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What is HPV infection? Is it serious if people have never heard of it? Are the teen years a bit too early to vaccinate against a sexually transmitted infection? Can the vaccine really protect one from cervical cancer? What are its side effects? Is it true that some girls have died after receiving the vaccine?
There are also socially related questions. How do parents inform their girls about the vaccine? Does talking about it encourage promiscuous behavior or signal mistrust of their daughters’ behavior? And finally, is it really necessary, as it is expensive and parents need to pay for it?
HPV infections are sexually transmitted infections that can be caused by any of several strains of the HPV. Dr. Harald zur Hausesn, who won the Nobel Prize and the Gairdner Award in 2008, first discovered that certain HPVs, such as types 16 and 18, cause cervical cancer. It is now established that infection with types 16, 18, 31 and 45 have high chances of causing cancerous changes in the cervix, as well as the anus, vulva and the penis. So these are considered high-risk HPV types.
Presently, cervical cancer is the second leading cause of death due to cancer worldwide, responsible for around 288,000 deaths annually. Most deaths occur in developing nations.
Cervical cancer deaths in developed countries decreased dramatically after a simple screening technique was implemented to identify cancers at a very early stage, at which time they can be treated and cured. This technique, called a cervical or PAP smear, involves collecting cervical cells on a plain glass slide and observing them under a microscope for abnormal or cancer cells.
Simple as it sounds, the procedure needs a solid infrastructure complete with trained and skilled manpower. The program is successful if more women participate and benefit from it.
One may imagine that with a vaccine that protects against HPV infections and subsequent cervical cancers, it is okay to forgo PAP smear screening. That is incorrect. The available vaccines, Cervarix and Gardasil, protect only against HPV types 16 and 18, which are implicated in a majority of cervical cancers. PAP smear screening should be continued lifelong to detect cancers that may be caused by HPV types other than these.
Studies have shown that both vaccines are 100 percent effective in protecting against HPV infections and subsequently against cervical cancers occurring due to HPV types 16 and 18.
In addition, Gardasil also protects against HPV types 6 and 11, which are responsible for most genital warts. Both vaccines are safe with side effects being few and not serious. Deaths due to the vaccine, reported in the United States and the United Kingdom, were confirmed to be unrelated to the vaccine by the U.S. Food and Drug Administration and the Center for Disease Control and Prevention and the U.K. Health Authority.
As one can get infected with HPV even at the very first sexual encounter, and because the vaccine does not cure a preexisting HPV infection, it is advisable to vaccinate girls in their teens before they have any sexual contact.
Dr. Diane Harper, a lead researcher in the development of the HPV vaccine, said, “It is advisable to vaccinate at ages closer to the onset of sexual activity.” Personally, I do not believe that giving this vaccine will adversely influence the behavior of girls. As a parent, I would prefer to err on the side of caution and vaccinate my daughter to protect against the killer cancer.
The question is, how long will the effects of the vaccine last? As of now, studies show that Gardasil is effective up to five years and Cervarix for seven and a half years. “We must have vaccine protection for at least 15 years in order for cancer to actually be prevented, and not just postponed,” says Harper.
Does this mean the girls will need boosters five to seven years after vaccination? According to the CDC and the U.S. Agency for Toxic Substances and Disease Registry, further studies are ongoing to see if booster doses can help maintain protection. Harper hopes that the vaccine studies will continue for 15 years and give more definitive answers.
I feel all parents should make a decision with open minds. I made mine and gave three shots of Gardasil to my 14-year-old daughter. Five years down the line I shall reconsider the available options – a better vaccine or a booster perhaps.
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(Dr. Pradnya Kulkarni is a clinical pathologist from India. She worked as a consultant pathologist in a private laboratory in Pune before moving to Hong Kong with her husband and young daughter. She is also a freelance writer, focusing on medical issues of public concern. ©Copyright Pradnya Kulkarni.)
