HPV Vaccine Coverage on the Rise, but Still Far From 2020 Goal


The proportion of boys and young men in the U.S. receiving the human papillomavirus (HPV) vaccine has more than tripled since 2011, new research shows.

Among 9- to 26-year-old males, 27 percent had received at least one dose of the vaccine in 2016, compared to 8 percent in 2011. Vaccination rates rose from 38 percent to 46 percent in girls and women over the same time period, according to the results published March 23 in the Journal of Infectious Diseases.

“We’re seeing an increase in HPV vaccination among male adolescents and young adults following the introduction of gender-neutral recommendations for HPV vaccination,” lead study author Eshan U. Patel, a public health researcher at Johns Hopkins University School of Medicine in Baltimore said in a phone interview.

“We also need to consider that we are not reaching everyone. There are still barriers to HPV vaccination at multiple levels, including the health care system level, the provider level and the parent level.”

Patel noted that the federal government’s Healthy People 2020 initiative calls for 80 percent of 13- to 15-year-olds, regardless of gender, to be fully immunized against HPV by the year 2020. “Unfortunately, we’re pretty far from reaching that target for both males and females.”

Routine HPV vaccination has been recommended for girls 11 to 12 years old since 2006, and the recommendations were expanded to include boys in 2011.

The vaccine protects against most cancer-causing HPV strains, as well as those that cause genital warts. The shot can also be given to 9- to 10-year-olds, and catch-up vaccinations are recommended for females aged 13 to 26 and males 13 to 21 years old, and up to age 26 for some subgroups of men.

A full course of the vaccine requires three doses, but girls and boys who start the vaccine before age 15 can be fully covered with two doses given their stronger immune response.

In their new study, Patel and colleagues reviewed data on 4,033 females and 4,007 males aged 9 to 26 who participated in the National Health and Nutrition Examination Survey (NHANES).

The rise in coverage among girls and young women was mainly driven by increases in uptake among women 18 and older, while rates remained stable for girls 17 and younger. Boys and men in all age groups had similar increases in vaccine uptake, but the increase was smaller among those without health insurance, those living in poverty and those born outside the U.S.

Not all providers strongly recommend the HPV vaccine, especially to boys compared with girls, Patel noted. Doctors should recommend it during well-child visits, when a child is getting other shots, and promote it as a cancer-preventing vaccine, he added.

Parents often don’t perceive younger children as having a need for the vaccine, given that they are not having sex, Patel noted. “That’s where the providers can come in to help explain the key role of the HPV vaccine in cancer prevention and correct misperceptions.”

The delay in HPV vaccine uptake among males is partly because it was originally promoted for preventing cervical cancer, Patel said. However, the shot also can prevent HPV-related cancers in men, such as cancers of the mouth and throat, which are on the rise, as well as penile and anal cancers.

The increase in HPV vaccination among males, especially the youngest age groups, is “incredibly encouraging,” Dr. Marcie Fisher-Borne, director of HPV vaccination at the American Cancer Society in Atlanta, said in a telephone interview.

About 32,000 new cases of HPV-related cancers are diagnosed in the U.S. annually, noted Fisher-Borne, who wasn’t involved in the current study. While cervical cancer is the most widely recognized HPV-linked cancer, rates of HPV-related cancers of the mouth and throat in men will soon outpace rates of cervical cancer in women, she added.

These oropharyngeal cancers are particularly devastating, she noted, because there is no way to screen for them, and they are typically not detected until they reach an advanced stage.

“Even though it’s incredibly encouraging to see where we are with boys, with both boys and girls we have a long way to go to get to 80 percent,” she said.

Give HPV vaccine to boys to protect against cancers, experts say


With rates of human papilloma virus on the rise, it is vital to immunise males as well as females, researchers believe

 Vaccines against HPV are routinely given to girls to prevent cervical cancer.
Vaccines against HPV are routinely given to girls to prevent cervical cancer. 

Millions of young British men are being denied a vaccine that could protect them from throat cancers in later life. Scientists say the problem is becoming increasingly worrying as rates of human papilloma virus (HPV) – a common sexually transmitted infection and the prime cause of these cancers – are now rising exponentially.

Researchers want the government to include adolescent boys in the current vaccine programme that immunises girls aged 12 and 13 against HPV before they become sexually active. HPV in women is known to lead to cervical cancers. The vaccine, if extended to boys, would protect them in later life against HPV-related head and neck cancers.

“If we want to eradicate male throat cancers – which are soaring in numbers – we need to act speedily and that means giving them the HPV vaccine we now give to girls,” said Professor Mark Lawler of Queen’s University Belfast.

Health experts say increased levels of oral sex are in part responsible for the spread of HPV. “Smoking and alcohol add to risks, but the fact that couples are having more and more oral sex is the main factor,” said Peter Baker, campaign director of HPV Action.

At present more than 3,000 women develop cervical cancer a year in the UK. Most other western nations have since introduced similar programmes.

“HPV is spread sexually. However, this vaccine will not work effectively if a person has already been infected by HPV,” said Baker. “That’s why it is given to girls when they are 12 or 13 – before they are sexually active.”

Tens of thousands of young women are now given the vaccine, although it is too early to say how cervical cancer rates are going to be affected, said virologist Professor Sheila Graham, of Glasgow University.

“However, rates of genital warts in women – which are also caused by HPV – are going down, so there is confidence the vaccine will work.”

However, the introduction of the HPV vaccine for women has come just as infection rates in men have started to soar, with cases of tonsil cancers and cancers of the base of the tongue – both caused by the virus – rising dramatically. Tonsil cancer cases have tripled in numbers since the 1990s, for example.

“Unfortunately, these cancers have very serious outcomes with dreadful morbidity,” added Graham.

Scientists say it would cost about £20m a year to extend the current HPV vaccine programme to boys.

“By contrast, it costs about £30m a year to treat males for genital warts while the costs of treating the rising numbers of throat cancers are even greater,” Lawler said. “So, in purely monetary terms, it makes sense to give boys the vaccine.”

This point is disputed by some health economists. They say the human papilloma virus will have virtually disappeared from sexually active UK women in a few decades, thanks to the vaccine now given to girls at school. As a result men will no longer pick up the virus when having oral sex with women. This effect is known as herd immunity.

But Professor Margaret Stanley, of Cambridge University, said the argument was flawed. “Relying on female-only vaccine programmes to remove HPV from the population is risky.

“In Denmark the take-up rate of the vaccine recently dropped from around 80% to 20% because of a scare story – which was quite untrue – suggesting the vaccine was spreading disease. We need protection for both sexes to be sure we eradicate HPV.”

In addition, reliance on a female-only vaccine programme would mean that gay men would never be provided with protection against HPV, she added.

This last point was crucial is persuading health officials in Australia to extend its school HPV vaccine programme to men in 2013. It is the only country to run a free HPV vaccine programme for both sexes.

The government’s joint committee on vaccination has been considering extending the HPV programme to boys for several years but is not due to give a ruling until 2017.

“Even if it gives approval then, we are unlikely to get the programme extended to boys until around 2020,” said Baker. “By then millions who could have been protected against throat cancers will have lost the chance to get the vaccine.”

Stanley was also emphatic the vaccine programme should be extended. “A great many health experts in this field are paying privately to have their sons vaccinated.

“It costs £160 for a double shot. I have had my grandson vaccinated. The nature of the problem is obvious.

“In any case, it is simply discriminatory not to give a vaccine to men when it could save their lives.”

Cancer doctors leading campaign to boost use of HPV vaccine


 

The nation’s leading cancer doctors are pushing pediatricians and other providers to help increase use of the HPV vaccine, which studies show could help avert tens of thousands of cancer cases during young Americans’ lives. Yet a decade after its controversial introduction, the vaccine remains stubbornly underused even as some of those diseases surge.

The vaccine’s low uptake among preteens and adolescents belies its universally acknowledged effectiveness in preventing the most common sexually transmitted infections linked to the human papillomavirus. Those infections can cause a half-dozen cancers, including more than 90 percent of anal and cervical cancers; 70 percent of vaginal, vulvar and oropharyngeal, or middle throat, cancers; and 60 percent of penile cancers.

The oncologists’ goal is to rebrand the vaccine to focus on cancer prevention. They are determined to dismantle what researchers say is the No. 1 obstacle to wider inoculation: pediatricians and family doctors who aren’t strongly recommending the vaccine.

We have a vaccine for certain cancers. Why don’t more people get it?

Studies show that a forceful endorsement from a physician is the most important factor in whether children get the vaccine, which is recommended for ages 11 and 12. Yet a frustrating level of “provider hesitancy” persists.

“The failure belongs to us,” acknowledged Jason Terk, a pediatrician in Keller, Tex. “It’s an epic fail.”

Terk has been working with experts at MD Anderson Cancer Center in Houston to spread the word. Lois Ramondetta, one of the hospital’s gynecologic oncologists, has taken to the road to meet with practitioners across the state.

Last month, she delivered a blunt message to the staff of Su Clinica in Harlingen, deep in the state’s south valley: If they didn’t increase HPV vaccination of their young patients, those youths would face a greater risk of developing deadly cancers as adults. Boys would be especially vulnerable to throat cancers, a growing scourge of middle-aged men.

“If you are not recommending the vaccine, you are not doing your job,” Ramondetta said. “It’s the equivalent of having patients in their 50s and not recommending a colonoscopy — and then having them come back with cancer.”

 

For Su Clinica’s doctors, the candid discussion hit home and quickly prompted changes in some procedures. Gynecologist Rose Gowen said many of the staff were especially surprised by the urgent need to vaccinate boys.

Ramondetta understands why the challenges are so pervasive. “Pediatricians never see the cancers caused by HPV, so some of them don’t recognize the vaccine’s importance in preventing cancer,” she said. “They don’t know how to talk about it with patients, or they wait too long. And their knowledge level is not where it should be.”

While the HPV vaccination rate varies widely from state to state, it has ticked up nationally over the past few years. Yet the latest statistics from the Centers for Disease Control and Prevention show that in 2014, 40 percent of teenage girls and 22 percent of boys had gotten all three doses. That’s far below the 80 percent to 90 percent rate for the vaccine booster for tetanus, diphtheria and pertussis — as well as for the shot to prevent meningitis — that most states require for middle-schoolers.

The 64,000-member American Academy of Pediatrics has urged members to use the vaccine. But Cleveland pediatrician Margaret Stager, who works on adolescent health issues for the organization, said it remains “brand-new territory” for many doctors, especially older physicians.

“They have seen whooping cough, meningitis, measles and mumps and have real-life evidence of the power of vaccines to save lives,” she said. “Now we have a whole new fundamental concept, because this vaccine is trying to prevent cancer several decades from now.”

A 2014 U.S. study, for example, projected that nearly 29,000 additional cases of cervical cancer would be averted over young girls’ lifetimes with a vaccination rate of 80 percent compared with 50 percent. Cancer doctors hope that pressing the case with such statistics can provide reinforcement for public health officials at the CDC and in state and local governments, as well as for the other medical groups encouraging doctors and parents.

Much of their current activity dates to 2013 when the President’s Cancer Panel, alarmed by how the HPV vaccination rate was leveling out, called for a drastic acceleration. The National Cancer Institute funded several efforts to identify barriers to vaccination, and earlier this year, all 69 NCI-designated cancer centers issued a first-of-its kind consensus statement saying the HPV vaccine was “tragically underused” and calling on doctors to strongly recommend it. The American Society of Clinical Oncology followed with a similar statement.

Meanwhile, the NCI is planning a large clinical trial to determine whether a single dose would be as effective as the current regimen. That could sharply accelerate utilization, especially in developing countries, where cervical cancer is among the deadliest cancers.

“We’re doing this to help the women of the world,” said NCI acting director Douglas Lowy, who was instrumental in discoveries that paved the way for the vaccine.

About 79 million Americans are infected with HPV, and 14 million become newly infected each year. While the body’s immune system clears most of the infections, high-risk strains are directly linked to 27,000 new cancers a year.

The vaccine is recommended for preteens because their bodies have the most robust responses, and it works best before sexual activity begins. (Intercourse isn’t necessary to contract HPV.) In 2006, the vaccine was first approved as Gardasil for girls, followed a few years later for boys, amid controversy that has never completely dissipated. Critics questioned the safety of the vaccine, made by Merck, and said it would encourage teenagers to be promiscuous — concerns that research has shown to be unfounded.

Ruth Marroquin, 13, looks away as she is vaccinated against HPV. (Matthew Busch for The Washington Post)

Unlike other childhood shots, the one for HPV isn’t required by most states; only Virginia, Rhode Island and the District have mandates. The vaccination rate varies sharply across the country, with relatively high rates in the Northeast and California and lower rates in the South.

Yet the vaccine is having an impact overall. A CDC study published earlier this year showed that the prevalence of the virus was reduced by almost two-thirds among teenage girls, compared with the years before the vaccine became available.

And this month, Merck announced that a review of 58 studies published in the last decade in North America, Europe, Australia and New Zealand found that vaccination sharply reduced cervical pre-
cancers and genital warts.

As for side effects, the most common are swelling and pain at the injection site, with occasional fainting. Several large studies over the past decade have more than proved the vaccine’s safety, the CDC says

 

But the concerns of some parents still aren’t assuaged. Aimee Gardiner, who is leading a group to repeal the Rhode Island mandate, said she won’t have her children inoculated. “I don’t think the risks of HPV are high enough to warrant getting the vaccine,” she said.

Similarly, the National Vaccine Information Center, an advocacy group founded by parents who opposed routine childhood inoculations, continues to raise questions about the research behind the HPV vaccine and its safety.

In Texas, Terk says he advises fellow pediatricians to recommend the shots in a matter-of-fact manner, to “bundle it” with other inoculations and to avoid talking about sex unless asked. “If you approach it in a confident, presumptive way, many parents will say, ‘Let’s do it,’ ” he said.

The HPV vaccine has a fraught history in Texas. In 2007, Republican Rick Perry became the nation’s first governor to require girls to get the vaccine, which caused a firestorm in part because of his close relationship with a former chief of staff who was a lobbyist for Merck. The Legislature overturned the mandate.

MD Anderson has been leading a major HPV initiative since 2014 that involves other cancer centers, pediatricians, nurses and school officials. During a meeting last summer, 69-year-old Michael Terry described his struggle with HPV-related throat cancer, saying, “You need to know how miserable it is to suffer from this disease.”

Terry, whose father was Luther Terry, the 1960s-era U.S. surgeon general who issued a landmark report about the dangers of tobacco, talked about undergoing surgery, chemotherapy and radiation and about living with splitting headaches, neck aches and difficulties swallowing. His concluding plea: “Vaccinate, vaccinate, vaccinate, boys and girls.”

 

In the fall, pediatrician Lori Anderson took a couple of pediatric residents from her community health clinic in Corpus Christi to hear Ramondetta speak at a Texas Pediatric Society meeting. The oncologist showed an emotionally wrenching documentary about cervical cancer called “Someone You Love.” When the lights went up, some of the doctors were in tears.

“I think it was an ‘aha moment’ for the residents,” Anderson said. With her help, they organized a recent school health fair in the beach community of Port Aransas.

Two dozen children got vaccinated against HPV.

HPV vaccine works even better than expected, study finds.


University of Miami pediatrician Dr. Judith L. Schaechter gives an HPV vaccination to a 13-year-old girl in her office at the Miller School of Medicine on Sept. 21, 2011 in Miami, Fla.

 

The vaccine against human papillomavirus (HPV) infection, which doctors believe causes most cases of cervical cancer, appears even more effective than believed, a new study finds.

“After eight years of vaccination, the reduction in the incidence of cervical neoplasia [abnormal growth of cells], including pre-cancers, have been reduced approximately 50 percent. This is greater than what was expected – that’s pretty exciting,” said lead researcher Cosette Wheeler. She is a professor of pathology and obstetrics and gynecology at the University of New Mexico, in Albuquerque.

The study also showed that the protection appears to occur even when only one or two of the recommended doses of the vaccine are given.

“Right now, the recommendation is three doses for girls and boys before the 13th birthday, so that you are protected before you become exposed,” Wheeler explained.

“People thought that three doses of vaccine were necessary, but there’s a lot of people who are getting one and two doses, and people are getting protection from one or two doses,” she said.

On average, 40 percent of girls aged 13 to 17 in New Mexico had received all three doses in 2014, the researchers found. But, Wheeler said, “It may be that two doses are sufficient.”

Protection from HPV is also coming from what’s called herd immunity , which increases as more people are vaccinated and reduces the spread of HPV, Wheeler said. “Herd immunity means that the probability of getting infected decreases for everybody, even the people who aren’t vaccinated ,” she explained.

Moreover, the vaccines protect against more types of HPV than they were designed to do, she added.

Although this is not the first report to show the effectiveness of the vaccine, it’s the first to show declines in precancerous lesions across a large population, Wheeler said. The researchers also found that the reductions in the number of precancerous lesions were greater than anticipated.

This study even took into account changes in Pap test screening over the last 10 years.

In 2009, the American College of Obstetrics and Gynecology said most women under 21 do not need Pap test screening and recommended longer times between screening. In 2012, the U.S. Preventive Services Task Force said women, regardless of age, do not need to get screened more than every three years, Wheeler said.

If these changes were not taken into account, the effect of the vaccine would appear even greater than it already is, because it would assume that more women were being screened than actually were, she said.

“Parents and doctors should pay attention. These vaccines are highly efficacious,” Wheeler said.

It’s up to doctors to be sure kids are vaccinated, she said. “It’s their job, just like other vaccines, to provide them to their patients. They are the key to get this done,” Wheeler added.

In addition to cervical cancer, HPV can cause genital warts in men and women, and some head and neck cancers.

Although cervical cancer can take decades to develop, it’s important to protect children before they become sexually active and risk getting infected with HPV, which is why Wheeler strongly recommends: “Get your kids vaccinated – both your boys and your girls – before their 13th birthday.”

For the study, Wheeler and colleagues collected data on young women tested for cervical cancer with Pap tests from 2007 to 2014, who were part of the New Mexico HPV Pap Registry. New Mexico should be considered representative of the whole country, Wheeler said.

One expert said the findings make the case for HPV vaccination even stronger.

“These data highlight and provide even more evidence as to the efficacy of the vaccine in preventing HPV infections and related diseases,” said Fred Wyand, a spokesman for the American Sexual Health Association/National Cervical Cancer Coalition.

Increasing HPV vaccination rates “goes back to the importance of health care provider’s recommending the vaccine to parents and patients,” he said. “Provider recommendation carries much weight, and parents are far more likely to have their child vaccinated if the provider encourages it.”

Another approach to increasing vaccination rates is to “normalize” HPV vaccines, he said. “Rather than treat it as something exotic, it should just be offered as part of the routine adolescent vaccine program,” Wyand said.

Dr. Metee Comkornruecha, an adolescent medicine specialist at Nicklaus Children’s Hospital in Miami, agrees that the vaccine “is effective, and parents should have their sons and daughters vaccinated.”

The report was published online Sept. 29 in the journal JAMA Oncology.

Is 20-Something Too Late For A Guy To Get The HPV Vaccine?


WFYI’s Jake Harper reports health stories for Side Effects Public Media in Indianapolis. His newest health anxiety stems from the human papillomavirus, or HPV.

Sex with someone new has always made me nervous. Now, TV is making it even worse.

I keep seeing scary ads featuring young people asking their parents why they didn’t get the vaccine to protect against the human papillomavirus — HPV. If you’re unfamiliar with HPV, it’s a sexually transmitted infection that has been linked to various cancers, including cervical cancer in women.

I didn’t get vaccinated. So lately I’ve been wondering: Now that I’m 29, is it too late for me to get the vaccine?

I found out about HPV eight years ago when a college girlfriend got immunized. Back then, the Centers for Disease Control and Prevention only recommended the vaccine for girls and young women between the ages of 11 and 26. The earlier the better, they said, to try to reach girls before they become sexually active. The vaccine is also more effective at a younger age.

At the time, I remember thinking that limiting it to females was strange — after all, males still spread HPV, right? But with my partner vaccinated, I let it go. I didn’t know HPV could cause health problems for men.

But HPV absolutely affects men. It causes genital warts and is pulling past tobacco and alcohol as a leading cause of cancers in the back of the mouth and throat, the area called the oropharynx. The CDC now estimates about 70 percent of all oropharyngeal cancers may be caused by HPV, including roughly 12,600 cases in men each year.

“There are now more oropharynx cancers in men in the United States each year than there are cervical cancers in women,” says Dr. Erich Sturgis, a surgeon and researcher at the University of Texas MD Anderson Cancer Center in Houston.

And there’s no way to screen for oropharyngeal cancer, so Sturgis says most people catch it late.

“Typically it’s a man, while he’s shaving,” says Sturgis. “He notices a lump in his neck. That means it’s already a cancer that has spread.”

HPV also puts men at risk for cancers of the anus and penis. Those are rare, but still make me anxious.

So, for men like me who missed the vaccine, is it still worth it?

The answer is complicated. In 2011, the CDC began recommending the vaccine for males ages 11 through 21 years old (26 for some high-risk groups).

Despite my age, researchers I talked to said that the vaccine could still help — if I haven’t already been exposed.

But therein lies a complication. An estimated 80 percent of sexually active people will be exposed to HPV by age 45. In most people, the virus goes away on its own after two years. For men, there’s no commercially available test to find out if you have been exposed. Women can be checked for HPV exposure as part of a Pap test.

To have 80 percent of sexually active young adults exposed sounds bleak. But there’s a caveat: “There are several dozen types of HPV that infect the genital region,” says psychologist Greg Zimet, who co-directs the Center for HPV Research in Indianapolis. Only a fraction of those cause cancer or warts, and the latest version of the vaccine Gardasil protects against nine of those HPV types — the ones responsible for a vast majority of HPV-related problems.

So let’s say — hypothetically — you’re kind of shy and haven’t had that many partners. Is it possible you’ve been spared?

“The chances you’ve been exposed to all nine types are actually vanishingly small,” says John Schiller, a microbiologist who studies HPV and HPV vaccines at the National Cancer Institute.

Schiller says the vaccine might not be a bad idea for someone outside the CDC’s recommended age range. Still, it’s not cheap.

“You’re past the age where your health insurance is going to pay for it,” says Schiller, so getting the vaccine isn’t imperative — it’s a personal decision.

“Peace of mind for you may be worth more than it is for some other people,” he tells me.

So, I got the vaccine. It’s costing $130 out of pocket per dose, and the CDC recommends three shots for those older than 14. But it could help me, even if it just calms my anxious inner voice. And it might keep me from spreading the virus to someone else.

HPV vaccine alert: Lead developer warns that it is all a big scam


At the 4th International Conference on Vaccination in Reston, Virginia, Dr. Diane Harper, the leading expert responsible for the Phase II and Phase III safety and effectiveness studies which secured the approval of the human papilloma virus (HPV) vaccines, Gardasil™ and Cervarix™, used her speech time to not only make note that cervical cancer is extremely rare in the U.S and 70% of cases resolve themselves naturally without treatment, but also bluntly came clean about the documented and often downplayed side effects directly associated with the vaccine.

Since coming forward with the truth about the devastating consequences of the HPV vaccine, Dr. Harper has been the victim of a relentless campaign, attempting to discredit the validity of her claims. But she has not backed down, and even further clarified her point that, “If we vaccinate 11 year old’s and the protection doesn’t last … we’ve put them at harm from side effects, small but real, for no benefit. The benefit to public health is nothing, there is no reduction in cervical cancers, they are just postponed, unless the protection lasts for at least 15 years, and over 70% of all sexually active females of all ages are vaccinated.”

HPV Vaccine is Recommended for Boys .


HPV vaccine can prevent certain cancers and other diseases in men caused by human papillomavirus (HPV). CDC recommends that you get your boys and girls vaccinated at 11 or 12 to prevent cancers caused by HPV.

Mother and son looking at books and talking

Do you know why boys need HPV vaccine too?

A lot of parents know that HPV vaccine protects girls against cervical cancer. But did you know that vaccinating boys can protect them against cancer, too?

HPV is short for human papillomavirus, a common virus in both women and men. HPV can cause cancers of the anus, mouth/throat (oropharyngeal cancer), and penis in men. Every year, over 9,000 men are affected by cancers caused by HPV.

Cases of anal cancer and cancers of the mouth/throat are also on the rise. In fact, if current trends continue, the annual number of cancers of the mouth/throat attributed to HPV is expected to surpass the annual number of cervical cancers by 2020.1

Many of the cancers caused by HPV infection could be prevented by HPV vaccine.

One HPV vaccine—Gardasil—is recommended by doctors and health experts for boys at ages 11-12 to prevent infection with HPV that could lead to cancer. HPV vaccine also helps prevent most cases of genital warts. HPV vaccination of boys is also likely to benefit girls by reducing the spread of HPV infection.

Infographic: HPV Cancer PreventionWhy does my son need this at 11 or 12 years old?

HPV vaccine is recommended at ages 11-12 for two reasons:

  1. HPV vaccine produces the highest immune response at this age.
  2. HPV vaccine must be given before exposure for it to be effective in preventing cancers and other diseases caused by HPV.

If you haven’t already vaccinated your sons (and daughters!), it’s not too late. Ask your child’s doctor at their next appointment about getting HPV vaccine. The series is three shots over six months’ time. Take advantage of any visit to the doctor—such as an annual health checkup or physicals for sports, camp, or college—to ask the doctor about what shots your preteens and teens need.

Is HPV vaccine safe?

HPV vaccine has been studied very carefully and shown to be safe. Approximately 67 million doses of HPV vaccine have been distributed in the U.S. since 2006, and no serious safety concerns have been linked to HPV vaccination. Common, mild side effects reported include pain in the arm where the shot was given, fever, dizziness, and nausea.

Some preteens and teens—even boys—might faint after getting the HPV vaccine or any shot. Preteens and teens should sit or lie down when they get a shot and stay like that for about 15 minutes after the shot. This can help prevent fainting and any injury that could happen while fainting.

How can I get help paying for HPV vaccine?

Families who need help paying for vaccines should ask their doctor or other healthcare professional about Vaccines for Children (VFC). The VFC program provides vaccines at no cost to children younger than 19 years who are uninsured, Medicaid-eligible, American Indian, or Alaska Native. For help in finding a local healthcare professional who participates in the program, parents can call 800-CDC-INFO or go to the Vaccines & Immunizations website..

References

  1. Chaturvedi AK, Engels EA, Pfeiffer RM, Hernandez BY, Xiao W, Kim E, Jiang B, Goodman MT, Sibug-Saber M, Cozen W, Liu L, Lynch CF, Wentzensen N, Jordan RC, Altekruse S, Anderson WF, Rosenberg PS, Gillison ML. Human papillomavirus and rising oropharyngeal cancer incidence in the United States. J Clin Oncol. 2011; 29(32):4294-301

A new HPV vaccine prevents nine strains of the virus .


The human papillomavirus (HPV) is pretty nasty – not only can it trigger genital warts, but if it’s not controlled by the immune system, researchers have found that it can also lead to a range of cancers.

Most famously, various strains of the virus are involved in more than 99 percent of cervical cancer cases. But scientists have recently found that HPV can also triggeranal and oral cancer, and although current campaigns are targeted to young women, both males and females could benefit from being protected.

There are already two effective vaccines on the market, Gardasil, which protects against four strains of the virus, and Cervarix, which protects against two. But new research published in the New England Journal of Medicine has revealed that a new vaccine, Gardasil-9, can protect against, you guessed it, nine strains of the virus.

A randomised, double-blind clinical trial of 14,215 women aged between 16 and 26 found that Gardasil-9 can protect against five additional strains when compared to Gardasil – HPV-6, 11, 16, 18, 31, 33, 45, 52 and 58.

This means that the new vaccine could in theory prevent 90 percent of cervical cancers, compared to the 70 percent Gardasil currently stops. Overall there are 14 strains of HPV associated with cervical cancer (out of 100 known strains), so being able to protect against more than half of them is a big step forward.

As Cathleen O’Grady reports for Ars Technica, the new vaccine was also associated with more side effects than the current options, but they weren’t severe:

“In the Gardasil-9 trial, the nine-valent vaccine was associated with more side effects, but the effects were not comparably dangerous to the kinds of cancers prevented by the vaccine. The slightly higher rate was to be expected, the researchers note, because the new vaccine has more virus-like antigens. The most common effects included swelling and pain at the injection site, and some patients experienced headaches, nausea, dizziness, and fatigue.”

Despite these side effects, it’s hoped that the new uptake will be encouraged in both males and females – something that’s important given how common the virus is.

“The female-only campaigns leave men who have sex with men unprotected,” lead author of the paper Elmar Joura, from the Medical University of Vienna in Austria, told O’Grady.

At any given time, one quarter of Americans have HPV, and it’s estimated that almost all sexually active people will be infected at some point in their life. And if these infections aren’t cleared up by our immune systems, they can lead to cancers.

The researchers are also hoping that the new vaccine may help increase the uptake of the vaccine, which in the US in particular is low, with only 33.4 percent of girlshaving completed the course of three HPV vaccines, compared to 60.4 percent in the UK and 71.2 percent in Australia.

While a vaccine that protects against only some types of cancer may not be as headline-worthy as a new treatment or a cure, it’s incredible that we have a quick and easy way to protect ourselves against a whole range of cancers. And even more incredible that not everyone who is able to use it chooses to do so.

 

Oncology Dietitian Exposes Fraud in CDC’s HPV Vaccine Effectiveness Study


HPV Vaccine

Story at-a-glance

  • An oncology dietitian has pointed out significant discrepancies in a new HPV vaccine effectiveness study that claims the vaccine’s effectiveness is “high”
  • Recent reductions in HPV infection prevalence among young women in the US cannot be said to be due to introduction of Gardasil vaccine in 2006 and use of HPV vaccines by pre-teen and teenage girls since then; the data clearly shows that unvaccinated girls had the best outcome
  • In 2007-2010, HPV prevalence dropped 27.3 percent in the unvaccinated girls, but only declined by 5.8 percent in the vaccinated group. In four out of five different measures, the unvaccinated girls had a lower incidence of HPV
  • According to Merck’s own research before Gardasil was licensed, if you’ve been exposed to HPV strains 16 or 18 prior to receiving Gardasil vaccine, you could increase your risk of precancerous lesions by 44.6 percent.
  • Judicial Watch has received previously withheld documents from the DDHS, which reveal that the National Vaccine Injury Compensation Program has awarded $5,877,710 to 49 victims for harm resulting from the HPV vaccine

There are currently two HPV vaccines on the market, but if there was any regard for sound scientific evidence, neither would be promoted as heavily as they are. The first, Gardasil, was licensed by the US Food and Drug Administration (FDA) in 2006. It is now recommended as a routine vaccination for girls and women between the ages of 9-26 in the US.

On October 25, 2011, the CDC’s Advisory Committee on Immunization Practices also voted to recommend giving the HPV vaccine to males between the ages of 11 and 21. The second HPV vaccine, Cervarix, was licensed in 2009.

Most recently, an oncology dietitian pointed out significant discrepancies2 in a new HPV vaccine effectiveness study published in the Journal of Infectious Diseases3, which evaluated data from the National Health and Nutrition Examination Surveys (NHANES), 2003-2006 and 2007-2010.

The study pointed out that HPV vaccine uptake among young girls in the US has been low but concluded that:

“Within four years of vaccine introduction, the vaccine-type HPV prevalence decreased among females aged 14–19 years despite low vaccine uptake. The estimated vaccine effectiveness was high.”

Assessing the Overall Impact of the HPV Vaccine

In her article4, Sharlene Bidini, RD, CSO, points out that the study’s conclusion was based on 740 girls, of which only 358 were sexually active, and of those, only 111 had received at least one dose of the HPV vaccine. In essence, the vast majority was unvaccinated, and nearly half were not at risk of HPV since they weren’t sexually active.

“If the study authors were trying to determine vaccine effectiveness, why did they include the girls who had not received a single HPV shot or did not report having sex?” she writes.

“Table 1 from the journal article compares 1,363 girls, aged 14-19, in the pre-vaccine era (2003-2006) to all 740 girls in the post-vaccine era (2007-2010) regardless of sexual history or immunization status.”

In the pre-vaccine era, an estimated 53 percent of sexually active girls between the ages of 14-19 had HPV. Between 2007 and 2010, the overall prevalence of HPV in the same demographic declined by just over 19 percent to an overall prevalence of nearly 43 percent.

As Bidini points out, this reduction in HPV prevalence can NOT be claimed to be due to the effectiveness of HPV vaccinations. On the contrary, the data clearly shows that it was the unvaccinated girls in this group that had the best outcome!

“In 2007-2010, the overall prevalence of HPV was 50 percent in the vaccinated girls (14-19 years), but only 38.6 percent in the unvaccinated girls of the same age.

Therefore, HPV prevalence dropped 27.3 percent in the unvaccinated girls, but only declined by 5.8 percent in the vaccinated group. In four out of five different measures, the unvaccinated girls had a lower incidence of HPV,” she writes.

Furthermore, in the single instance where unvaccinated girls had a 9.5 percent higher prevalence of HPV, a note stated that the relative standard error was greater than 30 percent, leading Bidini to suspect that “the confidence interval values must have been extremely wide. Therefore, this particular value is subject to too much variance and doesn’t have much value.”

Another fact hidden among the reported data was that among the 740 girls included in the post-vaccine era (2007-2010), the prevalence of high-risk, non-vaccine types of HPV also significantly declined, from just under 21 percent to just over 16 percent.

So, across the board, HPV of all types, whether included in the vaccine or not, declined. This points to a reduction in HPV prevalence that has nothing to do with vaccine coverage. Besides, vaccine uptake was very LOW to begin with.

All in all, one can conclude that there were serious design flaws involved in this study—whether intentional or not—leading the researchers to erroneously conclude that the vaccine effectiveness was “high.” Clearly the effectiveness of the vaccine was anything but high, since the unvaccinated group fared far better across the board.

Case Report of a Gardasil Death Confirms Presence of HPV DNA Fragments

Earlier this year, a lab scientist, who discovered HPV DNA fragments in the blood of a teenage girl who died after receiving the Gardasil vaccine, published a case report in the peer reviewed journal Advances in Bioscience and Biotechnology5. The otherwise healthy girl died in her sleep six months after receiving her third and final dose of the HPV vaccine. A full autopsy revealed no cause of death.

Sin Hang Lee with the Milford Molecular Laboratory in Connecticut confirmed the presence of HPV-16 L1 gene DNA in the girl’s postmortem blood and spleen tissue. These DNA fragments are also found in the vaccine. The fragments were protected from degradation by binding firmly to the particulate aluminum adjuvant used in the vaccine.

“The significance of these HPV DNA fragments of a vaccine origin found in post-mortem materials is not clear and warrants further investigation,”he wrote.

Lee suggests the presence of HPV DNA fragments of vaccine origin might offer a plausible explanation for the high immunogenicity of Gardasil, meaning that the vaccine has the ability to provoke an exaggerated immune response. He points out that the rate of anaphylaxis in girls receiving Gardasil is far higher than normal—reportedly five to 20 times higher than any other school-based vaccination program!

HPV Vaccine Is Associated with Serious Health Risks, Including Sudden Death

Many women are not aware that the HPV vaccine Gardasil might actuallyincrease your risk of cervical cancer. Initially, that information came straight from Merck and was presented to the FDA prior to approval6. According to Merck’s own research, if you have been exposed to HPV strains 16 or 18 prior to receipt of Gardasil vaccine, you could increase your risk of precancerous lesions, or worse, by 44.6 percent.

Other health problems associated with Gardasil vaccine include immune-based inflammatory neurodegenerative disorders, suggesting that something is causing the immune system to overreact in a detrimental way—sometimes fatally.

  • Between June 1, 2006 and December 31, 2008, there were 12,424 reported adverse events following Gardasil vaccination, including 32 deaths. The girls, who were on average 18 years old, died within two to 405 days after their last Gardasil injection
  • Between May 2009 and September 2010, 16 additional deaths after Gardasil vaccination were reported. For that timeframe, there were also 789 reports of “serious” Gardasil adverse reactions, including 213 cases of permanent disability and 25 diagnosed cases of Guillain-Barre Syndrome
  • Between September 1, 2010 and September 15, 2011, another 26 deaths were reported following HPV vaccination
  • As of May 13, 2013, VAERS had received 29,686 reports of adverse events following HPV vaccinations, including 136 reports of death,7, as well as 922 reports of disability, and 550 life-threatening adverse events

Lawsuit Reveals Payouts of Nearly $6 Million to HPV Vaccine-Damaged Victims

On February 28, 2013 the government watchdog group Judicial Watch announced it had filed a Freedom of Information Act (FOIA) lawsuit against the Department of Health and Human Services (DHHS) to obtain records from the Vaccine Injury Compensation Program (VICP) related to the HPV vaccine8. The lawsuit was filed in order to force the DHHS to comply with an earlier FOIA request, filed in November 2012, which had been ignored. As reported by WND.com9:

“Judicial Watch wants all records relating to the VICP, any documented injuries or deaths associated with HPV vaccines and all records of compensation paid to the claimants following injury or death allegedly associated with the HPV vaccines… The number of successful claims made under the VICP to victims of HPV will provide further information about any dangers of the vaccine, including the number of well-substantiated cases of adverse reactions.”

On March 20, Judicial Watch announced it had received the FOIA documents from the DDHS, which revealed that the National Vaccine Injury Compensation Program has awarded $5,877,710 to 49 victims for harm resulting from the HPV vaccine. According to the press release10: “On March 12, 2013, The Health Resources and Services Administration (HRSA), an agency of HHS, provided Judicial Watch with documents revealing the following information:

  • Only 49 of the 200 claims filed have been compensated for injury or death caused from the (HPV) vaccine. Of the 49 compensated claims, 47 were for injury caused from the (HPV) vaccine. The additional 2 claims were for death caused due to the vaccine.
  • 92 (nearly half) of the total 200 claims filed are still pending. Of those pending claims, 87 of the claims against the (HPV) vaccine were filed for injury. The remaining 5 claims were filed for death.
  • 59 claims have been dismissed outright by VICP. The alleged victims were not compensated for their claims against the HPV vaccine. Of the claims dismissed, 57 were for injuries, 2 were for deaths allegedly caused by the HPV vaccine.
  • The amount awarded to the 49 claims compensated totaled 5,877,710.87 dollars. This amounts to approximately $120,000 per claim.

This new information from the government shows that the serious safety concerns about the use of Gardasil have been well-founded,” said Judicial Watch President Tom Fitton. “Public health officials should stop pushing Gardasil on children.”

Review of HPV Vaccine Trials Conclude Effectiveness Is Still Unproven

Last year, a systematic review11 of pre- and post-licensure trials of the HPV vaccine by researchers at University of British Columbia showed that the vaccine’s effectiveness is not only overstated (through the use of selective reporting or “cherry picking” data) but also unproven. In the summary of the clinical trial review, the authors state it quite clearly:

“We carried out a systematic review of HPV vaccine pre- and post-licensure trials to assess the evidence of their effectiveness and safety. We found that HPV vaccine clinical trials design, and data interpretation of both efficacy and safety outcomes, were largely inadequate. Additionally, we note evidence of selective reporting of results from clinical trials (i.e., exclusion of vaccine efficacy figures related to study subgroups in which efficacy might be lower or even negative from peer-reviewed publications).

Given this, the widespread optimism regarding HPV vaccines long-term benefits appears to rest on a number of unproven assumptions (or such which are at odds with factual evidence) and significant misinterpretation of available data.

For example, the claim that HPV vaccination will result in approximately 70% reduction of cervical cancers is made despite the fact that the clinical trials data have not demonstrated to date that the vaccines have actually prevented a single case of cervical cancer (let alone cervical cancer death), nor that the current overly optimistic surrogate marker-based extrapolations are justified.

Likewise, the notion that HPV vaccines have an impressive safety profile is only supported by highly flawed design of safety trials and is contrary to accumulating evidence from vaccine safety surveillance databases and case reports which continue to link HPV vaccination to serious adverse outcomes (including death and permanent disabilities).

We thus conclude that further reduction of cervical cancers might be best achieved by optimizing cervical screening (which carries no such risks) and targeting other factors of the disease rather than by the reliance on vaccines with questionable efficacy and safety profiles.” [Emphasis mine]

Talk to Your Kids about HPV and Gardasil

There are better ways to protect yourself or your young daughters against cancer than getting Gardasil or Cervarix vaccinations, and it’s important you let your children know this. In more than 90 percent of HPV infections, HPV infection is cleared within two years on its own, so keeping your immune system strong is far more important than getting vaccinated.

In addition, HPV infection is spread through sexual contact and research12 has demonstrated that using condoms can reduce your risk of HPV infection by 70 percent, which is far more effective than the HPV vaccine. Because this infection is sexually transmitted, the risk of infection can be greatly reduced by lifestyle choices, including abstinence. In addition, there are high risk factors for chronic HPV infection including smoking, co-infection with herpes, Chlamydia or HIV and long-term birth control use. Women chronically infected with HPV for many years, who don’t get pre-cancerous cervical lesions promptly identified and treated, can develop cervical cancer and die.

So it is important to remember that, even if they get vaccinated, girls and women should get Pap test screening every few years for cervical changes that may indicate pre-cancerous lesions because there is little guarantee that either Gardasil or Cervarix vaccinations will prevent cervical cancer. After Pap test screening became a routine part of health care for American women in the 1960’s, cervical cancer cases in the U.S. dropped 74 percent and continued Pap testing is recommended for women who receive HPV vaccines.

Why We Must Protect Vaccine Exemptions

There can be no doubt that we are in urgent need of a serious vaccine safety review in the US. Quality science is simply not being done. And very few vaccine recommendations, which prop up state vaccine mandates, stand on firm scientific ground. Your right to vaccine exemptions is also increasingly under threat.

I urge you to get involved in the monumentally important task of defending YOUR right to know and freedom to choose which vaccines you and your child will use. The non-profit charity, the National Vaccine Information Center (NVIC), has been preventing vaccine injuries and deaths through public education for more than 30 years and is leading the advocacy effort in the states to protect vaccine exemptions. Supporting NVIC is one way you can help, in addition to signing up for the free online NVIC Advocacy Portal so you stay informed about threats to vaccine exemptions in your state and contact your state legislators to make your voice heard.

All across the United States, people are fighting for their right not to be injected with vaccines against their will. These threats come in a variety of guises like California bill AB49913, which permits minor children as young as 12 years old to be vaccinated with sexually transmitted disease vaccines like Gardasil without parental knowledge or parental consent! In light of the evidence that HPV vaccines have not been proven safe or effective, how wise is it to allow doctors to give a minor child Gardasil or Cervarix vaccinations without informing and getting the consent of parents? How are parents supposed to monitor their children for signs of a vaccine reaction if they don’t even know their children have been given a vaccine? It’s nothing short of reprehensible.

I cannot stress enough how critical it is to get involved and stand up for your human right to exercise informed consent to vaccination and protect your legal right to obtain medical and non-medical vaccine exemptions. This does not mean you have to opt out of all vaccinations if you decide that you want to give one or more vaccines to your child. The point is, EVERYONE should have the right to evaluate the potential benefits and real risks of any pharmaceutical product, including vaccines, and opt out of any vaccine they decide is unnecessary or not in the best interest of their child’s health. Every child is different and has a unique personal and family medical history, which may include severe allergies or autoimmune and neurological disorders, that could increase the risks of vaccination.

It is your parental right to make potentially life-altering health decisions for your own children. Why wouldn’t you want to keep that right—even if you want your child to receive most or all vaccinations currently available? Tomorrow there might be a vaccine you don’t want your child to receive, but if you’ve failed to support strong informed consent protections in public health laws, which includes the legal right for all Americans to take medical and non-medical vaccine exemptions, you’ve given away your own freedom to choose in the future…

Internet Resources Where You Can Learn More

I encourage you to visit the following web pages on the National Vaccine Information Center (NVIC) website atwww.NVIC.org:

  • NVIC Memorial for Vaccine Victims: View descriptions and photos of children and adults, who have suffered vaccine reactions, injuries and deaths. If you or your child experiences an adverse vaccine event, please consider posting and sharing your story here.
  • If You Vaccinate, Ask 8 Questions: Learn how to recognize vaccine reaction symptoms and prevent vaccine injuries.
  • Vaccine Freedom Wall: View or post descriptions of harassment by doctors, employers or school officials for making independent vaccine choices.
  • NVIC Advocacy Portal: Sign up today to be a user of this free online privacy-protected network of concerned citizens all working to educate legislators to protect vaccine exemptions in public health policies and laws.

Connect with Your Doctor or Find a New One That Will Listen and Care

If your pediatrician or doctor refuses to provide medical care to you or your child unless you agree to get vaccines you don’t want, I strongly encourage you to have the courage to find another doctor. Harassment, intimidation, and refusal of medical care is becoming the modus operandi of the medical establishment in an effort to stop the change in attitude of many parents about vaccinations after they become truly educated about health and vaccination.

However, there is hope.

At least 15 percent of young doctors polled in the past few years admit that they’re starting to adopt a more individualized approach to vaccinations in direct response to the vaccine safety concerns of parents. It is good news that there is a growing number of smart young doctors, who prefer to work as partners with parents in making personalized vaccine decisions for children, including delaying vaccinations or giving children fewer vaccines on the same day or continuing to provide medical care for those families, who decline use of one or more vaccines.

So take the time to locate a doctor, who treats you with compassion and respect and is willing to work with you to do what is right for your child.

Protect Your Right to Informed Consent and Defend Vaccine Exemptions

With all the uncertainty surrounding the safety and efficacy of vaccines, it’s critical to protect your right to make independent health choices and exercise voluntary informed consent to vaccination. It is urgent that everyone in America stand up and fight to protect and expand vaccine informed consent protections in state public health and employment laws. The best way to do this is to get personally involved with your state legislators and educating the leaders in your community.

THINK GLOBALLY, ACT LOCALLY.

National vaccine policy recommendations are made at the federal level but vaccine laws are made at the state level. It is at the state level where your action to protect your vaccine choice rights can have the greatest impact. It is critical for EVERYONE to get involved now in standing up for the legal right to make voluntary vaccine choices in America because those choices are being threatened by lobbyists representing drug companies, medical trade associations, and public health officials, who are trying to persuade legislators to strip all vaccine exemptions from public health laws.

Signing up for NVIC’s free Advocacy Portal at http://www.NVICAdvocacy.org gives you immediate, easy access to your own state legislators on your Smart Phone or computer so you can make your voice heard. You will be kept up-to-date on the latest state bills threatening your vaccine choice rights and get practical, useful information to help you become an effective vaccine choice advocate in your own community. Also, when national vaccine issues come up, you will have the up-to-date information and call to action items you need at your fingertips.

So please, as your first step, sign up for the NVIC Advocacy Portal.

Share Your Story with the Media and People You Know

If you or a family member has suffered a serious vaccine reaction, injury, or death, please talk about it. If we don’t share information and experiences with one another, everybody feels alone and afraid to speak up. Write a letter to the editor if you have a different perspective on a vaccine story that appears in your local newspaper. Make a call in to a radio talk show that is only presenting one side of the vaccine story.

I must be frank with you; you have to be brave because you might be strongly criticized for daring to talk about the “other side” of the vaccine story. Be prepared for it and have the courage to not back down. Only by sharing our perspective and what we know to be true about vaccination will the public conversation about vaccination open up so people are not afraid to talk about it.

We cannot allow the drug companies and medical trade associations funded by drug companies or public health officials promoting forced use of a growing list of vaccines to dominate the conversation about vaccination. The vaccine injured cannot be swept under the carpet and treated like nothing more than “statistically acceptable collateral damage” of national one-size-fits-all mandatory vaccination policies that put way too many people at risk for injury and death. We shouldn’t be treating people like guinea pigs instead of human beings.

Internet Resources Where You Can Learn More

I encourage you to visit the website of the non-profit charity, the National Vaccine Information Center (NVIC), atwww.NVIC.org:

  • NVIC Memorial for Vaccine Victims: View descriptions and photos of children and adults, who have suffered vaccine reactions, injuries, and deaths. If you or your child experiences an adverse vaccine event, please consider posting and sharing your story here.
  • If You Vaccinate, Ask 8 Questions: Learn how to recognize vaccine reaction symptoms and prevent vaccine injuries.
  • Vaccine Freedom Wall: View or post descriptions of harassment and sanctions by doctors, employers, and school and health officials for making independent vaccine choices.

Connect with Your Doctor or Find a New One That Will Listen and Care

If your pediatrician or doctor refuses to provide medical care to you or your child unless you agree to get vaccines you don’t want, I strongly encourage you to have the courage to find another doctor. Harassment, intimidation, and refusal of medical care is becoming the modus operandi of the medical establishment in an effort to stop the change in attitude of many parents about vaccinations after they become truly educated about health and vaccination.

However, there is hope.

At least 15 percent of young doctors recently polled admit that they’re starting to adopt a more individualized approach to vaccinations in direct response to the vaccine safety concerns of parents. It is good news that there is a growing number of smart young doctors, who prefer to work as partners with parents in making personalized vaccine decisions for children, including delaying vaccinations or giving children fewer vaccines on the same day or continuing to provide medical care for those families, who decline use of one or more vaccines.

So take the time to locate a doctor, who treats you with compassion and respect and is willing to work with you to do what is right for your child.

[+] Sources and Referen

Two doses of HPV vaccine may suffice for genital warts prevention.


Just two of the recommended three doses of human papillomavirus virus (HPV) vaccine may be enough to reduce the risk of condyloma (genital warts) infections and potentially the risk of cervical cancer, a Swedish study has shown.

Completing the three-dose HPV vaccine series still conferred the most protection, but an examination of data from national Swedish population-based health data registers showed that the difference in risk reduction between the second and third doses was small, especially among girls who received their first dose before age 17. [JAMA 2014;311:597-603]

“The number of condyloma cases prevented by three doses versus two doses was 59 cases per 100,000 person years, which is a small difference,” said researchers from the Karolinska Institutet in Stockholm, Sweden.

The researchers identified 20,383 new cases of condyloma among a population of 1,045,165 females in Sweden aged 10 to 24 years, followed up between 2006 and 2010. Of these new cases, 322 occurred after at least one dose of HPV vaccine.

Risk reduction was highest among females who completed their vaccine course. However, two doses of vaccine also conferred significant protection.

For example, among girls aged 10-16, the incidence rate ratio (IRR) for condyloma was 0.18 for those who completed the vaccine course, 0.29 for those who received two doses, and 0.31 for those who had only one dose (p<0.001 for all), compared with those who did not receive the vaccine.

These corresponded to an incidence rate difference (IRD) of 459 cases of condyloma per 100,000 person years for three doses, 400 cases per 100,000 person years for two doses, and 384 cases per 100,000 person years for a single dose (p<0.001 for all) compared with no vaccine.

The IRR and IRD was consistently the least different between two and three doses among girls of any age, suggesting significant, if not the most, risk reduction.

Accounting for the impact of varying vaccine dose levels is important because “actual vaccination programs include substantial numbers of women who do not complete the full vaccination schedules,” the researchers said.

HPV serotypes 6 and 11 cause about 90 percent of condylomas, which are the first measurable endpoint for HPV infection and have an incubation period between 1 and 6 months. The females included in the study received the quadrivalent HPV vaccine, which also protects against serotypes 16 and 18, which are related to cancer outcomes, including cervical cancer.

The researchers said further investigations need to be done to determine if there is any reduced risk of cervical cancer with fewer than three doses of HPV vaccine. The current data may have also underestimated the number of condyloma cases since some patients can’t or won’t seek medical care, nor did it account for disease outcomes other than condyloma.