HPV Update

The Kaiser Family Foundation has published a new fact sheet about the HPV vaccine, and below is a summary of some of the information in the fact sheet. HPV remains widespread in the United States. Recently the CDC reported that approximately one in four women ages 14-59 in the U.S. have HPV (27%), with the highest rates among women ages 20-24 (45%). There are more than 100 strains of HPV with over 30 types that can cause cervical cancer and genital warts.

The new vaccine, Gardasil, approved for use in women ages 9 to 26, prevents infection of four strains of HIV - 6, 11, 16, and 18. Strains 16 and 18 are associated with 70% of cervical cancer cases, while strains 6 and 11 are associated with 90% of genital warts cases. The vaccine is administered in three doses and has been shown to be effective up to five years, and it is not known yet if women will require a booster shot.

The 3-dose vaccine can cost $360, and many insurance companies cover it 100% as preventive care. There are also several federal programs that will pay for the vaccines including the Vaccines for Children (VFC) Program, the Immunization Grant Program for children who do not qualify for the VFC program, Medicaid, State Children's Health Insurance Program (SCHIP), and Merck's recently established vaccine assistance fund for uninsured women 19 to 26 years old.

A recent CDC survey found that only 10% of women ages 18 to 26 had received the HPV vaccine as of the summer of 2007. In addition, public awareness and knowledge about HPV is limited. While the federal government has recommended universal vaccination for girls and young women in the United States, there are still financing, public acceptability and awareness issues to be overcome before that goal is met.

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Labels: Healthline, HPV, Teen Health

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HPV Vaccine - For Boys?

The sexually transmitted human papillomavirus is not only linked to cervical cancer in women, but more recently it has been linked to oral cancer in men. The vaccine Gardasil is being given to young women and girls, but Merck plans to ask for permission to offer the shot to boys, as well.

There are several reasons to vaccinate boys:

• If boys are vaccinated, they are less likely to transmit the virus to women;
• HPV can cause genital warts, as well as penile and anal cancer in males;
• HPV has been linked to cancer in the tonsils, lower tongue, and upper throat in both genders; and
• The rates for those cancers are increasing.

Parents may want to start thinking about the conversations now - how to convince your teenage son that he is willing to get three shots during a year to prevent a disease spread mostly by oral sex will take some thought!

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Labels: Healthline, HPV, STD

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More Q & A About HPV and the New Vaccine

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States, with more than 6.2 million cases a year. There are more than 100 strains of HPV and more than 30 of these strains can infect the genitals, and some strains are associated with cervical cancer and genital warts. In June 2006 a new vaccine was produced by Merck called Gardasil that protects against certain strains of HPV and is recommended for women and girls ages 9 to 26. Since then, there have been many questions about HPV, so I thought I would cover a few of the commonly asked questions in this post.

How is HPV prevented?
HPV cannot be protected against, but condoms can help. Gardasil prevents infection of four strains of HPV that are associated with 70% of cervical cancers and 90% of genital warts cases. The vaccine will not cure HPV if the person is already infected.

Who should get the HPV vaccine?
The Centers for Disease Control and Prevention recommends that all girls ages 11 and 12, before they are sexually active, or all women between 9 and 26 receive the vaccine. In clinical trials the vaccine seemed to work better for girls between the ages of 10 and 15 compared to people over 16. The vaccine is given in a series of three shots and costs about $360, although most insurance companies cover it.

How is HPV transmitted?
HPV can be transmitted through genital contact, even without intercourse.

How do you know if you have HPV?
Like many other STIs, sometimes there are no symptoms. The Papanicolaou (Pap) test detects changes in cervical tissue, and is a major tool in screening for early identification of cervical cancer. The Pap test is completed by a medical provider by taking a swab of the cervical tissue. Women should get a Pap test done when they become sexually active and then at least every three years, more often if they are having unprotected sexual intercourse with multiple partners.

Some districts and states are requiring the HPV, but as of yet, there are no federal laws requiring it.

Previous posts about HPV on Teen Health 411:

Oral Cancer and HPV
Could 1-in-4 Women Have HPV?
New Hampshire & HPV Vaccine
New HPV Vaccine (Gardasil)

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Link Between Oral Cancer and HPV

An article in the New England of Medicine reported last week that having had 26 or more lifetime sexual partners, or six or more oral sex partners was significantly associated with oropharyngeal cancer, which is significantly associated with being infected with oral HPV type 16 (HPV-16). In addition, infrequent use of condoms and early age of first intercourse were also associated with HPV-16-positive oropharyngeal cancer.

The study was conducted at Johns Hopkins between 2000 and 2005 and included biological specimens as well as an audio, computer-assisted self-administered interview from 200 patients. The results suggest that oral sex without a condom may put teens at risk for sexually transmitted HPV-16, as well as HIV and other sexually transmitted infections.


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Labels: HPV, Research

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Could 1 in 4 Women be Infected with HPV?

In case you are still struggling with the question of whether or not to have your teen daughters vaccinated against HPV, there was another report that may encourage you to make the first (of three) appointments. A February article in USA Today reported that one in four U.S. women ages 14 to 59 is infected with HPV, the sexually transmitted virus associated with cervical cancer. The highest prevalence is in women ages 20 to 24, which includes the age range that the Centers for Disease Control and Prevention recommends should receive the new HPV vaccine, Gardasil.

The study they cite was published in the Journal of the American Medical Association (JAMA) which was conducted in 2003-2004 with 1,921 women. The results suggest that the highest risk group for HPV is young, sexually active women.

Previous related posts: New Hampshire & HPV; New HPV Vaccine
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Labels: HPV

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New Hampshire is the First State to Offer Free HPV Vaccine

New Hampshire announced recently that it will become the first state to offer the new HPV vaccine free to all girls ages 11 to 18. There are approximately 68,000 eligible girls in Hew Hampshire and the state has budgeted $4.8 million dollars for the vaccine in 2007.

The FDA approved the vaccine (Gardasil) in June for girls as young as 9. It prevents infection from some of the strains of HPV, a sexually transmitted virus, that can cause cervical cancer, the #2 cancer killer of women. This vaccine will not protect people who are already infected, but can prevent girls who have not been infected.

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Labels: HPV

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Getting Teens Hooked Into Preventive Health Care

A recent issue of the Journal of Adolescent Health (October 2006) included an article entitled "Vaccination: An Opportunity to Enhance Early Adolescent Preventive Services," by Rupp, Rosenthal, & Middleman. This aricle provided some great suggestions for how clinicians can use the new vaccines (HPV and meningitis) as opportunities to provide preventive services to a population that traditionally has received little preventive care.

There are many reasons why teens do not seem to get the preventive care they need during adolescence. Some lack insurance or transportation, and others just do not come in for annual exams, electing only for acute care or required physicals for sports or summer camp.

Any chance to screen a teen for health risks should be taken by clinicians, but some clinicians do not feel they have the time, are uncomfortable bringing up health issues with teens, or are not prepared to talk with parents about the need for preventive screening and time alone with the teen to ask the more "sensitive" questions about alcohol or drug use and sexual involvement.

It is clear that teens need more effective preventive services given that the major morbidities/mortalities of adolescence are psychosocial in nature, and thus, likely to be preventable. Unintentional injuries (including sports), violence and suicide are the major causes of death among this age group. Substance use, sexual behaviors, and dieting are behaviors with which adolescents being to experiment and can be associated with significant morbidity and mortality.

The 2003 Youth Risk Behavior Surveillance Survey conducted by the Centers for Disease Control and Prevention (CDC) reported that:

• more than 25% of teens report binge drinking;
• 22% report marijuana use;
• 10% of teens had taken some sort of diet pill, powder or liquid;
• and 6% had used vomiting or laxatives to control their weight.

The new immunization recommendations will hopefully motivate parents to get teens in to see their provider and motivate clinicians to screen teens for risky behavior, discuss confidentiality as well as physical, emotional, and cognitive changes associated with adolescence, and encourage teens to come in every year to discuss any health concerns they may have.

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Labels: Health Care, HPV

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Adolescent Immunizations

Most parents understand how important vaccines are during early childhood, but many do not know how important adolescent immunizations are in preventing infectious diseases. Teens can be an important bridge for diseases between the elderly and very young. Unfortunately, because teens are so healthy, many are not being seen for preventive care by their physicians and many physicians may forget to check their immunization records.

All adolescents should have their immunizations reviewed when they are 11 or 12 (or as soon as possible). Adolescents who have not received vaccinations for hepatitis A, hepatitis B (HBV), measles, mumps, rubella (MMR), and varicella (approximately 40%) should receive them. In addition, we know that the pertusis (whooping cough) vaccine is less effective after 5 – 10 years, so many teens should receive another dose of the tetanus, diphtheria, and acellular pertusis (Tdap) vaccine.

There are several new vaccines that every adolescent should receive, including one for meningitis (MCV4) and (for females) HPV (Gardasil). Meningococcal disease strikes most often in very young children and teens. It appears with flu-like symptoms but advances rapidly and can end in death or leave the victim with hearing loss and cognitive defects. Human papillomavirus (HPV) infection is a sexually transmitted disease that can results in genital warts, cancers of the reproductive tract, and anal cancer.

Finally, I think adolescents should get a flu shot each year. Adolescents are more than three times more likely to get the flu than adults and more than half of the flu cases each year are in people under 19 years of age.

Labels: HPV

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New HPV vaccine for cervical cancer (Gardasil)

In June, the FDA licensed a new vaccine (Gardasil) for the prevention of cervical cancer and other diseases in females caused by Human Papillomavirus (HPV). HPV is the leading cause of cervical cancer in women and the CDC recommends that (three doses of) the vaccine be given to girls when they are 11 – 12 years old (but can be given between 9 and 26 years old).

The idea is to vaccinate girls before they become sexually active, but all sexually active women should receive the vaccination, too. HPV is the most common sexually transmitted infection in the United States and is the most common in people in their teens and 20s.

How can parents tell their daughters about the new vaccine?
If you are a parent who has already starting talking with your preteen or teen about their changing body and sexual issues, this will not be difficult. You can explain that this vaccine protects her from a sexually transmitted disease that is linked to cervical cancer, and that professionals recommend every young girl get vaccinated (with three doses) before she is sexually active.

If you have not started these conversations, this is your opportunity. One could say, “it prevents cancer” and leave it at that, but that is not really accurate. If you are going to protect your child, start the talk. Begin with stating your values clearly – I expect that you will not have sex until [insert age or context]. Then talk about the importance of knowing how to prevent unwanted pregnancy, birth control, sexually transmitted infection, and the importance of using condoms.

If you think that your daughter, at age 11 is too young to hear about sexual intercourse, sexually transmitted infections, and condoms, think again. National surveys have found that about 7% of children have had sexual intercourse before age 13, and about 25% have done so by age 15. The Centers for Disease Control and Prevention (CDC) estimates that there are 6 million new cases of HPV each year – many of them in teens and young adults.

The vaccine has been tested with thousands of women and is considered effective without serious side effects and will be given in three injections over a six-month period. Talk to your parents and doctor about getting vaccinated. Most insurance companies cover vaccinations.

For more information, check this site: HPV Vaccine - CDC

Labels: HIV, HPV, Sexuality Education

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