HPV vaccine is too successful to ignore

News Journal, Mansfield, Ohio
18 February 2008

Most vaccines in common use are considered to be highly effective when they are 80 to 90 percent successful in preventing a specific disease. The new vaccine to prevent infection with the Human Papilloma Virus (HPV) is proving so successful that Darron R. Brown, MD, from the Indiana University School of Medicine organized a continuing medical education program to share the surprisingly good information with other health care providers.

The vaccine approved by the Food and Drug Administration (FDA) and available in this country is Gardasil, a product which produces an immune response to four different types of the HPV, two types which cause cancer of the cervix (types 16 and 18), and two types which cause genital warts (types 6 and 11). There is another vaccine (Cervarix) which has been approved by the European Union (Europe’s version of the FDA) and is under review by our FDA. Cervarix is a bivalent vaccine, containing only agents against types 16 and 18.

Gardasil was developed to prevent cancer of the cervix caused by HPV types 16 and 18, prevent abnormal Pap smears, and prevent genital warts. It has proven to be 95 to 100 percent successful in accomplishing these ends, but the success doesn’t stop there. Type 16 causes 55 percent of the cancers of the cervix, and type 18 is responsible for another 15 percent, so the vaccine was predicted to prevent only 70 percent of the cervical cancers. The other 30 percent of the cancers are caused by the other 100-plus types of HPV which are present in the environment.

Fortunately, the antigenic (immune) response to HPV types 16 and 18 is so strong that it confers immunity to other closely related HPV types and extends partial protection for at least another five types which have been associated with cervical cancer.

The HPV types which produce genital warts are shared by sexual activity, are generally self-limiting and eventually go away on their own, but they are ugly, produce a tremendous emotional burden, and affect a person’s quality of life. Young adults are the usual victims, and about one percent of the population will have a problem with these warts some time in their life.

A secondary problem is that these HPV types can also produce abnormal Pap smears, which then require further diagnostic evaluation and possible surgery. A vaccine which eliminates most “falsely abnormal” Pap smears can have tremendous public health implications and cost savings.

Cervical cancer is not one of the most common cancers in this country, but worldwide there are still 250,000 to 300,000 women who die from this disease each year. Preventing more than 70 percent of these deaths has significant public health impact. In addition, different types of HPV are now being looked at as the causative agent in 70 percent of anal cancers, 20 to 40 percent of cancers in the mouth and pharynx, 50 percent of vulvar cancers, 50 percent of vaginal cancers, and even 50 percent of cancers of the penis. When vaccines are developed for these HPV types, it will be a giant leap forward for preventive medicine.

Current recommendations are to vaccinate girls in their teens, before they have had a chance to become infected with these viruses. As more data are collected, the age group recommendations will probably be expanded. There are now some studies evaluating the effectiveness in women over the age of 40. The vaccine requires a series of three injections given over a six month period, and it is still expensive, in the range of $450. Insurance policies vary in their willingness to cover this expense, but it certainly would seem to be cost effective in the diagnostic and treatment procedures it would avoid.

Most parents don’t care what national medical societies recommend, they want to know what their personal doctor recommends. I believe the data are accumulating to convince most physicians to be positive in their recommendation for the vaccine, and not be wishy-washy about it. There were three physicians from different medical schools who presented this medical education program, and all three of them had vaccinated their own daughters. It seems this is a good way to protect the well being of our young women.

Dr. William Schamadan is a retired ob/gyn physician.

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