Cotton-Pickin’ Days

I am glad they are at least trying to get it past the FDA! I think it’s a great vaccine, if it really works, and will save millions, billions of lives over time! The whole ‘give it to babies’ argument is the same one they had for Hep B, which is now manditory in GA for school admission. Personally, I want to see 10 years of real world-real use data in people that voluntarily opt to try the drug. In 10 years, if it’s still considered safe, then we can talk about mandating it for everyone. In 10 years, if it isn’t a horrible fiasco like the rotavirus vaccine, I will be the first in line with my kids! I am sure the argument will be the same, probably even louder, if they ever make a reliable working AIDS vaccine. My stance is the same thought, prove to me it’s really safe and I’ll buy it! I’m for any vaccine that keep my kids from growing up dead!

I think it’s a positive thing, and I’ll be second in line after Joan to get my daughter vaccinated. I don’t see why it should be mandatory for school, but it should definitely be a stronly recommended vax.

But you know my opinion about vaccines – the benefits so massively outweigh the risks, I can’t see any reason to NOT get a vaccine that can prevent a disease that can cause serious discomfort, harm, and even death.

Conservative groups may object that the shot isn?t necessary when children are taught to abstain from pre-marital sex.

Puh-leeze.

Hi from California. This issue has been much in the news in the US, with the predictable social conservative reaction.

But first, the Rotavirus question — it wasn’t a “horrible fiasco”

http://www.rotavirusvaccine.org/vaccine-facts.htm

Rotashield?, the world?s first rotavirus vaccine, was licensed for use in the United States in 1998. Prior to licensing, clinical trials in the United States, Finland, and Venezuela had found it to be 80 to 100% effective at preventing severe rotavirus diarrhea, and researchers had detected no statistically significant serious adverse effects.

But the manufacturer of Rotashield withdrew the vaccine from the market in 1999, after it was discovered that it might have contributed to an increased risk for intussusception, or bowel obstruction, in one of every 12,000 vaccinated infants.

Social conservative opposition to the the papilloma virus vaccination:

http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2005/10/31/MNG2LFGJFT1.DTL

“”Some people have raised the issue of whether this vaccine may be sending an overall message to teen-agers that, ‘We expect you to be sexually active,’ ” said Reginald Finger, a doctor trained in public health who served as a medical analyst for Focus on the Family before being appointed to the ACIP in 2003.

“There are people who sense that it could cause people to feel like sexual behaviors are safer if they are vaccinated and may lead to more sexual behavior because they feel safe,” said Finger, emphasizing he does not endorse that position and is withholding judgment until the issue comes before the vaccine policy panel for a formal recommendation.

Conservative medical groups have been fielding calls from concerned parents and organizations, officials said.

“I’ve talked to some who have said, ‘This is going to sabotage our abstinence message,’ ” said Gene Rudd, associate executive director of the Christian Medical and Dental Associations. But Rudd said most people change their minds once they learn more, adding he would probably want his children immunized. Rudd, however, draws the line at making the vaccine mandatory.

“Parents should have the choice. There are those who would say, ‘We can provide a better, healthier alternative than the vaccine, and that is to teach abstinence,’ ” Rudd said. ”

Timing of the vaccination is also an issue

http://www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20060406-10010100-bc-us-cervicalcancer.xml

“It’s really wonderful we’re making all the progress, but there are still many questions that need to be answered,” said Michele Manos, an infectious disease epidemiologist at Kaiser Permanente’s Division of Research. One of those questions, Manos said, involves when to vaccinate girls — and that won’t be answered until the duration of the vaccine is fully understood.

Most girls’ peak period for contracting HPV viruses is late teens to early 20s. Both Harper and Manos stressed the vaccine should not be given too early, which would miss that crucial time.

As a cervical cancer survivor, I would vaccinate my daughter (who is in her late teens) as soon as the vaccine becomes available. Of course, she will be over 18 by that time, most likely–but you can be sure I will urge her to get the inoculation (and for whooping cough and meningitis before she goes to college).

This vaccine is prophylactic, not theraputic. The important thing about the vaccine is to have young girls vaccinated BEFORE they are sexually active- and by age 15 at least 25% of girls have had vaginal sex. Most exposures happen to women who are 16-22, so why not give them the vaccine when they are younger, covered potentially by insurance, and in a lower risk group- BEFORE exposure.

Promotion of condoms have never been shown to increase sexual promiscuity- why would a vaccine?

Condoms DO NOT prevent HPV.

I’m not sure it will ever be mandatory. That seems a little extreme for right now- but the guidelines are that the vaccine will have the most effect on women who receive it before becoming active. Would you prefer they were 14?
What really would be wrong with giving it to a 9 year old? IF we separate the vaccine from the icky-sex talk, then does it make it a bit easier?
There is some debate as to whether boys should recieve it- but the Merck vaccine is quadravelent and does have two strains that protect against the genital wart causing strains of HPV. The phase IV studies right now are looking at if the strain is transmitted to women less if men have the vaccine, which seems intuitive, but has yet to be completely proven.

Oh, and the rotavirus risk — a new vaccine has been developed

http://www.usatoday.com/news/health/2006-02-21-rotavirus_x.htm

Virus as killer

Rotavirus, which can be spread by contact with toys or other surfaces touched by sick children or through contaminated food and water, sends about 250,000 children to emergency rooms each year, says infectious-disease specialist Paul Offit of Children’s Hospital of Philadelphia, a co-creator of the vaccine.

[snip]
“If you have a child under 3 who comes into the emergency department in winter with fever and vomiting or diarrhea or both, there’s a 90% chance it’s rotavirus,” Offit says. He says 40 to 60 children in the USA die of the disease each year.

Thanks for the input, everone. I hope you don’t think that I’m against the HPV vaccine because I’m not. I’m glad there is one available for women who choose to have it. I’m just concerned about the age at which children might be required to have it. I support an informed choice at a later age. One that each family can make on their own without coercion from the government.

Amber: Thanks for letting me know about the HPV prevention and condoms. I’ve edited the post to include some information from Planned Parenthood.

BTW, sex talk isn’t icky, it’s a part of life. I’m glad we’re all having this conversation because I hope to encourage people to think things through instead of accepting everything at face value. There are extremes to everything – rabid anti-vaxers on one end and people who will vaccinate and medicate for EVERYTHING. I’d like to think there is some leeway in some instances for people to make an informed decision for themselves. Not everyone is as knowledgeable as you are!

You are welcome- I really love HPV vaccine discussion- so I tend to get a bit overzealous- and I do think more discussion=more education=better health choices. I’m not sure I agree with mandatory vaccines ever though- but that is the constitutionalist in me, not the public health person.

I am really really lucky to have smart, educated, informed, passionate people like you guys (Amber, Joan, Liz, and river2sea72 and everybody else) to talk me through these things. Often times, I write off the cuff and love a discussion to learn more.

I think they should continue to push for it to be included in the mandatory school vaccines, and the reason is that a lot of parents are going to say “MY kid isn’t ‘messing around’” and not bother having it done.

As for kids and transmission- girl, you need to get educated about what goes on in schools these days. Talk to the teachers about how many days per month they catch grade school children having sex in the bathrooms or hallways. It is -common-. Not a rare occurence. Especially in the minority/low-income /immigrant population areas. If vaccination isn’t mandatory, these kids probably won’t get it. And they’re at the most risk, with the least resources.

HPV is common. Something like 1 in 4 people has HPV, unless I’m thinking of one of the other STDs. It isn’t some miniscule percentage of the population that carries it. Women will often develop cervical cell mutations, which if caught early enough can be surgically removed before they become cancerous. Which saves lives. Cervical cancer is scary stuff.

However, many women just don’t bother going in for a yearly exam. A -lot- of teenage girls never see an OBgyn at all. Unless they have a pregnancy scare, or think they have an STD, they probably won’t go in unless their mom/grandma/dad/etc makes them.

All but the most straight-laced kids are probably going to at least be fooling around, even if they don’t “go all the way”, at some point during their school years. Men DO transmit it to women (or the only people with HPV would likely be women in strictly lesbian relationships)- they should be vaccinated so that they aren’t carriers.

I could really go on & on, but sexual health is just as important as other aspects of our health, and if there is something that will prevent suffering and death, and the best odds are if it’s done in childhood, then by all means do it.

Frankly, I hope they can develop vaccines against all the sexually transmitted ailments. All it takes for a person to get an STD is one condom breakage, or one moment of mis-placed trust. Truely sad.

you know me. not shy about throwing that SEX word around

Hey, Deb. Thanks for joining in the discussion. I guess since thoughts of sex never crossed my mind when I was in high school and younger, I just can’t imagine what is going with kids today. Then again, I just posted about that 11-year-old mother last weekend. *sigh*

So I guess we’re all agreed that we should just vaccinate away? If only life could just be sterile.

PS In the facts I listed above, 20 million people are infected with HPV in the U.S. which is closer to 4-5%.

A sexually active woman has a 40% chance annually of contracting HPV. The majority of these exposure are sub-clinical and spontaneously resolve. A smaller number of the high risk strains advance to low grade lesions, and even smaller progress to high grade lesions and then cancer.
A woman (and assuming a man as well) has about a 75% lifetime chance of contracting HPV.
The HPV cases are usually picked up in early adulthood and may or may not be detected. Pre-cancerous abnormal pap’s usually happen in the late 20’s and 30’s. Cancer in women due to HPV doesn’t usually happen until late 30’s or 40’s- but you got the HPV 20 years ago and can’t do anythign about it now. The HPV vaccine is the first “anti-cancer” vax (if you don’t count long term liver damage leading to liver cancer)- and while I competely agree most women should get it- I get a little creeped out by mandatory vaccinations- it just doesn’t seem democratic.

amber: I’ll assume those stats are for the population as a whole. For sub-groups, however, there will be some at higher risk and some at lower risk of HPV infection. And, as you point out, the majority of cases are asymptomatic.

It stands to reason that people should be given the information they need to decide their own level of risk and their own willingness to accept any inherent risk. On the other hand, most people will never bother to get educated on the matter.

I’m sure there are cost-benefit calculations available for all of this. Wonder which specific populations are best to target at this stage….

I think I was thinking of the stats Planned Parenthood gives, which I looked up out of curiosity, and those include several STDs:

“At least 65 million people ? more than one in five Americans ? are believed to be infected with a viral STI other than HIV (NCHSTP, [1999]). These incurable infections, such as genital herpes, human papilloma virus (HPV), and hepatitis B, have consequences ranging from recurrent painful outbreaks to chronic liver disease to cancer(CDC, 2000a).”
http://www.plannedparenthood.org/pp2/portal/files/portal/medicalinfo/sti/fact-sexually-transmitted-infections.xml

I really don’t care about the democracy of requiring the vaccinations, and why is that? I’ll tell ya why heh.

I’m thinking that if the best age to vaccinate is when people are kids, how are we in good conscious supposed to let kids make that kind of decision? I remember being 9, vaguely, and my long-term world view on romance was “growing up and marrying the Lone Ranger”. Hardly the maturity level needed to make life & death decisions.

Deb: Well, it comes down to optimal age at which to administer this particular vax. Some are suggesting teen years which seems more reasonable to me. In general, I’m in favor of longer spacing between vaccinations whenever possible.

Just out of curiosity, is part of the issue you have with this the question of whether the child should be able to decide whether s/he wants the vaccine or not?

river2sea72: Hell no. Parents need to be able to decide what’s right for their kids. And, of course, when the kids are old enough to join in the discussion, all the better!

P.S. Check out this letter to the editor in the June 2006 issues of Scientific American:

“Thank you for highlighting in “To Banish a Cancer” [SA Perspectives"] the achievements in the fight against human papillomavirus (HPV), which causes all the cervical cancers. I must point out, however, a few facts that your editorial overlooked, because understanding the virus’s biology removes the sexual connotation.

“HPV can live only in the squamous skin layer, which is about 400 nanometers deep. No other sexuallty transmitted infection (STI) lives in the skin. HPV is rapidly transmited from squamous skin to squamous skin cells but is not transmitted by bodily fluids, as are all other STIs. Most important is that penetrative intercourse, though the most efficient method for transmission, is not necessary for this rapid transfer from skin to skin. fingernails and the skin around them contain the same types of cerviacal cancer-causing HPV as the anogenital skin does, allowing autoinoculation from simple habits such as toilet hygeine or tampon insertion. The virus is ancient and omnipresent in all environments, and 80 percent of women (and probably more men, but this has not been well documented yet) develop at least one HPV infection in their lifetime.

“Thus, all references, surveys, and propagation of “educational” materials that assert cervical cancer is transmitted solely through sexual contact are deceiving and do the public a dsiservice. The potential for improved health with the new vaccine in both men and women is tremendous – and it is the biggest health care advance in 50 years for women. Therefore, it is important to emphasize the truth.”

Diane M. Harper
Director, Gynecologic Cancer Prevention Research Group
Dartmouth Medical School

[apologies for typos - the June issue isn't online yet, so it's just my typing...]

sorry – i wasn’t logged in when i made that last comment

river2sea72: Thanks for taking the time to type that out! BTW, your previous comment finally showed up in my spam catcher. So weird.