Monday, April 20, 2009

HPV Vaccine: Personal Choice or School Mandated?




















Katie Couric HPV Vaccine Video:

http://www.cbsnews.com/video/watch/?id=2423068n



What is the HPV vaccine and how is it effective?


HPV is the most commonly transmitted sexual disease in the world. The virus is spread through sexual and genital contact. It is most commonly transmitted in the teenage and young adult years, when individuals are most sexually active, and because many people are unaware they have HPV or their partner does due to its symptomless appearance. Also, condoms do not necessarily protect from HPV –HPV can infect areas that are not covered by a condom. Some forms of HPV may cause cervical cancer for women and different types genital cancers (mouth, neck, anal, penal). Other types of HPV can cause genital warts. Each year, there are about 12,000 women diagnosed with cervical cancer and about 4,000 die from this disease in the U.S The vaccine targets the types of HPV strains which do cause cervical cancer. It is still important for women to get regular pap exams and to lower their risk with possible infected persons by using protection. The vaccine’s protection is projected to last a long time and is most effective in preventing HPV in women who have not previously been exposed to any forms of the disease, which is why testing at a young age is suggested. The vaccine does not treat current HPV infections or the diseases they may cause; it can only prevent HPV before a person gets it.


"Clinical trials have shown the vaccine to be highly immunogenic, safe, and well tolerated in females 9 through 26 years of age. Antibody responses are highest in girls 9 to 15 years old. In sexually active females 16 to 26 years of age, protection has been demonstrated against persistent infection, precancerous lesions, and genital warts caused by HPV types within the vaccine." -CDC

Some Statistics:

---Among teen girls in California aged 13 to 17, about 378,000 out of 1,468,000 (26 percent) reported receiving at least one dose of the vaccine. Among California females aged 18 to 26, about 262,000 out of 2,273,000 (12 percent) reported receiving at least one dose of the vaccine in 2007.

---76 percent of teen girls aged 13 to 17 and 60 percent of young adult women aged 18 to 26 reported an interest in getting the HPV vaccine themselves, while 57 percent of parents of age-eligible girls reported an interest in getting the HPV vaccine for their daughters.

(Source: Science Daily Online)

How Safe & Affordable Is It?


The vaccine had been licensed by the FDA and approved by the CDC as safe and effective. It has been studied in thousands of females around the world, ages 9 through 26, and it continues to be monitored by the FDA and CDC. Studies have not found any serious or adverse reactions or side effects to the vaccine and the most commonly reported symptom is pain at the injection site. For more information, please visit this site:

http://www.cdc.gov/vaccinesafety/concerns/human_papillomavirus_vaccine.htm


A common problem with the HPV vaccine is that many insurance companies do not offer full coverage of the pricey, $360 some estimate for all three shots. This is usually because a patient is over the age of 18 and because the vaccine has not been in practice long enough to foresee the long-term benefits and outcomes. However, there are also public health clinics that will offer the shots for very reduced costs (even Ingham Health Center in the Lansing area offers them for $24 if you are uninsured).


Should the vaccine be MANDATORY for school?

School mandates on vaccines are considered a huge public health success, credited with compliance rates near 100% for 5-year-olds. Schools and health departments are responsible for enforcement and school mandates in the adolescent population have been particularly successful given the poor compliance with routine vaccination in this age range.

On September 12, 2006, Michigan State Senator Beverly Hammerstrom introduced the first bill requiring vaccination of girls aged 11-12 prior to entry into the sixth grade. Since this time, school mandates have been considered or are being considered in 24 states, including:

  • Governor Rick Perry of Texas issued an executive order requiring vaccination for sixth-grade girls in Texas
    in February 2007
  • Virginia is the only state to have signed a bill into law requiring HPV vaccination of girls prior to entry into the sixth grade. This bill initially required a parent's signature but was altered such that a verbal opt-out is sufficient. All of the HPV vaccine mandate bills introduced thus far have a clause regarding parental opt-out separate from the states' current vaccination exemption laws.




“The HPV vaccine has sparked ethical debate along many lines, including the utility of compulsory vaccination. Currently, the vaccine is approved only for use in females and, therefore, herd immunity in the truest sense is unable to be achieved at the moment. Further, given the prevalence of HPV in the general population, the greatest benefit to each person receiving the vaccine is to the individual in protection against the 4 viral types in the current quadrivalent vaccine. Therefore, given the individual benefit and the assumed individual risk, autonomy of the person or parents of the child receiving the vaccine becomes the larger consideration.” - California Health Interview Survey


Additionally, many parents feel that their rights are being violated when the vaccine is mandatory and that it only encourages an immoral lifestyle, and sexual activity. Further, HPV could be prevented by a monogamous lifestyle or through abstinence. Religious and cultural values come into play here and public schools should not be allowed to force families and parents to have to vaccinate for something can be seen as a personal choice protection vaccine. Parents could instead become more aware and educated by the school system about the prevalence of HPV and the risks it poses, so that they may best decide as to how to inform their daughters (and sons) and whether or when to go to the vaccine. While Virginia schools took a public health approach to try and mitigate the prevalence of HPV in society, it should be remembered that this is not a disease in which the transmission of infection is like that of traditional communicable diseases for which we have childhood vaccinations (measles, mumps, rubella, chickenpox). Since research has already discerned that the age group most at risk for HPV is the teens and early twenties, perhaps the shot, if it is to be mandated, should be for adolescents entering high school or college. Parent opinion has actually favored this:

“In a survey of nearly 10,000 parents, only 49 percent said they intended to vaccinate their daughter if she were 9 to 12 years old. Meanwhile, 68 percent and 86 percent intended to vaccinate their 13-15-year-old and 16-18-year-old daughters, respectively.”
(Source: Jennifer Young, MD, MPH)

Ethical Principles Involved

Utilitarianism:
Getting vaccinated requires an individual to accept the risk of an immunization for the good of the society in the form of "herd immunity." It is unlikely that the individual will suffer from the disease itself because the particular diseases vaccines target are rare in the general population. Immunizations are more of a benefit to the "greater good" of society. Certain vaccinations are important for people of all ages, and it is important that children are immunized so as to not harm pregnant mothers.

Compulsory Vaccination:
Currently, the vaccine is only approved for use in females, which hinders the concept of "herd immunity." Given its prevalence of HPV in the population, the greatest benefit each person receives is protection against the 4 strains most likely to cause cervical cancer and genital warts. Because the individual benefits, and is also at risk for a drug with few long-term studies, the autonomy of the girl (and her parents involvement in) receiving the shot is a much greater consideration.


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