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 ?

juule, Im glad you are helping your daughters to make an informed choice, but please remember that the newspapers will report a biased version of events.

The girl that was being interviewed was vaccinated months before any symptoms developed and her doctors have agreed that vaccination in an unlikely cause.

In terms of the volume of adverse reports, it does not really put it into any context. I really do think its more useful to look at the scientific papers, not the journalist views.

There has been an update on the questions asked by Diane Harper in that interview from 2009 as further research was released in January of this year

hsionline.com/2008/08/27/could-the-gardasil-vaccine-actually-help-increase-cervical-cancer-rates/

Sensationalist heading but thought-provoking piece imo.

you are right, sensationalist journalism.
If you are sensible and use this vaccine as it was meant to be (along side screening) this is nothing more than a hypothesis.
And the research into the causes and prevention of HPV and cancer is ongoing.
Therefor it would be more balanced to say that if other strains started to cause cancer, realistically we could isolate and prevent them too

I said a sensationalist heading. I don't think that the body of the report was.

"And the research into the causes and prevention of HPV and cancer is ongoing."

Which is why I personally feel that this treatment is still at a trial stage. They don't really know how long it lasts, how effective it will be, whether or not it causes the adverse reactions that have shown up. Probably other things too - what do I know? Actually what I do know is that I won't be putting my daughters forward into this trial at the present time. Maybe when it's had longer to prove itself.

"Therefor it would be more balanced to say that if other strains started to cause cancer, realistically we could isolate and prevent them too"

Maybe or maybe not. What do you really know? Although I do admire your faith.

Which is why I personally feel that this treatment is still at a trial stage
It is not, it has been licensed for over 5 years. I have posted info on how drugs are licensed if that helps? This would not be recommended as a national programme if it was still on trial

And the report is sensationalist. The vaccine has to be given with the counselling that regular screening and good sexual health are still very much needed. This is not the job of the manufacturer to ensure understanding. The do make this clear in their information, but the parents, teachers and health professionals administering the jab all have a duty to ensure that this is an informed decision made with good plans for sexual health.

"This would not be recommended as a national programme if it was still on trial"

PIMS, please stop with the misinformation.

there has been more than one vaccine in recent times rolled out on a national programme that is, effectively, a mass trial.

this is just the latest one to be being used in this way.

I hope that is remains as effective as it has been talked up to be. I hope that the serious reactions are all, in time, investigated. I hope most of all that reactions are not brushed aside and swept under the carpet in the name of mainting the predicted safety rate. and that falling numbers of cervical cancer are not wrongly attributed to a vaccine that is in it's infancy.

the drugs have to be licensed before the can be used on a national program

MHRA

Which vaccines silverfrog?

Gosh PIMS you're still going!!!! Well done!!

A summary

HPV VACCINE OVERVIEW ? Human papillomavirus (HPV) is a virus that causes cervical cancer and genital warts. Persistent infection with certain types of HPV can lead to cancer of the cervix, which affects more than 10,000 American women every year. HPV can also cause cancers of the vulva, vagina, and anus, although these cancers are much less common than cervical cancer.

Two vaccines (Gardasil® and Cervarix®) are available to prevent infection with several types of HPV known to cause cervical cancer. It is hoped that these vaccines will significantly reduce the number of women who develop cervical cancer and pre-cancer.

WHAT IS HPV? ? Human papillomavirus (HPV) is a virus that is spread by skin-to-skin contact, including sexual intercourse, oral sex, anal sex, or any other contact involving the genital area (eg, hand to genital contact). Condoms do not provide complete protection from HPV infection because condoms do not cover all exposed genital skin. People do not become infected with HPV by touching an object, such as a toilet seat.

The risk of HPV exposure increases with the number of sexual partners you have and the number of partners your partner has. It has been estimated that 75 to 80 percent of sexually active adults will acquire HPV infection before the age of 50. A majority of women and men become infected with HPV for the first time between ages 15 and 25 years. Most people who are infected with HPV have no signs or symptoms and clear the infection within two years, often without treatment.

In 10 to 20 percent of people, however, the infection persists. In this situation, there is a greater chance of developing cervical pre-cancer and then cancer. However, it usually takes at least 20 years for HPV infection to cause cervical cancer. Thus, regular testing is important in detecting cervical abnormalities early, before cancer develops.

Over 100 different types of HPV have been identified; 40 of these are known to infect the cervix and 15 are known to cause cervical cancer. Researchers have labeled the HPV types as being high or low risk for causing cervical cancer.

HPV types 6 and 11 can cause about 90 percent of genital warts. These types are low-risk because they do not cause cervical cancer. (See "Patient information: Genital warts in women".)

Types 16 and 18 are the high-risk types that cause most (about 70 percent) cases of cervical cancer. HPV types 45 and 31 are also high-risk types, causing about 5 to 10 percent of cervical cancers.

There are two HPV vaccines available. Talk to your healthcare provider to determine which vaccine is best for you.

One HPV vaccine (Gardasil®) helps to prevent infection with four HPV types (6, 11, 16, and 18)

The other vaccine (Cervarix®) prevents infection with HPV types 16 and 18, and it may offer some protection against HPV types 45 and 31.

HPV VACCINE TIMING AND DOSE ? Gardasil® is given by injection and requires three doses; the first injection is followed by a second and third dose two and six months later, respectively.

Cervarix® is also given by injection and requires three doses, although the schedule is slightly different than with Gardasil; the first injection is followed by a second and third dose one and six months later, respectively.

It is not clear if the vaccine is effective if fewer than three doses are given.

Who should be vaccinated? ? In the United States, HPV vaccination is recommended for all girls and women who are between ages 9 and 26 years.

With both vaccines, you will have the greatest protection from HPV if you are vaccinated BEFORE becoming sexually active. The vaccine does not help to get rid of HPV infection after it has occurred. However, if you are less than 26 years old and you have been sexually active, had genital warts, a positive HPV test, or an abnormal Pap smear, you may still obtain some benefit from the HPV vaccine.

How long will you be protected for? ? Scientists do not know exactly how long the vaccine protects against HPV infection. Clinical trials show that it provides protection for at least five years.

Neither vaccines contain mercury

Efficacy

Efficacy in females

The FUTURE II trial ? In a phase III, multi-national prospective, double-blind, placebo-controlled trial (FUTURE II), more than 12,000 women, aged 15 to 26 years (mean age of 20 years), were randomly assigned to receive a three-dose regimen of vaccine or placebo. The majority of the study participants were from Europe (65 percent) and Latin America (26 percent). Women with greater than four lifetime sexual partners or a history of abnormal cytology were excluded from the study. Evidence of past or current infections with HPV 16 and/or HPV 18 (as measured by serology and DNA detection in cervical specimens) was found in approximately one-fourth of the women in the vaccine and placebo arms (23 and 28 percent, respectively) through one month follow-up after vaccination.

The primary efficacy analysis (According-To-Protocol [ATP] analysis) was performed in those subjects who did not have evidence of either HPV 16 or 18 infection (by HPV DNA or HPV serological testing) through one month after the third dose of vaccine; these patients were referred to as "HPV-naive" as per protocol. The primary composite end point was the development of CIN 2 or 3, adenocarcinoma in situ, or cervical cancer related to HPV 16 or HPV 18 among the "HPV-naive" women. After a mean follow-up of three years, the following results were demonstrated:

Vaccine efficacy, for the prevention of the primary composite end point, was 98 percent in study participants who were "HPV-naive".
Vaccine efficacy remained high (95 percent) in those HPV-negative participants who did not receive all doses of vaccine according to protocol, suggesting some flexibility in the timing of the vaccine schedule.
Seroconversion rates at 24 months among 1512 vaccinated women in the immunogenicity sub-study were 96, 97, 99, and 68 percent for HPV types 6, 11, 16, and 18, respectively.

The FUTURE 1 trial ? A similarly designed phase III placebo-controlled trial was conducted in 5455 women aged 16 to 24 years to assess the efficacy of quadrivalent vaccine to prevent HPV-related anogenital disease (FUTURE I) . The majority of the study participants were from Latin America (41 percent) or North America (29 percent). Women with greater than four lifetime sexual partners or a history of any genital warts or abnormal cytology were excluded from the study. Evidence of past or current infection with one or more of the vaccine genotypes (HPV 6, 11, 16 and/or 18) as measured by serology and DNA detection in cervical specimens was found among women in the vaccine and placebo arms (38 and 42 percent, respectively) through one month follow-up after vaccination.

The primary aim of the trial was to determine vaccine efficacy in reducing the combined endpoint of incidence of anogenital warts, vulvar intraepithelial neoplasia (VIN) or vaginal intraepithelial neoplasia (VAIN) grades 1 to 3 or cancer associated with HPV 6, 11, 16, or 18. A secondary aim was to observe whether the administration of vaccine reduced the combined incidence of CIN grades 1 to 3, adenocarcinoma in situ, or cancer associated with vaccine-type HPV. After a mean follow-up of three years, the following results were demonstrated:

The vaccine was 100 percent effective in preventing anogenital disease in women who were "HPV-naive" (ie, no cases were identified in the vaccine group versus 60 cases in the placebo group).
Vaccine efficacy was 100 percent in preventing CIN grades 1 to 3 or adenocarcinoma in situ caused by the vaccine-type HPVs in those women who were "HPV-naive" (ie, no cases were diagnosed in the vaccine group, whereas 65 cases were diagnosed in placebo group).

refs

FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus to prevent high-grade cervical lesions. N Engl J Med 2007; 356:1915.
Garland SM, Hernandez-Avila M, Wheeler CM, et al. Quadrivalent vaccine against human papillomavirus to prevent anogenital diseases. N Engl J Med 2007; 356:1928.

Brown DR, Kjaer SK, Sigurdsson K, et al. The impact of quadrivalent human papillomavirus (HPV; types 6, 11, 16, and 18) L1 virus-like particle vaccine on infection and disease due to oncogenic nonvaccine HPV types in generally HPV-naive women aged 16-26 years. J Infect Dis 2009; 199:926.

Wheeler CM, Kjaer SK, Sigurdsson K, et al. The impact of quadrivalent human papillomavirus (HPV; types 6, 11, 16, and 18) L1 virus-like particle vaccine on infection and disease due to oncogenic nonvaccine HPV types in sexually active women aged 16-26 years. J Infect Dis 2009; 199:936.

most up to date info on safety

further research
a 2011 meta analysis of all 11 published studies on safety and efficacy

conclusion
Prophylactic HPV vaccines are safe, well tolerated, and highly efficacious in preventing persistent infections and cervical diseases associated with vaccine-HPV types among young females. However, long-term efficacy and safety needs to be addressed in future trials
(this is because the longest study is only at 6.4 years follow up and can not give info beyond that.) Be assured the research is continuing

Based on the information already obtained, we are highly unlikely to see the appearance of long term safety issues. Efficacy is predicted to last 15 years

Hope that overview helps you all to make your own informed decision

Thanks for the info PIMS. worth summarising I think:

There are over 100 types of hpv, 15 of them may cause CC if they cause cell changes that aren't treated.

It usually takes 20 years for CC to develop from HPV but we know it can develop faster (I'm surprised you were happy to quote that tbh PIMS) so smear tests are important to detect the pre-cancerous cells and prevent them from developing into cancer.

The cevarix vaccine offers protection (although it is not 100% guaranteed) against 2 of the strains of hpv that can cause about 70% of CC, as long as you haven't been sexually active before you have the vaccine. 30% of CC cases are caused by another 13 strains.

90% of hpv cases won't cause any problems and will resolve themselves without requiring treatment so just because you have hpv (which 80% of people will do at some time in their life) does not necessarily mean that you will have cell changes or that those cell changes will develop into cancer.

They aren't sure how long the vaccine will protect against the 2 strains for, at the moment they reckon 5 years.

We don't know what the longterm risks of the vaccine are yet but they don't think there will be any.

So it all really boils down to - If you want to get vaccinated and are happy to accept that there are risks (as with any vaccine, this one is no exception) and that there may be some that we don't know about yet then have it, if you aren't, then don't.

Whatever you decide to do make sure you get regular smear tests - they are the best way of preventing cervical cancer according to Cancer Research UK.

Also worth bearing in mind that there is no need to be rude, critical or judgemental because someone has looked at the information and has come to a different conclusion than you did.

Juule, interesting posts about gardasil/cevarix on their own actually leading to an increased incidence of CC. I can understand why if it means that false reassurance from the vaccine results in people not having regular screening. The trials that have been done to test effectiveness of the vaccine have meant that women have to have regular smears. In the general population people are probably more complacent so it will be interesting to see if the vaccine does actually have the expected impact or if the 'vaccine prevented cases' will be replaced by cases caused by the other strains due to people missing their smear tests because they (incorrectly) think they are completely protected against CC .

Not sure why you felt the need to post info on things I have given much more detail about.

I think the info as it has been written in the science papers is pretty comprehensive and objective. Don't think you need to give 'your spin' on it. I havent

Just summarising the main facts. Also worth pointing out that none of the information you have posted contradicts anything I have said despite your accusations.

I am surprised that you arewilling to accept it as accurate information when it does state that hpv usually takes 20 years to develop into cancer and when I mentioned that earlier you jumped on me because of your friend. Tbh it seems like you are just automatically disagreeing with anything I say and then posting sources that say the same thing anyway.

A summary is helpful to some of us.

Good tabs, hope the info helped :)

Glad it helped Tabitha :)

The DDs who are teens got it and youngest DD will in time. DS (age 18) will also be having it. I will be paying for gardasil as opposed to cevarix. This is what the DDs got.

Condoms do not prevent transmission of HPV.

Commitment to abstinence does not protect against rape.

The vaccine will not eliminate the need for annual or very regular pap smears.

bumbleymummy, thanks for the summary.

Condoms can prevent transmission of HPV actually, that's misleading. They don't always, so they can't be relied upon, but it's not true to say they don't ever.

I'm not sure it's a good idea to base a vaccination decision on the likelihood of your daughter being raped. I think that's rather dramatic and scare-mongering.

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

Actually, you are far more likely to be raped than to suffer any adverse reaction from a vaccine, even something very insignificant like soreness at the site of the jab. Scroll down to 'It's much more common than people think'.

Here is what the CDC has to say about condoms and HPV:
'Genital ulcer diseases and HPV infections can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered. Consistent and correct use of latex condoms reduces the risk of genital herpes, syphilis, and chancroid only when the infected area or site of potential exposure is protected. Condom use may reduce the risk for HPV infection and HPV-associated diseases (e.g., genital warts and cervical cancer).'

If you think condoms are going to be used by your DDs' partners consistently and correctly 100% of the time and none will ever tear, and if you are sure they will never be raped or subjected to forced sex or sex on terms that they do not agree with (i.e. without condoms) then by all means do not vaccinate.

I have deferred my decision on dd 12 having it this year. To my mind I have another couple of years to be sure and it also gives 2 more years for any potential problems with the virus to have been discovered. I am more worried about long term health issues and the fact that we won't know for a good 10 years if it actually works and cuts cc.
I question the 20 years development time though, as girls in their 20s have died from it.
Regarding the condom issue, surely it is the same percentage as failed condoms in the case of inwanted pregnancies, yes it happens but bot that often. We are also forgetting the fact that not all men have the virus, so you would have to be extremely unlucky to catch it via a failed condom and the man having hpv.

Worm, I think you need you need to be really clear on the actual stats. Condoms are 97-98% effective at preventing pregnancy. They are less than 70% effective in preventing HPV.
It is also estimate that 90% of the population will catch HPV at some point in your life.

Would you put ur faith completely in a contraceptive method that failed on more than 1 in 4 occasions???

I don't think this is a case of being
unlucky. It is the most commonly transmitted STD and the most difficult to prevent. You don't even need to have penetrative sex to catch it. ANY skin to skin.
Even if your dd has only had one partner, he may have had two, who in turn have had three. From this you can see how even a single exposure to a single person is risky. If any of those 9 people have hpv, it is easily transmittable to ur dd.

The vaccine studies ongoing show there are no signs of declining immunity.
It is 95-100% effective in preventing the HPV virus that causes 70-80% of cancers.
There are no increased risk of serious side effects with either vaccine.
Gardisil is 90% effective I'm preventing the strain that causes genital warts.
Thousands of woman have been studied. Millions and millions of woman/girls have had it.
hth

I havn't said dd won't have it, she will have it aged 14 provided no negative side effects, short or long term come to light in that time. I havn't had the jab. I think you are being a bit hysterical to be honest.

Not hysterical. Just factual. It would be wrong to base a decision on information that's not true.
You compared condoms giving the same efficacy of protection against pregnancy and HPV, that's just not true they are no where near that effective.

My best friend died from a preventable form of cervical cancer in her mid twenties having only had two partners in her life.
I agree that the chances of young girls developing cancer from this are small But they are significant . In 2007 there were 25,033 new registrations of carcinoma in situ of the cervix uteri in the UK. Most (23,791 - 95%) cases are registered in women under 45, with peak incidence in the 25-29 age group.
this cancer caused 273000 deaths world wide last year.
Regardless of the cancer stats The chances of catching hpv are very high (90%)
I don't think it is fair to dismiss the 'luck' of those diagnosed as minimal.
In your lifetime the risk of getting cervical cancer is one in 136. That's quite a significant risk that can be reduced with the vaccine and regular pap smears
Again, I'm not hysterical, just unfortunately very aware of the dangers and real risks of this horrible disease

Where did the % figure for the number of hpv virus' caught via a condom mistake come from? As I am questioning how that information can be gathered?
I am sorry you lost your friend. Have you had the vac?