HPV Vaccination Programme

[AnneWiddecomesArse]

I'm a bit side swiped by this.
I've read some stuff in papers etc. but now my DD has been offered the vaccine in this school year (she's 12 years old); and it's time for a decision.
What are your thoughts/research on this ?

Just to clarify - the classification of 'carcinoma in situ' includes CIN3 changes with or without mention of severe dysplasia. There were 2,828 cases of cervical cancer diagnosed in 2007. While the chances of catching hpv are quite high (50-80%) 90% of those cases will not cause any/long lasting cervical changes. Cervical changes can usually be successfully treated if caught early. Currently the vaccination is thought to provide protection for 6 years.

Wormshuffler, transmission of HPV is skin to skin and not through body fluids. That is why condoms are not going to have the same effect or failure rate with HPV as they might with pregnancy.

They are acting as a barrier between infected and non-infected skin in the case of HPV but obviously can't be a barrier for skin that is not covered by the condom.

"the risk of getting cervical cancer is one in 136."

How is this worked out?

Actuallly, math, it's membrane to membrane, isn't it, not skin to skin? Slightly different.

And hinting about possible dire repercussions of vaccines somewhere down the line is not?

I don't think it is. I don't think we should brush these things away and not think about them.

It's mucous membrane to mucous membrane, not skin to skin.

Is there are reason you didn't bold this: Condom use may reduce the risk for HPV infection and HPV-associated diseases (e.g., genital warts and cervical cancer).' It contradicts your statement Condoms do not prevent transmission of HPV. As I said, they can reduce the risk but they cannot be relied upon. I didn't realise it was nearly 70 pc cent effective but that is certainly not "do not prevent transmission of HPV".

There are no increased risk of serious side effects with either vaccine.

They've certainly been reported: they're just denied because they don't fit into any pattern. They're just denied - even though the health authorities don't know what else caused the paralysis and the severe symptoms that are very similar to adverse reactions acknowledged by the manufacturer.

They're just put down to coincidence, so that statement above is an optimistic assertion.

McGill University (Canada) HITCH Cohort Study

From this site --
How is HPV transmitted?
'HPVs that infect the genital area are sexually transmitted.

HPV viruses are very common. So much so that more than 75% of women and men will have this type of infection at one point of their life or another, and between 10% and 70% of women and men have HPV at any one time. HPV is most common in young women and men who are in their late teens and early 20s.

HPV can be transmitted through skin-to-skin sexual contact, whether or not there is penetration. It can be transmitted through vaginal or anal intercourse, oral sex and mutual masturbation (genital touching). The vaginal and anal tracts are particularly susceptible to sexually-transmitted HPV and the risk of transmission is greatest during penetration without a condom. This being said, HPV is also found on parts of the body such as the vulva, scrotum and inner thighs which are not covered by a condom. It is thus possible to for partners to transmit HPV even when a condom is used.

HPV can be transmitted through vaginal sex, anal sex, oral sex, or skin-to-skin contact of the genitals.'

The kind of HPV infection that causes cancer is not visible:
'The types of HPV that cause genital warts do not cause cancer. Genital warts (also called Condylomata) may be flat or look like a small cauliflower. They can appear on the vulva, cervix, penis, scrotum, rectum, or thigh area.

The types of HPV that can cause cancer are often a ?silent infection?. They have no obvious signs or symptoms, and most people will not even know they are infected. For women, the main concern is infection of the cells of the cervix. These infections can lead to changes in the cervical cells that can be observed under the microscope in a Pap test.'

Bluberties, I do not understand why you would be prepared to take your chances with a condom (which you say is 30% ineffective wrt HPV) yet disregard the statistics when it comes to vaccine side effects and insist there are shenanigans associated with them.

'HPVs that infect the genital area are sexually transmitted'.

I would like to clarify this statement from the site I quoted: 'Sexually transmitted' is used in the sense of 'transmitted during sexual activity' and is not meant to imply that the exchange of body fluids is involved in the transmission process.

Math, it isn't me doing the disregarding. I don't understand how you are happy to accept that an event that happens directly after a vaccine, and bears so many similarities to adverse events acknowledged by the manufacturer, and for which no other explanation is given - is not, in your view, and without question, caused by the vaccine. It seems beyond rational thought to accept that.

Condom use, care with partners and frequent smears all seem to me to be a rational alternative to a vaccine, the effects and effectiveness of which are still being researched.

I haven't said, ever, that temporal correlation rules out direct causation (more research will ferret out more information here), and clearly if a side effect is listed by the vaccine manufacturer then some sort of causation is implied -- what is important to me is how many serious adverse reactions there are compared to the total number of doses administered, and I am inclined to think the more serious the reaction the more likelihood there is of it being reported. A 3 in 10 chance of a condom failing to prevent transmission of HPV is far more worrying to me than a 1 in 100,000 or 1 in 10,000 chance or even 1 in 1,000 chance of an adverse reaction to a vaccine.

Condom use is far less likely to happen after partners have been having a sexual relationship for a while and when no signs of infection are present. You can be as careful with partners as you feel you can be, but neither you nor your partner would know if either one of you had the HPV strains most likely to cause cc as this can only be ascertained using lab techniques. Frequent smears will only possibly catch the likelihood of a problem after it has already developed.

Problems associated with Pap smears:
"A. Highly effective for screening only. It is not diagnostic. It only identifies those at risk for dysplasia or cancer.
B. False Negative Pap Smears: Rate = 5 - 50% -- 10 - 29% usually quoted. 80% are true false negatives, 20% are lab errors.
C. Repeating cervical smears.
1 LSUHSC Study: "Using follow-up cervical smears to monitor patients who have low-grade SILs carries unacceptable risks, and a diagnostic test such as colposcopy is indicated." J Fam Pract 1995; 40:57-62
2 ASCCP Consensus Guidelines recommend routine colposcopy instead of repeated Paps since follow-up cytological studies have usually had high rates of loss to follow-up, a 53% to 76% likelihood of abnormal follow-up cytology results requiring eventual colposcopy, and a small but real risk of delaying the identification of invasive cancers.

D. Inadequacies in Pap Smear Screening

1 False negative Paps.
2 Failure to identify high risk patient at entry.
3 Inaccurate or incomplete reports from the lab to clinic to patient
4 Lack of adequate tracking and follow-up.
5 Poor patient compliance.

E. Summary of lesions missed by Pap:

1 Occur outside of a large eversion.
2 Small lesions.
3 Advanced invasive lesions since they have infection and necrotic tissue, which can obscure the true cytology. Koss, JAMA. 1989:737.
4 Rapidly progressive lesions.
5 Lesions deep in the cervical canal.

F. Factors That Diminish the Accuracy of Pap Smears - Clinician Factors

1 Contamination with blood or oil-based lubricants.
2 Mislabeled or unlabeled slides.
3 Inadequate clinical history.
4 Inadequate sampling of the transformation zone.
5 Slide material too thick or insufficient.
6 Performing pap in spite of obvious infection.

GH. Factors That Diminish the Accuracy of Pap Smears - Laboratory Factors

1 Confusing smears or names.
2 Failure to identify dysplastic cells.
3 Misinterpretation of diagnostic cells.
4 Poorly controlled technical process."

Actually, though, you will soon be able to get tested for HPV iirc from another thread; so in the case you cite, partners would be able to find out if stopping using a condom would be OK; they could both be certain of HPV status before doing so.

So you could both go and be tested for HIV and HPV - if you hadn't already ascertained the status of both of you - before stopping using a condom.

How likely or realistic is that though, in the case of most people?

When you look at stats that indicate that stds are increasing across the board in both the general population and in specific groups, and read that teen pregnancy rates in the UK are the highest in Europe, it should be really obvious that taking sexual health seriously and trying to manage general risks associated with sex is not happening among the 16 - 25 year old section of the population.

Chlamydia, which can also have no symptoms, remains an out of sight and out of mind infection. Testing rates remain low despite the risks associated if it goes undiagnosed.

No, I accept that many, many young people are not taking sexual health seriously, and are taking terrible risks.

However, I do know my own dc and that they will not be in that category. I know people will say I can't possibly say that, but IMO I can.

Your own DCs are only half of the equation when it comes to sex.

This is why you are being unrealistic; while you could possibly say they will not be in the category of irresponsible young people, you really cannot predict how other people's children will behave when it comes to sex, nor can you say what their attitude to your DCs' health will be.

True; but my dc can be picky about who they sleep with. (Or with whom they sleep.)

They can be as picky as they like but I would bet the farm that they would not be able to weed out convincing liars. Or even reasonably good liars, when they are in love.

Haha, you underestimate us.

Do you ever look at the Relationship topic?

Math, the vaccine won't ensure better sexual health or encourage young people to be more sexually responsible. In fact there are concerns that there may be an increase in cc caused by the other strains of hpv because people will think they are protected against all strains and won't take other precautions and won't go for regular smears. There is a study being carried out at the moment.

"I haven't said, ever, that temporal correlation rules out direct causation (more research will ferret out more information here), and clearly if a side effect is listed by the vaccine manufacturer then some sort of causation is implied -- what is important to me is how many serious adverse reactions there are compared to the total number of doses administered, and I am inclined to think the more serious the reaction the more likelihood there is of it being reported."

It's good to acknowledge that temporal correlation cannot be conflated with coincidence, in the same way it can't be conflated with causality. I think this can happen too often, as if saying "it just happened at the same time" is an automatic get out clause. Too often people give "amusing" examples of totally unrelated events happening at the same time to dismiss the importance of temporal correlation.

Re: the part I bolded -the problem is this. To find how how many serious adverse reactions there are you have to count them, and they are not being counted, even when they are reported.

It is true that more serious reactions are reported. According to CDC estimates, only about 30pc of serious vaccine reactions are under-reported, compared to 99pc of the mildest reactions. (These figures don't concern HPV vaccination but other childhood immunisations.)

My bolding didn't work (obviously) but you can see where I put the stars.

Bumbley: I see no reason to think this won't happen. Nobody wants to go for their smear, it's no fun, you're working, it's difficult to get an appointment, it's a bore, you have to wait. The vaccine is another reason not to go, especially for teenagers/early twenties when the government says they don't need one anyway. People seem to think teenagers and young women will acquire some great wisdom from having the vaccine about sexual health. It's not true - they'll be as irresponsible as they were going to be anyway. Maybe more so, who knows, but the truth is the importance of smear tests will be lost.

'Math, the vaccine won't ensure better sexual health or encourage young people to be more sexually responsible. In fact there are concerns that there may be an increase in cc caused by the other strains of hpv because people will think they are protected against all strains and won't take other precautions and won't go for regular smears. There is a study being carried out at the moment.'

So because a vaccine may make people feel they are not vulnerable to one std, not being vaccinated is therefore sensible?

People are, or are not, going to take adequate precautions (and a condom is not adequate when it comes to HPV) depending on how immortal they are feeling on any given Friday night.

And they are not going to make their decisions based on statistics or science related to HPV any more than they would based on stats or science based on any other std -- if they were, std rates would be dropping.

There has been enough reporting and counting, as well as cross checking with other sources of reports, to satisfy me that there is no vast 90% of the iceberg lurking beneath the surface when it comes to vaccine safety and statistics.