Wednesday, March 12, 2014
By Jonathan Fanburg
SOUTH PORTLAND - I heard it from two of the 15 families I saw at my practice today: "I don't want my child receiving the HPV (human papilloma virus) vaccine. It is too controversial."
As an adolescent medicine specialist who has been practicing for more than 15 years in Maine, I scratch my head and think, "There is nothing controversial about the HPV vaccine."
It seems like a no-brainer to have access to a vaccine that obliterates the possibility of 80 percent of cervical cancers, some head and neck cancers and many cases of genital warts.
It is the first vaccine to protect against cancer, and it is almost 100 percent effective. Although males don't have cervixes, they can get head and neck cancer and genital warts, which is why the vaccine is recommended for both sexes.
Some parents say the HPV vaccine is "too new." What these parents might not be aware of is that the vaccine started being developed 30 years ago and took its present form in 1993.
In 2006, one study was stopped midway through because the HPV vaccine was so effective that withholding it from patients who were getting placebos was considered wrong.
As of June 2011, 35 million doses of the vaccine have been administered. The only side effects associated with it have been redness on the arm, fever and, in some cases, fainting, all of which are the same as or similar to the side effects of vaccines that children receive when they are younger.
In my opinion, the real controversy is whether withholding the HPV vaccine from a child is doing him or her a disservice.
Whether or not a child is having sex is almost always unrelated to his or her HPV vaccination status. One recent study shows that getting the HPV vaccine does not increase one's likelihood of initiating sex.
Convincing data also shows that many teenagers are having sex with or without their parents' consent and that parents incorrectly think their children are still virgins when they aren't.
Impulsivity is a common part of teen sex, underscored by the fact that teens are least likely to use contraception in the first six months of having sex.
This all adds up to mothers and fathers who are unaware of their children's sexual habits (despite what these parents think) and teens who don't plan at least six months ahead to complete the three-dose HPV vaccine series before starting sex.
Since 70 percent of sexually active teens acquire HPV within one year of starting sex and the vaccine is not effective after being exposed, it is important to get children vaccinated before they become sexually active -- as early as 11 or 12 years old.
For those who are sexually active, condoms protect against a number of sexually transmitted infections, such as chlamydia, gonorrhea and HIV, but for unknown reasons, condoms don't protect against human papilloma virus.
The HPV vaccine is not perfect. Its biggest downside is that it protects against only four strains of HPV. However, those four strains represent the majority -- about 80 percent -- of cervical cancers. Someday there will be a better vaccine that covers more of the strains of HPV, and we may need to re-vaccinate people when that improved vaccine comes out in the future.
However, vaccines are the most effective form of preventative medicine that exists. Commonly occurring chickenpox is hardly ever seen anymore since the existence of a vaccine.
When I was in residency 18 years ago, I regularly saw kids with meningitis from Haemophilus influenzae, pneumococcus and meningococcus, yet we hardly see these diseases anymore.
If I only got to choose one option, my stethoscope or vaccines, I would easily put my stethoscope away in exchange for the proven health benefits of immunizations.
With the two families I saw today, I discussed the vaccine and its benefits, as well as the parents' concerns. We also discussed what the data actually shows, and what we know about the 12,000 patients who will get cervical cancer this year in the U.S., 4,300 of whom will die of HPV-related cancer..
I shared with the parent that my son and daughter were vaccinated with HPV vaccine as part of good routine preventative health care.
Jonathan Fanburg, M.D., M.P.H., is a pediatric and adolescent medicine specialist at Maine Medical Partners Pediatrics in South Portland. He was appointed to the Legislature's Cervical Cancer Task Force in 2007.