Thursday, January 16, 2014
Gardasil- What's Up Down Under?
The HPV (Human Papilloma Virus) vaccine, Gardasil, was FDA approved in the United States for use in young women in June, 2006, then extended for males in October, 2009. In October of 2011, the Advisory Committee on Immunization Practices (ACIP- the group that creates our national guidelines that you see posted on your doctor's office walls) extended their official recommendations to include ROUTINE VACCINATION of both boys and girls at age 11-12 years, with "catch up" immunizations for those youth ages 13-21 who had missed getting this vaccine series.
Why are we vaccinating?
We vaccinate primarily for CANCER PREVENTION. Each year in the United States, we have over 33,300 cases of HPV-related cancers (data from CDC, 2012). About 2/3 of these occur in women, primarily with cervical cancers, but also other genital, anal and oral cancers. In men, the majority of HPV related cancers are oral, but they, too, can have genital and anal cancer, though it is less common than in females.
Gardasil also protects against the two strains of HPV that cause 90% of genital warts, and with over one million cases of this malady each year in the US, you can see what an impact prevention can make here!
How well are we doing?
Not as well as we could do...because national immunization surveys have shown that in teenagers 13-17 years old, only 53% of young women had started the series, and only 1/3 of that group had completed the series. A bit more encouraging is an improvement in the very low percentage of teenage males getting the vaccine, which was at 8% in 2011 (the first year it was considered a "routine" universal vaccine) and more than doubled to over 20% in 2012.
How effective is this vaccine? Here is the GREAT news- the HPV vaccine is unbelievably effective when given to young adults not previously exposed to HPV (with no prior sexual intimacy). The CDC's data demonstrates efficacy nearing 100% protection for women in preventing cervical, vulvar & vaginal cancers and genital warts, and 90% efficacy in men for genital wart prevention and 75% efficacy preventing early anal cancers.
What happened down under?
From 2007-2009, Australia provided the HPV vaccine free of charge to all young women ages 12-26, and had extremely high vaccination rates as they utilized the school system to give out these shots. Follow up studies in 2011 and 2012 showed dramatic results, with 92% decline in genital warts in young women (< 21years old), 72% decline in women ages 21-30, and interestingly...an 81% delicate in young (< 21) heterosexual men and 51% decline in men ages 21-30. This is interesting because the young men saw improvement not because they had been immunized, but simply from the widespread immunization of all the women. Pre-cancerous cervical abnormalities also markedly declined in this short time period, and since cervical cancer typically is very slow growing, we expect to see dramatic falls in cervical cancer rates in the next few years and certainly, in the next decade.
BOTTOM LINE: HPV vaccination SHOULD BE a routine immunization for our sons and daughters- talk to your family physician about it at your next visit*
(In this day and age, I feel compelled to add two things: one, I in no way financially benefit from the makers of the Gardasil vaccine; two, yes, we chose to vaccinate our daughters.)