In 2006, a new vaccine was introduced in the US – a vaccine for the Human Papilloma Virus (HPV). This virus is responsible for most cases of cervical cancer, some throat, penile and anal cancers, as well as genital warts. The vaccine is effective against the 4 strains of HPV that cause the majority of cervical cancer and genital warts. It is given as a series of 3 shots over a 6 month time period, and is approved for females and males, ages 11-26. There are two brands of vaccine, Gardisil and Cervarix, currently FDA approved in the US. Recently, there has been a lot of media attention to HPV vaccines, leading to a lot of confusion about what the vaccine does and how safe it is. As the father of a 12 year old girl, I thought I’d share my views and research.
What is HPV?
Human Papilloma Virus is the most common Sexually Transmitted Infection and responsible for most cervical cancer, as well as genital warts in both sexes. It can also cause throat, penile and anal cancer. The 4 strains of the virus that cause the most harm are 6,11,16, and 18, which are the strains in the vaccine. HPV causes almost 34,000 cancers a year, with about 2/3 of them in women. Almost 12,000 of the cancers are cervical cancer, which is usually treated by removal of the cervix and uterus (hysterectomy) which makes it impossible for a woman to have children. Over 14 million people per year get infected with HPV.
HPV can be tested for in women during a PAP smear, hopefully identifying lesions before they become cancer. However, there is no reliable test in men, other than doing a biopsy on a wart or other visible lesion.
What is the controversy?
Mark Twain once said, “There are 3 kinds of lies: Lies, Damn Lies and Statistics.” All three have been used in the argument for and against vaccines. Vaccines in general provoke very strong reactions from many people. Vaccines have been blamed for many conditions and reactions completely separate from the diseases the vaccines were meant to prevent. There have been vaccines that have been recalled and discontinued because the risk of side effects was higher than the disease rate – a vaccine for Rotavirus and for Lyme Disease have both been discontinued. There are immune reactions that are possible that can have serious health consequences, but these are not very common. Allergic reactions to a vaccine are possible, just as they are possible with other medications or foods. These reactions need to be considered and a good medical history obtained before they are administered. However, I think that as medical science has progressed, we have lost sight of the devastation these preventable diseases caused.
Out of 57 million doses of HPV vaccine given through March of 2013, there have been 22,000 reactions reported. Of those, less than 1800 have been considered severe reactions, mostly headache, nausea and fainting. Enough people fainted that it is recommended that people wait 15 minutes after the vaccine before leaving the doctor’s office. There have been about 30 deaths reported after the vaccine – but none of those deaths have been shown to be directly related to the vaccine. For example, if someone died in a car accident after receiving the HPV vaccine, it is reported.
Much of the recent controversy regarding HPV vaccine comes from 2 events in the past year. In one, a physician submitted a case report of a 16 year old girl with irregular periods and eventual ovarian failure – with the symptoms beginning a few months after receiving the vaccine. There was no evidence linking her condition to the vaccine, and it is known that in cases of early ovarian failure a cause is only found 10% of the time. In addition, the reporting physician had strong personal beliefs that may have biased her reporting of the case.
The other event was when Katie Couric had a physician on her talk show who was involved in the development and testing of the HPV vaccine. This doctor in several interviews did not question the safety of the vaccine or it effectiveness, but rather called attention to the fact that it is not yet known how long the vaccine lasts, and a booster may be needed. She also questioned the need for the vaccine when PAP smears could detect the cervical cancer early. However, HPV causes 20,000 cases of non-cervical cancer per year which would be missed.
Her statements also assume a much higher rate of women going for PAP smears than is likely to occur. Ms. Couric did not give equal airtime to her own medical expert, her comments supporting vaccination were on the show’s website
. Ms. Couric did issue an apology after the show aired
acknowledging that not enough airtime was given to talk about the benefits and safety of the HPV vaccine.
How does this affect us?
Our ability to treat disease has advanced tremendously in the past 100 years. The rate of mothers dying during childbirth was reduced dramatically by having doctors and nurses wash their hands prior to delivering the baby… simply by preventing infection!
Today, it is accepted that by not smoking, maintaining a healthy body weight, normal blood pressure and cholesterol, we can prevent heart disease. If we stop preventing disease, a healthy life and life expectancy would be very different from what it is today. The CDC estimates that if we stopped preventing diseases with vaccines:
- 13,000 – 20,000 people a year, mostly children, in the US would contract polio, requiring braces, crutches, wheelchairs and breathing machines
- Almost everyone in the US would get measles, 20% of whom would need to be hospitalized, and 450 would die per year in the US, and 2.7 million worldwide
- Haemophilous Influenzae (Hib) would cause 20,000 cases of meningitis or epiglottis in the US, killing 600 people per year. About 1 in 200 children under 5 would be infected, and those that survive are often left deaf, with seizures or mental impairments
- Almost all children would contract whooping cough, with about 9000 deaths per year
- Pneumococcus would infect 63,000 Americans yearly, killing 10% of those infected
- Rubella, while mild in most children and adults, causes birth defects in 90% of children whose mothers got infected while pregnant, causing heart defects, deafness, cataracts and mental retardation
- Mumps would infect 300,000 people a year, and causes deafness in about 6% of cases. It also caused miscarriages in women infected while pregnant
- Hepatitis, Diptheria, Tetanus and Chickenpox are all diseases with potential long term consequences that we are preventing with vaccines
Vaccines are some of the most closely monitored treatments in medicine, both because the diseases they prevent are serious, and the consequences of not getting it right are real as well. This is a great conversation to have with your physician during an Annual Physical. My daughter will be getting her vaccination shortly.
The path to wellness begins with a proper diagnosis