The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices approved the use of Gardasil, a vaccine that could potentially prevent more than 70 percent of the cases of cervical cancer worldwide and more than 90 percent of the cases of genital warts. The vaccine protects against the four most common types of sexually transmitted human papilloma viruses (HPV), two of which lead to cervical cancer and the others to genital warts. Good news, certainly. But the Merck vaccine has opponents who decry the CDC’s recommendation of the vaccine for all girls ages 11 and 12. Maria Trent, a specialist in adolescent and young adult reproductive health in the Harriet Lane Clinic, was asked how the primary care clinic is administering the vaccine.
Where do things stand?
We’re now administering the HPV vaccine in our clinic, targeting 11 and 12 year olds. We’re located in a community with a particularly high STD prevalence, so we want to be able to offer all the prevention options available. This is about preventing in childhood a disease that infects more than 6 million Americans – and an adult cancer that kills more than 3,500 Americans – each year.
What about boys?
In boys, the vaccine may offer protection against genital warts and prevent the spread of HPV to their partners when they’re older. We’re waiting for its approved use in boys and young men.
The vaccine’s cost – about $360 – presents a challenge. The CDC’s Vaccines for Children Program, Medicaid and most private insurers are covering the costs, but reimbursement rates are still an issue for many community pediatricians.
What do you say to parents who see the vaccine as spurring sex at an early age?
For parents, who of course must consent to having their child vaccinated, it’s saying to their child: “I want to protect you against whatever you could be exposed to in the future.” Today’s standard immunization of infants against hepatitis B – another sexually related disease – does not imply that the parents condone untoward sexual behavior, nor is there any evidence that it has led to more sexual behavior. Neither should the
HPV vaccine. Regardless, we should immunize earlier rather than later.
The age of onset of first sexual experience is dropping. Most kids have had sex by the time they leave high school, and nearly 30 percent by the end of eighth grade. That’s the reality. And we know that immunization rates drop dramatically after that 12-year-old visit because they don’t come to clinic as often. We want to get them before they’re exposed.
How does your clinic address issues of sexuality?
In a sense, the vaccine pushes us harder as physicians to talk with patients about sexuality. A child’s onset of menstruation, on average around the age of 12, is a good time for doctors and parents to begin the discussion about changing bodies.
How do you get the message across?
We’re working on developing effective ways to communicate and engage with adolescents. In my research on pelvic inflammatory disease (PID), for example, we’re conducting a randomized controlled trial of a behavioral intervention to improve infected adolescents’ ability to care for themselves. PID affects 800,000 to 1 million people every year; approximately 20 percent of them are adolescents. These kids face a long-term risk of ectopic pregnancies and infertility. In related research, we’re looking at testing measures to see whether kids’ perceptions of potential infertility, as a result of acquired or untreated STDs, affect their sexual behavior.
We don’t screen for the virus, and girls and women will still need routine Pap smears within three years of their first sexual encounter, regardless of whether they were inoculated. The vaccine does not protect them against all strains of HPV.
For more information, go to: www.cdc.gov and search for HPV vaccine.