If you could give your daughter a shot that would virtually guarantee that she’d never get a deadly disease, would you do it?
It sounds like a simple question, but it’s one many parents are asking themselves with regard to the Gardasil shot, a vaccine that prevents certain types of human papillomavirus (HPV), a common sexually transmitted disease that can cause cervical cancer. The shot, which was approved by the Food and Drug Administration in 2006, is recommended for girls as young as 9.
The fact that a vaccine for an STD is being marketed to such young girls has led to significant controversy — even doctors are looking at it as something different from other vaccines.
Maggie Lewis, of Liverpool, was prepared to get the shot for her 11-year-old daughter, Casey, a sixth-grader at Willow Field Elementary School.
“I wanted to get it for her,” Lewis said. “I asked about it at her last checkup, but her doctor said she wouldn’t recommend it for her.”
Casey’s doctor said, given Casey’s age, socioeconomic status and low risk for early sexual activity, she didn’t need to get the shot just yet. Had she been at higher risk or more likely to become sexually active at an early age, Lewis said, the recommendation would have been different. Lewis said, given that reasoning, she agreed.
“To a certain extent, you can rely on the fact that your 11-year-old is not going to be sexually active,” she said. “Given her age and the newness of the vaccine, I figured we can afford to wait a couple of years.”
Casey Lewis may be able to wait to get the shot, but others aren’t as fortunate. Emily Weinstock, 22, of Oneida decided to have the vaccine after a cancer scare.
“In college, I had to have surgery because I had precancerous cells that lead to cervical cancer and are caused by HPV,” Weinstock said. “They removed a section of my cervix.”
While the surgery was quick and “semi-painless,” doctors told her it could cause complications during childbirth due to the shortening of the cervix if the same surgery is necessary more than once. In addition, the cells came back in Weinstock’s case and she had to have the surgery again. After the second surgery, she opted to get the Gardasil shot.
“It couldn’t cure the strain I already had, but it can keep me from getting another strain,” she said. “I just wanted to make sure nothing else could develop.”
What is HPV?
Human papillomavirus is one of the most common sexually transmitted infections in the United States. Recent estimates, according to the New York State Department of Health, approximately 20 million Americans are infected with HPV. Six million new cases are diagnosed each year. Of those, 74 percent are found in 15- to 24-year-olds. Most of them never know they’re infected.
Weinstock had no idea.
“HPV is more rampant than people realize,” she said. “Some may not even know [they have] it. I didn’t. I had no symptoms before the screening showed it.”
Despite the lack of symptoms, HPV can be very dangerous. Thirteen strains of the virus have the potential to lead to cervical cancer, and 99.7 percent of cervical cancers are caused by an HPV infection. Two strains of the virus, Type 16 and Type 18, cause 70 percent of cervical cancers.
Those two strains, along with Types 6 and 11 (which cause 90 percent of all genital warts), are prevented by the Gardasil vaccine. The vaccine has been shown to be 100 percent effective, a statistic that has led researchers to estimate that, with widespread vaccination, cervical cancer deaths worldwide will drop by two-thirds.
In November of 2006, the federal government added Gardasil to its Vaccines for Children program, which offers free vaccinations to low-income and uninsured children. About 20 states have added the shot to the list of required vaccinations for schoolchildren.
In New York, while the shot is not required, it is recommended by the health department.
“We strongly support the vaccine,” said Dr. Cynthia Morrow, commissioner of health for Onondaga County. “We agree with the recommendations of the Advisory Committee on Immunization Procedures [ACIP].”
The same is true in Madison County, said Kathy Baksa of the health department.
“We go by ACIP’s recommendations,” Baksa said. “We do discuss it with parents and try to go over the pros and cons with them, but it’s ultimately their decision. We’re here to provide as much information as we can.”
While the counties do recommend the shot, figures aren’t available at this time to illustrate how many girls have gotten it. Morrow said that will change this year, when health care providers will be required to report all vaccinations given to children under 19.
Why not get it?
Despite all of the glowing recommendations for the shot, there are factors that keep some parents from getting it for their daughters.
The first is the cost. At $120 a shot for the three-course vaccination, it’s prohibitive for some, especially the under- or uninsured.
The second is the pain factor.
“That was one thing our pediatrician said — it’s a really painful shot,” Lewis said.
Indeed, Gardasil has been making headlines as one of the more painful vaccines out there. The Centers for Disease Control have reported a higher incidence of post-vaccination pain and fainting — between its release and July of 2007, the CDC received reports of 180 cases of fainting after the vaccine (there were 230 reports total for all vaccines).
Merck, the vaccine’s manufacturer, has confirmed that the shot can be very painful. This is likely due to virus-like particles on the needle, which cause burning and pain after the vaccine and soreness for up to a day. The increase in fainting is likely due to the facts that Gardasil is a three-course vaccination, meaning more shots, and that teenage girls are more likely to faint after vaccines than other groups.
Weinstock said, while painful, it wasn’t bad enough to keep her from getting the shot.
“It was more painful than most shots — the needle felt like it was burning,” she said. “But afterward I wasn’t sore or anything. It was definitely less painful than the surgery.”
The biggest question — does the shot promote teenage sex? It’s been approved for females ages 9 to 26, but it’s recommended for ages 10 to 12.
Why so early?
“It is important to vaccinate people before they have sexual encounters and risk becoming infected with HPV,” said a release from the New York State Department of Health. “Fifteen- to 25-year-olds have the highest prevalence of HPV infections. Vaccination must, therefore, occur earlier in adolescence.”
In addition, Merck has reported that, in its clinical trials, the vaccine produces a stronger immunological response in girls ages 10 to 15 than in women ages 16 to 23.
Still, a number of “family” groups have objected to the vaccine, fearful that it undermines the principles of abstinence education and will promote sexual activity in teenagers.
The New York State Department of Health release strongly disagrees with that assertion.
“Making sexual activity safer does not cause teens to become sexually active at an earlier age,” the release said. “If your daughter isn’t sexually active, she’s protected from the HPV infection. However, most teens do become sexually active. If she is vaccinated, you can be sure that she’ll be protected.”
Regardless of the controversy, the shot’s effectiveness has never been disputed. Weinstock said the promise of avoiding cervical cancer should make all arguments against it irrelevant.
“If it minimizes your chance of developing cancer,” she said, “it’s worth it.”
Some names have been changed to protect the privacy of those interviewed.
