 14 million Americans contract HPV every year. Most individuals don't even know they have the infection until the onset of cancer.

Are you now scared? Thanks to science, you might not have to be.

The HPV quadrivalent vaccine, also known as Gardasil (or Silgard in Europe) can prevent infection by human papillomavirus, substantially reducing the risk of these types of cancers. An HPV bivalent vaccine, known as Cervarix, is used in some countries, but only provides protection again two of the subtypes most associated with cervical cancer.

Currently in the United States, the Advisory Committee on Immunization Practices (ACIP) recommends that preteen girls and boys aged 11 or 12 are vaccinated against HPV. The immunization is also recommended for teenage girls and young women up to the age of 26 who did not receive it when they were younger, and teenage boys and young men up to the age of 21.

Despite these ACIP recommendations, the CDC reported, in this week's Morbidity and Mortality Weekly Report, that only 57% of girls and 35% of boys, aged 13-17 years, have received at least one of the three recommended doses of the HPV vaccine. The vaccine uptake rate was developed from the CDC's National Immunization Survey-Teen (NIS-Teen), which determined vaccination information, via telephone survey, from adolescents aged 13-17 years across the USA. (By a show of hands, how many people reading about this survey wondered if antivaccination cultists were certain that the CDC was trying to identify unvaccinated children so that they could send in the black booted CDC Vaccination Shock Troops to force vaccines on poor little kids?) The goal of Healthy People 2020, the CDC's initiative to set clear objectives and strategies to improve the health of Americans, has set a goal that 80% of American teens have received all three doses of the HPV vaccine by 2020.

There is some good news. Even though the vaccine uptake rate is much lower than other vaccines, it is growing. From 2012-13, the vaccine update grew for girls from 53.8% to 57.3%–unfortunately, only a third had received the full three doses. On the other hand, vaccine uptake for teenage boys grew from 20.8% to 34.6% in the same period of time.

According to the lead author of the report, Shannon Stokley, assistant director for science at the CDC's Immunization Services Division, still believes that the 80% goal is still realistic:

The data on missed vaccination opportunities tells us that it is possible. When we look at the most recent cohort of girls that turned 13, 91% of them had a health care encounter where they could have started the HPV vaccine series before their 13th birthday. Also, 86% of 13-17 year-olds have received the Tdap vaccine. What these numbers tell us is that preteens and teens are getting to the doctor and they are getting vaccinated, but they aren't always receiving the HPV vaccine.
The report also identified some reasons why uptake is so low:
  • Given that 86% of this same group have received their Tdap vaccine, it's clear that these teenagers have regular encounters with their health care providers. One can only assume that physicians (or others) are not providing appropriate information about the HPV vaccine, including the cancer statistics. It's hard for me to ignore numbers, like 14 million Americans contracting HPV every year, which leads to significantly higher risk of some awful cancers, so physicians need to provide that data to their patients and their parents. The HPV vaccine should be near the top priority of immunizations given to teens.
  • Parents are also part of the reason of the low vaccination rate against HPV. Many parents believe that their child isn't sexually active (which may or may not be true), but eventually they may become so. And even if one had a belief that their child will never have sex until she's married, with the high rate of sexual violence against men and women, contracting HPV could, in some cases, be unavoidable. Protecting your child with an effective and safe vaccine against a cancer causing disease is the wise choice.

Which leads me to one of the most important points in the article. The CDC and authors stress that, after reviewing and analyzing 8 years of post-licensure safety data, including studies that involved several hundred thousand to over a million teens, no serious safety concerns have been linked to the HPV vaccine since it became available. When you go looking for issues in epidemiological studies that include well over one million subjects, and you find no serious adverse effects, published the results for review, and the consensus from real scientists says "there are no serious adverse effects," then we've reached the point that there should be no hesitancy about the HPV vaccine.

Some of the antivaccine cult will go dumpster diving in the Vaccine Adverse Event Reporting System (VAERS),  which is a program for vaccine safety, managed by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). VAERS functions as a post-marketing safety surveillance program (similar to other programs for almost every regulated medical device and pharmaceutical) which collects information about adverse events (whether related or unrelated to the vaccine) that occur after administration of vaccines.

VAERS has numerous limitations, including lack of scientifically designed questions, unverified reports, underreporting, inconsistent data quality, and absence of an unvaccinated control group. VAERS is basically a collector of information, but has limited value in making conclusions since it does not provide information that is obtained in a controlled manner.  However, it does have some usefulness, in that certain trends may be spotted given enough time and data points.

I'll be a cheerleader here. Go get your kids vaccinated with Gardasil. It'll save their lives. It'll prevent cancer. And the vaccine is probably the best studied for adverse events, and there simply are no bad ones. None. None. None. Here is another vaccine that truly saves lives.

 

Visit the Science-Based Vaccine Search Engine.

 

Key citations:

Poll

Have your children received Gardasil?

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Comment Preferences

  •  Tip Jar (24+ / 0-)

    Skepticism is evaluating the quality and quantity of evidence to reach a conclusion. It is not gathering evidence to support a closed minded conclusion.

    by SkepticalRaptor on Sun Jul 27, 2014 at 01:36:09 PM PDT

  •  My husband, paradise50 (22+ / 0-)

    endured a rigorous treatment schedule for HPV+ throat cancer, including surgery, 7 weeks of daily radiation, and chemotherapy. For 5 months all of his nutrition was by feeding tube as he could not swallow. He was on hourly liquid morphine drops.

    Fortunately for him, it was caught early, he had health insurance, and two years later he is considered "cured."

    My brother had HPV+ anal cancer over 10 years ago. It was not caught early, he did not have health insurance, ad he died.

    Early detection and treatment is effective.

    Prevention is essential.

    Please, vaccinate your kids. It isn't very often that a vaccine can prevent cancer.

    The dinosaurs never saw that asteroid coming. What's our excuse?
    ~~ Neil deGrasse Tyson

    by smileycreek on Sun Jul 27, 2014 at 02:16:12 PM PDT

    •  That's rough (4+ / 0-)
      Recommended by:
      Treg, smileycreek, mimi2three, Sonnet

      But you're like the poster child for getting the vaccine. My girls were in line to get it as soon as they could.

      Skepticism is evaluating the quality and quantity of evidence to reach a conclusion. It is not gathering evidence to support a closed minded conclusion.

      by SkepticalRaptor on Sun Jul 27, 2014 at 06:56:34 PM PDT

      [ Parent ]

      •  I take advantage of every opportunity (5+ / 0-)

        to promote the vaccine. Thank you for letting me get up on my soapbox in your diary.

        I run a small wordpress website for caregivers of throat cancer (where I just linked to this diary) and one afternoon I spent nearly two hours on the phone with a woman whose husband was halfway through the treatment and she was freaking out. We had a really good interpersonal connection going born of empathy, but you know what? At one point I said I was so grateful for the vaccine, that our husbands' misery could be prevented for others, and she shut right down. She has two teenaged daughters and she swore she would never get them vaccinated "because people die all the time from that vaccine."

        I asked her where she got that information and looked it up while we were talking, and it was some Alex Jones kind of site. I didn't even have a chance to refute it because for her the conversation was over. I haven't heard from her again.

        Both she and her husband were in ancillary health care.

        This willful ignorance broke my heart.

        The dinosaurs never saw that asteroid coming. What's our excuse?
        ~~ Neil deGrasse Tyson

        by smileycreek on Sun Jul 27, 2014 at 07:25:09 PM PDT

        [ Parent ]

  •  ...I wanted to point out something... (30+ / 0-)

    ...about HPV. First of all, they didn't even allow boys to get the vaccine until 2012. They only let girls get it before then, so you're stats about the low rate of boys getting Gardasil in 2012-2013 looks somehow bad, but boys were NOT allowed to get it prior to 2012.

    Now they do believe that men will eventually end up having 400% more (4X) cancer from HPV than women. This will happen in the throat or tongue for men for obvious reasons.

    HPV16 caused cancer will give men more cancer than women.

    Thank God they finally wised up and allow boys to get Gardasil now. It was insane that they refused to do that prior to 2012.

    The treatment for this cancer is considered to be the most intense cancer treatment out there (I was told by my surgeon, my radiology oncologist and infusion oncologist). The pain is indescribable as your nerves are burned through and through from inside completely to the outside of your throat. Saliva ends and your teeth become trashed by the radiation. I now have cavities by the bunch every 6 months due to the enamel of my teeth being destroyed by radiation. I NEVER had cavities before.

    Liquid morphine every 1/2 hour did NOTHING. There was no relief from the pain of burns except to marijuana edibles. Later my doctors told me they new morphine was worthless as NOTHING helps with the pain from nerves that are burned.

    I received the maximum amount of radiation they ever give to anyone for any cancer. I can never have radiation again. My carotid arteries are fully expected to calcify and will have to be "stripped" when that occurs. They tell me there is a pretty good chance I'll end up with a new cancer DUE to the massive radiation I received to deal with HPV16 tongue cancer.

    I have nerve damage to my accessory nerve (cranial nerve XII) and can no longer use my right shoulder. The muscles that control my shoulder girdle no longer work due to that nerve being whacked.

    My thyroid was destroyed by the radiation (obviously) so I know have to take synthroid.

    MY POINT is this cancer treatment is extremely brutal and often leaves folks permanently damaged from it. The pain on a scale of 1-10 is 15. The results of radiation poisoning and chemotherapy poisoning are horrific for months.

    AND it can all be avoided by getting the Gardasil vaccine as a young teen. They won't give anyone over 26 years of age the vaccine because it is medically believed that 100% of people will have come in contact with HPV16 by age 26. Once you're exposed, the vaccine is worthless...it's too late.

    The strange thing about this is they told me I most likely picked it up 25-30 years before I developed cancer. And there is no sign of anything until you get cancer...that IS the first sign.

    By giving women oral sex when I was in college caused me to have tongue cancer 30 years later. They didn't even know this until about 7 years ago. So "safe sex" won't cut it.

    Get your children, girls or boys, the Gardasil vaccine...

    Ignorance is bliss only for the ignorant. The rest of us must suffer the consequences. -7.38; -3.44

    by paradise50 on Sun Jul 27, 2014 at 02:52:56 PM PDT

  •  insane not to give it to boys prior to 2012-and (7+ / 0-)

    why did they not? where the heck did they think the girls were getting infected?

    We are all pupils in the eyes of God.

    by nuclear winter solstice on Sun Jul 27, 2014 at 02:58:00 PM PDT

    •  ...actually it's the other way around... (1+ / 0-)
      Recommended by:
      Sonnet

      ...in most cases...

      Ignorance is bliss only for the ignorant. The rest of us must suffer the consequences. -7.38; -3.44

      by paradise50 on Sun Jul 27, 2014 at 03:19:13 PM PDT

      [ Parent ]

    •  I'll try to explain this (6+ / 0-)

      But, I am not an employee of either the Advisory Committee or the CDC.

      ACIP is the body that makes recommendations on the vaccine schedule in the USA. They are tasked with determining both the safety and effectiveness of the vaccine. The first version of the vaccine, called Cervarix, only prevented infection of 2 of the 100 HPV subtypes. Those two caused Cervical cancer.

      With the release of the quadrivalent vaccine, called Gardasil, which prevents infections of 4 subtypes, 2 of which are the cause of most other HPV cancers, except cervical, came later.

      ACIP takes a long time to deliberate about new vaccines. Part of the reason is that anti-vaccination lunatics are constantly complaining to ACIP about the dangers of vaccines.

      But ACIP needs evidence in the form of clinical trials, and the original clinical trials for Cervarix and Gardasil was only done with teen girls. It wasn't until later was it done with boys.

      So, this is just how the process goes. Yes, it seems insane to not give it boys, but they aren't allowed to make a determination on vaccines without scientific evidence. They moved as quickly as they can.

      Blame the anti-vaxxers for the delays and slowness in this decision.

      Skepticism is evaluating the quality and quantity of evidence to reach a conclusion. It is not gathering evidence to support a closed minded conclusion.

      by SkepticalRaptor on Sun Jul 27, 2014 at 07:03:44 PM PDT

      [ Parent ]

  •  Missed opportunities (11+ / 0-)

    are certainly a key problem. Providers of pediatric health care need to do a much better job of educating parents and strongly recommending the vaccine. I am a Pediatric Nurse Practitioner in a rural health clinic, and I read the study you're referring to. I believe one of the things that convinces parents most is having a health care provider they trust, and that provider taking on the responsibility of thoroughly educating them and their child.

    I find parents to be almost apologetic when they say their child had the HPV vaccine..they frequently add "but of course he/she's not doing anything!". So I tell them "that's great, because the vaccine works the best in a young and sexually naive person". It seems to make them feel better.

    BTW, I am smileycreek's sister, and so I have also seen the dark side of this cancer.

    I am loving your vaccine diaries. Keep them coming, please!

    “The painter constructs, the photographer discloses.” ― Susan Sontag, On Photography

    by mimi2three on Sun Jul 27, 2014 at 02:59:12 PM PDT

  •  Thank you for this! (9+ / 0-)

    I was hesitant to have my daughter get the vaccine five years ago when she was 11. But with safety stats like this we're going to ask for it at her next doctor's appointment.

    I have to say that the doctor hasn't been very helpful with information on this vaccine and they stated directly that we didn't have to worry about it if she wasn't sexually active (or preferred girls). Should have followed up on it but life has been a bit of a struggle for the last several years...

    Thanks again!

  •  Thanks SO much SR, Smileycreek and P50, (6+ / 0-)

    You may have just saved my son's life. I messaged him a minute ago to go and get vaccinated ( hopefully it's available in Canada for men). He's 22 and, of course, sexually active. I'll message him again in a few days to get an update.

    My daughter was done at age 14 and again the next two years, so no worries about her in that department. I was always on top of teaching them about sexual safety. The vaccination was not available to males 7 years ago.

    Again, thanks for these diaries SK. Education is key to healthy living.

    And Paradise50, I'm so glad you were able to make it through such a horrible harrowing illness. A testament to both yours and smileycreeks determination and courage.

    A fo ben, bid bont. - Welsh proverb. ( translation: If you want to be a leader, be a bridge.)

    by Gwennedd on Sun Jul 27, 2014 at 05:23:21 PM PDT

  •  My personal opinion is (2+ / 0-)

    that everyone, of any age, and of both sexes, should get this.  It may be more effective for younger people, but it is likely to be quite effective at any age.

    Does anyone have data or references to suggest otherwise?

    •  You know, I've been wondering that too (2+ / 0-)
      Recommended by:
      SkepticalRaptor, PeterHug

      and at least why not run a clinical trial on older folks. I'd get in line to test it.

      What will happen the next time the mob comes?--Neil deGrasse Tyson

      by mem from somerville on Sun Jul 27, 2014 at 06:33:36 PM PDT

      [ Parent ]

      •  I think it is assumed... (2+ / 0-)
        Recommended by:
        smileycreek, PeterHug

        most adults are or have been sexually active and are already exposed.  I believe the number is something like 80%.

        •  I'm not sure this is the case - (1+ / 0-)
          Recommended by:
          smileycreek

          I found this:

          J Adolesc Health. (2008) 43, S25.e1-41.
          doi: 10.1016/j.jadohealth.2008.07.009.

          Age-specific prevalence of infection with human papillomavirus in females: a global review.
          Smith JS, Melendy A, Rana RK, Pimenta JM.

          From the abstract:

          Consistently across studies, HPV infection prevalence decreased with increasing age from a peak prevalence in younger women (< or =25 years of age). In middle-aged women (35-50 years), maximum HPV prevalence differed across geographical regions: Africa (approximately 20%), Asia/Australia (approximately 15%), Central and South America (approximately 20%), North America (approximately 20%), Southern Europe/Middle East (approximately 15%), and Northern Europe (approximately 15%).
          I certainly think it would be worth taking a look at efficacy in older people (provided it hasn't already been done).
          •  Yes (1+ / 0-)
            Recommended by:
            PeterHug

            If I were in my 40's and I had no clear signs that I had HPV (like a genital wart, which may not be visible), I would get the shot, because it won't hurt and it may protect. I don't think there's any valid scientific reason to think that the vaccine wouldn't be useful up until you were 50 or 60 years old, although I have no real evidence to support that. I just have a really good understanding of the immune system, and the immune response is adequate for most people beyond 60.

            ON the other hand, insurance will probably not pay for it, so it will be out of pocket. And if you work for Hobby Lobby, probably not, because you should have been a virgin when you got married to another virgin.

            Oops. I went off track.

            Skepticism is evaluating the quality and quantity of evidence to reach a conclusion. It is not gathering evidence to support a closed minded conclusion.

            by SkepticalRaptor on Mon Jul 28, 2014 at 01:44:26 PM PDT

            [ Parent ]

    •  Agreed. The smaller we can make the reservoir (0+ / 0-)

      of infection, the better off everyone is.

      Information is abundant, wisdom is scarce. ~The Druid.
      ~Ideals aren't goals, they're navigation aids.~

      by FarWestGirl on Sat Aug 02, 2014 at 05:13:40 AM PDT

      [ Parent ]

  •  is the cost of this vaccine covered by the ACA? (2+ / 0-)
    Recommended by:
    PeterHug, smileycreek

    and does age REALLY matter? if a person has 100% never been sexually active, does it really make a difference if they're 11 or 21?

    "real" work : a job where you wash your hands BEFORE you use the bathroom...

    by chimene on Sun Jul 27, 2014 at 05:52:20 PM PDT

  •  Do they test for HPV before they vaccinate (2+ / 0-)
    Recommended by:
    smileycreek, SkepticalRaptor

    with older people?

    I know a young woman who is 22, I know she has been sexually active. I assume they can test for HPV?

    •  Yes, there is a new test (0+ / 0-)

      Just a few months ago, Roche diagnostics got FDA approval for a diagnostic test for HPV. It tests for HPV 16 and 18 which are most implicated in cervical cancer.

      So, if she hasn't been infected by HPV, she ought to be running to her doctor right now and getting all three injections.

      I hope that helps.

      Skepticism is evaluating the quality and quantity of evidence to reach a conclusion. It is not gathering evidence to support a closed minded conclusion.

      by SkepticalRaptor on Mon Jul 28, 2014 at 01:48:23 PM PDT

      [ Parent ]

  •  what about adults? (0+ / 0-)

    does it only work on teens?

    and if so why?

  •  So a couple of things, on practical matters (0+ / 0-)

    In our area, Tdap is required for school. So it's the first one given.

    It would be typical to also vaccinate with Gardasil at that same visit.

    The followup two boosters are harder, because those are one-off appointments, and they're also fresh in the memory of "shot hurt" and the kids are now teenagers and old enough that you can't do it if the child won't allow it.

    It will be a huge public health benefit when we can vaccinate without needles.

    Fry, don't be a hero! It's not covered by our health plan!

    by elfling on Mon Jul 28, 2014 at 10:29:55 AM PDT

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