HPV vaccine update
Where things stand one year later
Monday, May 21, 2007
Short stuff: Health roundup
A year ago you probably hadn’t heard of HPV and knew little about cervical cancer. But one year after the FDA approved the first ever vaccine that immunizes against the viral strains that lead to the second deadliest cancer for women in America, chances are you’re a little more familiar.
Genital HPV infection is a sexually transmitted disease caused by human papillomavirus, a group of viruses that includes more than 100 different strains or types, including the warts kids often get on their hands and feet and more than 30 that are sexually transmitted.
According to the Centers for Disease Control and Prevention, at least half of sexually active men and women acquire an infection during their lives and by age 50, 80 percent of women will have acquired a genital HPV infection.
Last June the FDA approved Merck & Co.’s Gardasil, a three-dose immunization for females ages 9-26. It is the first vaccine developed to prevent cervical cancer, precancerous genital lesions and genital warts due to four types of HPV.
Proponents of the breakthrough touted its nearly negligible side effects (the drug’s Web site lists pain, swelling, itching and redness at the injection site, as well as fever, nausea and dizziness) along with its potential to reduce cervical cancer by 70 percent. Opponents questioned vaccinating young girls for an infection transmitted by sexual contact and wondered about its long-term effects.
So one year later, what’s the status?
Dr. Ken Alexander, associate professor of pediatrics and chief of pediatric infectious diseases at the University of Chicago, says, "mandating the vaccine, immunizing boys and immunizing women past the age of 26, those are the big issues right now," he says.
Illinois is one of several states considering that mandate.
According to Dr. Julie Morita, medical director of the Chicago Department of Public Health’s Immunization Program, there is currently a bill before the Illinois House that would require vaccinating for HPV before students enter sixth grade. Another before the state Senate addresses education programs and making the vaccine available to everyone.
Though the vaccine has been proven safe and effective for more than five years, Morita says many people still don’t know enough about it.
"I think the value of this vaccine will speak for itself soon enough and the public will be very accepting of it," she says. "But it’s critical for people to have the opportunity to learn about it and become comfortable with it."
Morita, who plans to vaccinate her 10 year-old daughter when she turns 11, says public health specialists are supportive of vaccines in general when they’re equally available to all.
"There’s great value in getting people vaccinated," she says, "but I think it’s premature to require [Gardasil] for school entry."
The Chicago Department of Public Health has already implemented education programs for both providers and patients in Chicago’s underserved and high-risk communities.
Both Morita and Alexander say studies are under way to determine if the vaccine is effective for older women and boys, too.
Another drug company, GlaxoSmithKline, has a cervical cancer vaccine, Cervarix, awaiting FDA sanction that has proven to be effective for women 26-55.
"We don’t have an answer right now, and we still have lots of research to do," says Alexander of the questions still facing the vaccine and its advocates.
"In fact, this is probably why we shouldn’t mandate right now," he adds. "While mandates are emotionally popular and maybe even politically popular, what we lack at present is the scientific evidence to show that this is good public health policy."
Gardasil costs about $150 per dose including administrative fees, and with vaccine prices in general rising, this is a significant issue, says Alexander, who had his 14- and 17-year-old daughters vaccinated last November.
However, "in terms of accessibility, the majority of insurance companies are now picking it up, and they’re covering women through the age of 26," he says.
The vaccine has also been picked up by the Vaccines For Children Initiative, a federal program providing vaccines to children on Medicaid free of charge. In Illinois, the initiative picked up Gardasil in January, so young women on Medicaid can be immunized up to age 18.
"There are kids falling through the cracks," says Alexander, pointing to those 19-26 without insurance or insurance covering the vaccine.
However, he says, like many drug companies, Merck supports such patients with a program providing replacement dosages to physicians free of charge, or at a discount. Women need only tell their doctors they want it and fill out a form that’s then faxed to Merck for approval. Once approval has been granted, the vaccine will be given, and the dosages will be replaced.
Parents need to understand, says Morita, "cervical cancer is a preventable disease and the vaccine is safe and effective."
Maayan S. Heller is a freelance writer living in Chicago who covers issues in health, women’s health and fitness