HPV Vaccine for MY Preteen?

Here at MamasOnCall there are several topics that tend to … well, make us nuts. One of these is vaccines and immunization. We are unabashedly pro.

There is no question we believe that in the vast majority of cases childhood immunization is the way to go. Yes, there are exceptions, and if it makes parents more comfortable to push the time frame a bit, that’s usually fine. But to just say no? To refuse recommended vaccines without good reason? We think that’s generally a bad idea.

So when a vaccine is available that prevents a common form of cancer in young women, and parents take a pass, we worry. That’s the situation with the HPV (human papilloma virus) vaccine. The HPV vaccine is designed for young teens. The idea is to immunize against this virus that causes cervical cancer in women before they become sexually active and are likely to come in contact with it. It’s a relatively simple form of cancer prevention, yet it’s estimated that only 25-30% of 11-15 year old girls are getting it.

Courtney, an MOC regular, sent us this question:

I just took my 12-year-old daughter for her physical (she starts middle school this fall) and her doctor recommended she get the vaccine that protects against genital warts, which he explained can lead to cervical cancer in the future??!! I’ve heard some scary things about this vaccine causing fainting and seizures, and I certainly don’t expect my daughter to be sexually active anytime soon. I decided to hold off, but now I’m having second thoughts. What’s your recommendation?

A week later a good friend, who’s daughter is 11, asked the same question. We think it’s time to lay out the facts.

Human papilloma virus (HPV) is directly responsible for up to 80% of cervical cancers. The vast majority of HPV strains go undetected and unnoticed and are quickly destroyed by our immune systems. Although almost 250 strains of HPV have been detected, only 4 of them have been linked to cervical cancer. Of these, #16 and #18 are the most dangerous.

Cervical cancer is treatable in its early stages, but the problem is that it often goes undetected until the cancer is well advanced and inoperable. The HPV strains that cause cervical cancer can sit dormant for long periods of time while they slowly alter the structure of cervical cells. Therefore, it is critical for all women who are sexually active to have regular Pap tests. A Pap smear can detect the presence of abnormal cells so that further investigations can be conducted.

The HPV vaccine has been developed to prevent cervical cancer that occurs as a direct result of HPV. The cervical cancer vaccine is called Gardasil and a campaign is under way to vaccinate all girls and women between the ages of 11 and 18. The vaccine is administered in a series of 3 injections. All 3 injections have to be completed before the vaccine can be considered protective. However, the vaccine is not guaranteed if the recipient has already been sexually active and at risk of having already been exposed to HPV.

Why is there controversy surrounding the vaccine? Various groups have opposed the vaccine for a variety of reasons. The HPV vaccine has only been available for a short period of time, so the long term effects of the vaccine have not had time to be fully investigated. While limited side effects, including slight nausea or irritation around the site of the injection have been noted, some reports have indicated that up to 3 girls have had serious reactions as a result of being vaccinated. The proof is inconclusive at this time.

While clinical tests of the HPV vaccine in the US have proven it to be virtually 100% effective against HPV types #16 and #18, it does not offer protection against the many other strains of HPV (which are not thought to be significant causes of cervical cancer) and won’t protect women who have been sexually active before the vaccine was administered.

The slight discomfort that young girls may experience when given the HPV vaccine is insignificant when compared to the consequences of cervical cancer, which is responsible for approximately 4,000 US deaths each year, so the solution for parents is to gather as much information as possible about HPV and its consequences and then make an informed decision.

Dr. Dianna Tolen, a pediatrician in Canfield, Ohio recently commented on her experience with the vaccine in her practice:

“We have been giving this vaccine in our office for more than a few years and routinely offer it at the 11-12 year visit.  Can you guess how many takers we get?  Less than 25%.  My ratio of ordering Tdap [the tetanus, diptheria, pertussis vaccine], which is required for school, to HPV, which is not, is amazing.

I am a huge proponent of vaccines and our practice has reached a 98% vaccination rate of required vaccines by our state chart review in past years, so many of our patients get vaccines at any and all visits.  Our parents are accustomed to me ‘catching’ their kids up at sick visits, and even a sibling’s visit, and I don’t continue to treat total vaccine refusers.  But for some reason this vaccine has been a hard sell.

I usually get the head shake immediately, “no, we are going to wait on that one.”  Or, “no, her father doesn’t feel she needs that vaccine yet.”  These people are in total denial.  With the Kinsey Institute showing 1/4 of both males and females admitting to having sexual intercourse by age 15 and half by age 17, how long do they think they are going to wait on that one?  What’s even more obvious is that when I talk to the teens by themselves to offer the vaccine, they all want it, it is the parents that have blinders on and refuse it.”

So there you have it. We understand how hard it can be to see your child as a soon-to-be young adult and sexual being, but knowledge is power, so do all the research you can and come to a decision that’s right for your daughters (and sons, as the vaccine is now recommended for boys as well). But beware of the bias you encounter in the process. We’re clear about ours. Not all sources of info are as up-front.

For more information about the HPV vaccine, go to the Centers for Disease Control and WebMD.com.