Cervical Cancer Vaccines May Start Soon
A cervical cancer vaccine programme is likely to be introduced in the Republic in the near future, on foot of today’s publication of a Health Information and Quality Authority (Hiqa) report.
The HIQA value-for-money report should pave the way for the early announcement of a formal immunisation programme aimed at 12-year-old girls. The report also recommends a once-off vaccination programme for 13 to 15 year-olds.
Cervical cancer is caused by certain types of the human papillomavirus (HPV), with evidence of infection found in 99 per cent of women with cervical cancer.
The Minister for Health, Mary Harney has said she would introduce a HPV/cervical cancer vaccine programme if advised to do so.
Although there are in excess of 200 HPV strains, just a small number are associated with the development of cancer of the cervix. HPV types 16 and 18 are found in almost 70 per cent of cervical cancers, while another five sub types are responsible of a further 20 per cent of cases. Some HPV types are non cancerous but are linked to the presence of warts in the genital area.
Cancer of the neck of the womb (cervix) is diagnosed in almost 200 women here every year; some 70 women die from the disease annually.
Cervical cancer usually develops quite slowly, passing through a number of pre invasive stages (carcinoma in situ - CIN) before progressing to full blown disease. If caught in the early stages, it has a five-year survival rate of 80 per cent or greater.
HPV is a sexually transmitted infection; it is estimated that almost 80 per cent of sexually active people have been infected with at least one virus type by the age of 50. It is usually symptomless and in 90 per cent of cases, the body clears itself of the virus within two years of infection. But it is when the virus persists that the risk of cervical cancer increases.
Gardasil and Cervarix are the approved vaccines against HPV. Both aim to prevent cervical cancer; in addition Gardasil is active against those HPV subtypes known to cause genital warts. Both products involve a three-vaccine course, given over a six-month period. And clinical trials involving a five-year follow-up, have shown that vaccination is 100 per cent effective in preventing HPV infection and non-invasive cancer .
HPV vaccines must be given before infection with the virus occurs. This means administering the course prior to the person becoming sexually active so that a comprehensive vaccination program would need to be administered to girls in the 11- to 13-year age bracket.
Vaccination Against Human Papillomavirus Decreases Related Tests and Treatment for Cervical Cancer
Researchers affiliated with the Quadrivalent HPV Vaccine Merck Study Group have reported that vaccination against human papillomavirus (HPV) is associated with a reduction in Pap tests, colposcopy, cervical biopsy, and definitive treatment among women who were uninfected at the time of vaccination. The details of this study were presented at the 39th annual meeting of the Society of Gynecologic Oncologists (SGO) in Tampa, Florida, from March 9 to 12, 2008.
Pap smears have decreased the incidence and death rate of cervical cancer among women in developed countries such as the United States. Cervical cancer is caused by specific high-risk strains of HPV, which can be detected by a special test called Hybrid Capture II (made by Digene).
Now that an HPV vaccine (Gardasil®, manufactured by Merck) has been approved by the U.S. FDA, further reductions in cervical cancer incidence and death may be anticipated. Gardasil is a quadrivalent vaccine because it confers protection against four subtypes of HPV (HPV 6 and HPV 11, which cause 90 percent of genital warts, and HPV 16 and HPV 18, which cause 70 percent of cervical cancers).
Despite the success of Pap smear programs and the ability to detect HPV, over 2 billion dollars in healthcare expenditure occurs annually as a result of abnormal Pap tests and their subsequent evaluation, which often requires cervical biopsies and other surgical procedures on the cervix. This is because, although Pap smears and HPV detection allow a pre-cancerous or dysplastic state of the cervix to be detected and treated before it can turn into cancer, neither of these two methods eliminate the original problem, which is infection with HPV.
The end-of-study data from three pivotal Phase II/III clinical trials of the quadrivalent HPV vaccine were reported at the SGO meeting. A total of 18,150 16 to 26-year-old women were enrolled in one of three randomized, placebo-controlled trials. Vaccine or placebo was given at Day 1, Month 2, and Month 6. Subjects underwent Pap testing on Day 1 and every six to 12 months for up to 48 months. Patients with specific abnormalities on the Pap smear were referred for colposcopy and, depending on the findings, definitive treatment was carried out.
After an average follow-up period of four years, the investigators noted a reduction in Pap tests, colposcopy, cervical biopsy, and definitive treatment among women who were uninfected with HPV at the time of vaccination. Interestingly, these reductions were seen irrespective of the specific type of HPV involved.
Comments: Vaccination with the quadrivalent vaccine appears to be able to decrease the number of Pap tests, colposcopies, cervical biopsies, and treatment women require. This occurs presumably because the vaccine protects against infection with HPV, which is the inciting event in the development of pre-cancerous cervical disease. Long-term studies are required to determine the duration of protection that is achieved by the three-dose vaccination series.
Gen-Probe HPV assay launched in Europe
Gen-Probe has launched its new Aptima HPV Assay in Europe. The diagnostic test, for detecting high-risk strains of the human papillomavirus (HPV), has been CE-marked and is now available for sale in 13 European countries.
The assay is an amplified nucleic acid test that detects 14 high-risk HPV types associated with cervical cancer. Specifically, it detects two messenger RNAs (mRNAs), E6 and E7, that are made in higher amounts when HPV infections progress toward cervical cancer. Gen-Probe believes that targeting these mRNAs may more accurately identify women at higher risk of having, or developing, cervical cancer than competing assays that target HPV DNA. Detecting HPV DNA identifies women who are infected, but HPV infections are common and many resolve without causing cervical cancer.
“Increased specificity – meaning fewer false positive results – is important so women are not subjected to the anxiety and expense of unnecessary medical procedures,” said Jack Cuzick, professor of epidemiology at the Cancer Research UK Centre for Epidemiology, Mathematics and Statistics in London, who is leading the 953-woman ‘Predictors’ study – a head-to-head comparison of various HPV assays.
The assay has been designed to run on Gen-Probe’s fully-automated Tigris instrument system and on the company’s semi-automated DTS instrument platform.
It is being manufactured in Cardiff by Molecular Light Technology, a subsidiary of Gen-Probe.
The assay is still in clinical studies in the US, and has not yet been approved for marketing in that country by the US Food and Drug Administration.
HPV is a group of viruses with more than 100 types, 14 of which are considered to be high-risk for the development of cervical cancer. Most women will be infected with HPV at some point in their lives, but most of these infections resolve without any clinical symptoms or consequences. A small number of HPV infections progress and result in disease, which can range from genital warts to cervical cancer.
1 in 4 teen girls have STD
A virus that causes cervical cancer is by far the most common sexually transmitted infection in teen girls ages 14 to 19, while the highest overall prevalence is among black girls — nearly half the blacks studied had at least one STD. That rate compared with 20% among both whites and Mexican-American teens, the study from the federal Centers for Disease Control and Prevention found.
About half of the girls acknowledged ever having sex; among them, the rate was 40%. While some teens define sex as only intercourse, other types of intimate behavior including oral sex can spread some infections.
For many, the numbers likely seem “overwhelming because you’re talking about nearly half of the sexually experienced teens at any one time having evidence of an STD,” said Dr. Margaret Blythe, an adolescent medicine specialist at Indiana University School of Medicine and head of the American Academy of Pediatrics’ committee on adolescence.
But the study highlights what many doctors who treat teens see every day, Blythe said.
Dr. John Douglas, director of the CDC’s division of STD prevention, said the results are the first to examine the combined national prevalence of common sexually transmitted diseases among adolescent girls. He said the data, from 2003-04, likely reflect current rates of infection.
“High STD rates among young women, particularly African-American young women, are clear signs that we must continue developing ways to reach those most at risk,” Douglas said.
The CDC’s Dr. Kevin Fenton said given that STDs can cause infertility and cervical cancer in women, “screening, vaccination and other prevention strategies for sexually active women are among our highest public health priorities.”
The study by CDC researcher Dr. Sara Forhan is an analysis of nationally representative data on 838 girls who participated in a 2003-04 government health survey. Teens were tested for four infections: human papillomavirus, or HPV, which can cause cervical cancer and affected 18% of girls studied; chlamydia, which affected 4%; trichomoniasis, 2.5%; and herpes simplex virus, 2%.
Blythe said the results are similar to previous studies examining rates of those diseases individually.
The results were prepared for release Tuesday at a CDC conference in Chicago on preventing sexually transmitted diseases.
HPV can cause genital warts but often has no symptoms. A vaccine targeting several HPV strains recently became available, but Douglas said it likely has not yet had much impact on HPV prevalence rates in teen girls.
Chlamydia and trichomoniasis can be treated with antibiotics. The CDC recommends annual chlamydia screening for all sexually active women under age 25. It also recommends the three-dose HPV vaccine for girls aged 11-12 years, and catch-up shots for females aged 13 to 26.
The American Academy of Pediatrics has similar recommendations.
Douglas said screening tests are underused in part because many teens don’t think they’re at risk, but also, some doctors mistakenly think, ‘”Sexually transmitted diseases don’t happen to the kinds of patients I see.”‘
Blythe said some doctors also are reluctant to discuss STDs with teen patients or offer screening because of confidentiality concerns, knowing parents would have to be told of the results.
The American Academy of Pediatrics supports confidential teen screening, she said.
HPV Vaccine & Fainting
by Amy Fleming
Allentown, PA - Recently the Centers for Disease Control & Prevention reported that in the last two years, more than 450 youngsters fainted after getting a vaccination.
That may explain why some teenagers are taking a new position on the HPV vaccine.
Gardasil protects against a virus that cervical cancer and genital warts.
Researchers aren’t sure why, but about 10% of girls in studies for the HPV vaccine got dizzy or passed out after the shot.
The Gardasil website lists fainting as a possible side effect.
To be safe rather than sorry, doctors are proposing an easy solution.
“The recommendation as a result of this, is pretty simple. Just that you give them a vaccine either sitting sown or lying down and you watch them for 15 to 20 minutes just to make sure that they don’t have any significant reaction,” said Dr. Larry Glazerman.
The vaccine is given in a series of three shots.
For more information on the vaccine go to www.gardasil.com.
More links found between cancer in men and HPV, but men aren’t approved for vaccination
by Brian Boyer
Men are neither vaccinated nor screened for human papillomavirus, but two university studies suggested last week that it may be the cause of cancer for many men, and that those cancers could have been prevented.
The virus, better known as HPV, is the primary cause of cervical cancer in women. Recent research, at the University of Michigan and University of Louisville, suggests that it is also the cause of a disease that disproportionately affects men, cancers of the head and neck.
“You should be testing everybody,” said Payal Desai, leader of a pilot study at the Louisville’s James Graham Brown Cancer Center. Both men and women carry HPV, the virus that will affect at least 50 percent of sexually active people, according to the Food and Drug Administration, though only a fraction of those will develop cancer.
More than 35,000 new cases of head and neck cancer are expected to be diagnosed in the United States in 2008, according to the American Cancer Society. Twice as many men as women will develop the disease, which the society estimates will kill 7,590 Americans this year.
Currently a screening test only exists for women. Similarly, a vaccine for HPV exists, but is only approved for use in women ages 9 to 26. Studies are under way to test the efficacy of the HPV vaccine in men, according to the FDA.
If the vaccine were successful in preventing HPV infections in men, the studies suggest it is possible that a significant number of cancer cases in men could be avoided.
In one study, tissue samples from 43 head and neck cancer patients were tested by the Louisville team. They found that almost one-third of the samples tested positive for HPV, specifically the strain of the virus known as HPV 16.
In the other study, at Michigan’s Comprehensive Cancer Center, had similar findings. More than one-third of the 66 head and neck cancer cases they examined tested positive for HPV 16. This study’s primary finding was encouraging: The HPV-associated tumors responded significantly better to treatment than those not associated with HPV.
In women, HPV types 16 and 18 are responsible for 70 percent of cervical cancer cases. The American Cancer Society estimates that 11,070 cases will be diagnosed, and that the disease will kill 3,870 women in the United States in 2008.
Infection by strains 16 and 18 can be prevented through vaccination, with almost 100 percent effectiveness. The drug Gardasil, first made available to young women in 2006, also vaccinates against types 6 and 11, which are responsible for 90 percent genital warts cases.
Desai presented the findings of their study May 15 at the American College of Physicians Internal Medicine Conference. The results have not yet been published. The University of Michigan study was published online May 12 in the Journal of Clinical Oncology. In February, another study, at the National Cancer Institute and Johns Hopkins Medical Insitutions, suggested a link in men between HPV and oral cancer.
Boys should also get HPV protection
Kelly Sinoski, Vancouver Sun
Published: Saturday, May 17, 2008
B.C. I Boys as well as girls should be offered the free HPV vaccine to stop the spread of the cervical cancer-causing disease, former deputy health minister Dr. Penny Ballem says.
The vaccine, which will be offered by the provincial government to girls entering Grade 6 and 9 on a voluntary basis next year and women up to age 26, is not even licensed for use on males in Canada.
But Ballem insists that should change if the province is intent on controlling the spread of the human papillomavirus, which can lead to cervical cancer in women and genital warts and other cancers in both sexes.
“If you really want to wipe out a scourge, you have to go after the people who carry the virus and pass it on,” Ballem said. “There needs to be more of a burden on men in our society in protecting women.”
The virus is among the most common sexually transmitted infections in Canada. The vaccine, Gardisil, targets the two strains of the infection responsible for 70 per cent of cervical cancer.
Boys and men can only access the vaccine “off label” from their doctors if they want it but will have to pay the full cost, which is about $300 to $400 for treatment, said provincial health officer Dr. Perry Kendall.
Kendall said although there are calls to offer the vaccine to men, he doubts doctors are recommending it to males because of the high cost. Nor does he think it will be offered to the male population in the next year because it hasn’t been tested or licenced for use on males in Canada.
If it was to spend $100 million, he said, the government would likely to find other areas where the money could be better spent.
He noted it would about $8 million to vaccinate the Grade 6 girls, but said if you calculated over a lifetime how many deaths the vaccine would prevent and the quality of life for survivors, it works out to “$25,000 per quality of life adjusted year.”
For males, it would be about $35,000.
“The question is the return worth the investment?” he said.
“If the price comes down substantially it might be something you offered to both sexes.”
Kendall noted that while HPV can cause genital warts and a few hundred cases of penile and other cancers in males, it carries a higher risk for women, who can get cervical cancer and be possibly rendered sterile if they require invasive surgery to their cervix.
Cervical cancer is the second most common cancer for Canadian women aged 20 to 44, with 150 women contracting the disease each year, he said. Of those about 50 die annually.
“Far fewer boys die from cancer associated with HPV and no one dies from genital warts,” Kendall said. “We’re doing it for cancer.”
But Ballem said she doesn’t believe the decision to offer the vaccine to only girls and women was well thought out, noting there are “gaps in the coverage.”
The vaccination, which requires three shots over six months, will not prevent all cervical cancers, meaning women will still have to have annual pap smears, she said.
She added girls may even get false sense of security that sex is safer than it is because they’ve had the vaccine.
Apart from passing on the disease, she maintains that by vaccinating boys it would help boost immunity across the sexually active population.
She added women are more vulnerable to disease because they have more mucus membranes exposed to bodily fluids than men.
“The focus was never on where do they get the virus from? They get it from men,” Ballem said. “Frankly, maybe we should go after the source of HPV and the people who are spreading it around.”
Government promises free cervical cancer vaccination campaign
FREE vaccinations against a virus that can cause cervical cancer will be made available for girls aged 12 to 18 within the next five years.
Prime Minister Helen Clark announced last week that the government will pledge $164.2million to fund a vaccine against the human papilloma virus (HPV), a common sexually transmitted infection linked with cervical cancer.
A national immunisation programme will be rolled out from September.
Dr Nikki Turner of the Immunisation Advisory Centre says the move will have a “significant impact on reducing cervical cancer”.
“It has already been introduced to many Western countries including Australia, the UK, the USA, and Canada. This is a hugely positive step for young women in New Zealand.”
HPV viruses are part of the wart virus family and lead to a range of genital cancers and genital warts.
Every year 180 women are diagnosed with cervical cancer and around 60 die from the disease.
“HPV infection is extremely common in all sexually active women,” says Dr Turner.
“Three years after becoming sexually active, around two thirds of women have been exposed to HPV virus, regardless of their number of sexual partners.
“While 98 per cent of infections resolve without any problems, about two per cent are still present after five years.
“Persistent on-going infection over 10 years or more can lead to cancer.”
The vaccine will be free for more than 300,000 young women aged 12 to 18 and is expected to save around 30 lives each year.
Officials urge caution after local STD increase
A local syphilis outbreak has renewed concern over the growing number of people infected with sexually transmitted diseases each year in the United States. With an estimated 19 million new infections reported last year, health officials are warning that just because you’re not showing symptoms it doesn’t mean you’re STD-free.
According to Melissa Brennan, director of Clinical Services at the Broome County Health Department (BCHD), all STDs, including syphilis, can be asymptomatic.
“There’s a pervasive belief in our country that ‘if I had an STD I would know it,’” Brennan said. “That is absolutely not true.”
“Every single STD can be, and often is, completely without symptoms,” she added, listing syphilis, gonorrhea and chlamydia as examples.
Brennan also said that though the recent syphilis outbreak in Endicott includes less than 10 cases, it’s still a cause for concern.
“Until 2005 we hadn’t seen any syphilis cases since the early 1990s,” Brennan said. “So any cases catch our attention.”
The disease was believed to have been inactive in the area toward the end of the 1990s, but has made a dramatic comeback in the last several years. According to the Centers for Disease Control and Prevention (CDC) Web site, the number of nationally recorded syphilis cases rose in 2007 for the seventh year in a row.
Theresa Lyczko, public information processor for the Tompkins County Health Department, said that the county has also seen a large increase over the last two years.
“Typically we have had, on average, one case a year,” said Lyczko, who has been working with Health Services at Cornell University and Ithaca College to combat the spread of the STD. “Then in 2007 we had six cases and this year, so far, we’ve had five.”
According to Lyczko, it’s incredibly important to be tested for syphilis because it is a curable disease.
Sharon Dittman, associate director at Gannet Health Services at Cornell University, echoed Lyczko’s statement and said that the number of recent syphilis cases were very unusual for the county.
Four of the syphilis cases reported in Tompkins County were of people affiliated with Cornell University, Dittman also said.
Free syphilis and HIV testing is being provided for Cornell students and faculty for the rest of the semester in response to the cases, Dittman said.
Reports of a syphilis outbreak in Tompkins County, some of which have been linked with anonymous sex acts between people who met over the Internet, broke just weeks before the BCHD issued their warning.
Both Lyczko and Brennan said that they were unaware of a connection between the cases reported in the two counties.
According to University spokeswoman Gail Glover, BCHD indicated that the recent syphilis cases in Broome County could include members of the Binghamton University campus community, though a specific number was not given.
The BCHD offers free syphilis testing, available Tuesdays and Thursdays. Planned Parenthood also offers testing, with fees covered by student insurance or decided on a sliding scale, and University Health Services provides testing for students and requires payment of all laboratory processing.
Syphilis does not necessarily show symptoms at first but can be fatal if left untreated.
The growing number of STD infections has caught media attention recently after a study conducted by the Centers for Disease Control and Prevention reported that one in four teenage girls in the United States has an STD.
According to the report, the two most common STDs found were the human papillomavirus (HPV) and chlamydia. Different strains of HPV can cause genital warts and cervical cancer, while untreated chlamydia, according to Brennan, is the No. 1 cause for female infertility in the U.S.
In Broome County an average of 1,029.4 people per 100,000 of 15- to 19-year-olds have chlamydia. The infection average of the total county population is 231.2 people per every 100,000.
Brennan said the amount of gonorrhea cases reported in the county has also risen significantly because people haven’t been getting treatment since the virus has begun to exhibit fewer or even milder symptoms that don’t get their attention.
Planned Parenthood has also seen a dramatic increase in gonorrhea cases in the area, according to Ingrid Husisian, director of public communications for the Planned Parenthood of South Central New York.
“In 2006 we tested 3,492 women for gonorrhea and came back with eight positives,” Husisian said. “In 2007, 5,236 women were tested with 26 positives.”
While Glover said BU’s Health Services has not seen an increase in sexually transmitted diseases on campus, it’s possible that students have tests done at other locations.
Both Brennan and Husisian stressed the importance of education, safe sex and understanding that not all infections will show symptoms.
Each also advised using the testing and treatment services of BCHD and Planned Parenthood respectively.
“If you don’t look for it, you won’t find it,” Brennan said.
University Health Services nears 1,000th course of HPV vaccine
The first cancer vaccine was supposed to be unequivocally a good thing.
The Gardasil vaccine, touted as a triumph of modern medicine, protects against four strains of human papilloma virus (HPV) that commonly cause genital warts and cervical cancer.
In the two years since obtaining FDA approval and being released by Merck, however, the vaccine has faced tremendous opposition from critics who believe that it encourages sexual activity in young women.
Adel Mahmoud, a senior policy analyst at the Wilson School and a molecular biology professor, is eagerly watching the controversy and anticipating the day when Gardasil will be routinely administered to all Americans as children.
But Mahmoud is not just a casual observer. Before coming to the University, he oversaw the development of the Gardasil vaccine during his tenure as president of Merck Vaccines from 1998 to 2006.
Mahmoud said that the search for the HPV vaccine “was very high on [Merck’s] development program” since a “discovery in the ’80s and ’90s [showed] that HPV was directly related to cervical, anal, penile, head and neck cancers.”
By age 50, 80 percent of women in the United States are infected with HPV. Cervical cancer kills 233,000 women every year, including about 3,700 in the United States.
The Gardasil vaccine protects against the two strains of the disease that cause more than 70 percent of HPV-related cancers as well as against the two other strains that cause more than 90 percent of genital warts, Mahmoud said.
About 20 million Americans and at least 50 percent of sexually active people in the world have genital warts, according to a 2005 study by the Centers for Disease Control and Prevention (CDC).
The vaccine was also widely hailed as a great success of scientific innovation because the HPV genome was particularly challenging to study and sequence. To develop an effective vaccine, the researchers first needed to understand what proteins were coded for by the genome.
Scientists are unable to culture HPV in vitro, a process needed to develop most vaccines. Nonetheless, “the HPV genome was sequenced, its proteins characterized, and their functions defined,” Mahmoud wrote in a May 2007 letter to Science magazine.
Distributing the vaccine
In June 2006, the vaccine was approved for distribution in the United States in a three-dose series over the course of six months.
Merck, like many healthcare practitioners, had originally hoped that states would mandate the vaccine for school-age girls to systematically combat the most common sexually transmitted infection (STI) in the world, HPV.
Not everyone, however, thought preventing the spread of genital warts was a good enough reason to mandate vaccination.
An ongoing controversy
Texas seemed poised to lead the charge against HPV, but heated controversy greeted Gov. Rick Perry’s executive order in February 2007 requiring that 11- and 12-year-old girls receive the vaccine. Three other states — New Jersey, Massachusetts and Virginia — mandated in 2007 that girls entering sixth grade receive the Gardasil vaccine.
“Vaccines work best when they are given before exposure to the infective agent,” Mahmoud said. “So the 11-to-12 age group was targeted for the vaccine because the idea was that this was definitely before exposure and sexual activity.”
Abstinence advocates believed the vaccine encouraged sexual activity in young girls who should instead be protecting themselves against the disease by avoiding sexual activity entirely. Legislators, on the other hand, were concerned that not enough was known about the relatively new vaccine to assure them of its safety.
The backlash against mandating the vaccine was successful.
Merck announced that same month that it would stop lobbying state legislatures to mandate the vaccine, fearing that campaigns instigated protests that actually hindered widespread adoption of the vaccine.
Following this decision, the Texas House of Representatives passed a law in April 2007 that barred the state from mandating Gardasil immunizations until at least 2011.
“We did not want to be the first in offering young girls for the experiment to see if this vaccine is effective or not,’’ State Representative Dennis Bonnen told The New York Times at the time.
Mahmoud, however, disagrees, citing the six years of vaccine testing, “which is probably more than most vaccines that come to market have. It would never have been approved by the FDA or the Europeans or the Australians if it had not been rigorously tested. They absolutely know the consequences.”
In these studies, the vaccine was found to be almost 100 percent effective in preventing HPV infection and absolutely 100 percent effective in preventing the pre-cancerous changes in the lining of the cervix that signal the beginnings of cancer.
The vaccine was initially tested on more than 25,000 women up to the age of 25, and thus, the vaccine is only approved for females ages 9 to 25, Mahmoud said.
Women who have already been infected with HPV should still consider getting the shots, Mahmoud explained, because the vaccine is effective against four strains of the virus and can protect women infected with one strain against the other three.
The FDA has not approved the vaccine for males, but Merck is currently conducting a clinical trial of the vaccine with a test group of 4,000 men. Some scientists, however, believe that waiting years for the final results of this trial could mean failing to protect an entire generation of American men and their sexual partners.
Australia and countries in Europe have already decided to give the vaccine to young men, a decision that was based on preliminary data showing that Gardasil produces an immune response in boys.
What about college students?
While legislators continue to debate mandating the vaccine for girls before they enter their teenage years and become sexually active, many healthcare practitioners are advocating that high school and college students get the shots before they get any older.
This campaign has met with only limited success, Mahmoud said, because of the difficulties associated with adolescent vaccination.
In fall 2006, University Health Services (UHS) began offering the shots to members of the University community at a cost of $402. UHS has since administered almost 1,000 doses of the vaccine, UHS coordinator for women’s and men’s health Olga Hernandez said.
Mahmoud explained that one of the biggest problems is that vaccination is widely regarded as “a childhood phenomenon.” This is coupled with the additional issue that adolescents interact with the healthcare system less frequently than other age groups. “And this [HPV is] an STI, which gives it a little bit more of a twist,” he said.
A CDC study announced in March showed that one in four females aged 14 to 19 is infected with at least one of the four most common STIs: HPV, chlamydia, trichomoniasis or genital herpes. HPV was by far the most common, affecting 18 percent of the girls who took part in the study.
Mahmoud said he thinks it’s likely that the current college-aged generation won’t be as thoroughly protected as it could be against HPV. Still, he has hope for the future.
“This was exactly what happened with the hepatitis B vaccine. When it first came out, it was also recommended for adolescents, and that was problematic, but now the first dose is given at birth, and it’s done; it protects us for the rest of our lives,” he said. “I think that’s what will happen with Gardasil, and I look forward to that day.”