To not let dd have the HVP vaccination?

[DogGoneMad]

Dh and I really disagree on this.

Pims: there's nothing to take outside: all I ever wanted to talk about was the issue. You introduced playground politics when a couple of posters came along who could seriously challenge your assesment -- and now you're trying to play the innocent.

Please don't do this, not on this thread or in the future. It could all be so much more valuable.

BB, please find something relevant to contribute

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. (See "Patient information: Cervical cancer screening".)

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.

he 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) [9]. 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 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 to make your own informed decision

I've been mentally modifying the 'puberty talks' to have with my kids.... "...wait until you are ready, always wear a condom...and don't ever, ever date the children of non-vaccinators."

LOL loving the other frequently seen old chestnut when people disagree with you- cry troll [fecking bemused face]

Yet again; it is Women that are being made fundamentally responsible for sexual health..
When exactly will Men join the party ?

Obviously large amounts of helpful information have already been posted by bubbley.

The most important worries are extent and length of coverage: the risks of the vaccine: and concerns that women may be "over-reassured" by a vaccine thus leading to a failure to attend smears.

Accompanied, of course, by the undeniable fact that regular and more frequent smears than are currently offered with still be recommended, even with the vaccine. Women might therefore consider a frequent smear programme to be an effective preventative when weighed against risk. Links I posted earlier detail some of the adverse events reports - which despite what Pims says are not all individually investigated.

I will copy and paste an article linked to on another thread. I'm sure the poster won't mind. Please note it refers to Gardasil and not Cervarix. Dr Harper is not "against" the Gardasil vaccine.

"?The side effects that have been reported are real and they cannot be brushed aside.?

That quote, from Diane Harper, M.D., might mark a turning point in the way the medical mainstream perceives Gardasil, the controversial vaccine for human papillomavirus (HPV). Dr. Harper is part of that mainstream. In fact, she was one of the principal investigators in the initial Gardasil trials. But she hasn?t been timid about recognizing Gardasil?s dangers.

More than a year ago, HSI writer and researcher Michele Cagan interviewed Dr. Harper, who revealed a surprising fear about the way Gardasil might influence women?s health habits. This is an excerpt from that interview.

?Even though Dr. Harper believes in the vaccine, she does not think it should be mandated for young girls. She also told me about several concerns she has surrounding public perception of the vaccine, including this stunner: Dr. Harper is afraid that the way the vaccine is being presented could actually have the effect of increasing the rate of cervical cancer in the U.S.

?Why is Dr. Harper afraid of this outcome? ?Because of the way the vaccine is being advertised and portrayed in the media. The vaccine is not a silver bullet. It can?t clear up an existing HPV infection, and it can?t cure cervical cancer. But the advertising doesn?t make that very clear.? If women think the vaccine offers 100% protection ? or, even worse, can cure the virus or the cancer ? they may skip their annual Pap tests, and that could very well lead to an increase in cervical cancer rates.

?Another gray area is the duration. It appears to remain effective for at least five years, but we have no idea how long it will last in the real world. And that could mean that girls vaccinated at 11 or 12 actually lose protection when they?ll need it most ? but it?s impossible to know that until after large numbers of vaccinated girls contract the virus.

?Here?s another little tidbit the advertising fails to mention ? but it?s a critical point. If a girl already has an HPV infection, the vaccine won?t work. I asked Dr. Harper if that was only true for the strain in question, but it?s not. ?If someone has HPV 18, for example, the vaccine won?t provide any protection for that strain, or full protection for any of the other strains.? And since millions of women have HPV, millions of women could be getting vaccinated for nothing. Except side effects, that is?

I will also copy and paste the thoughts of Dr Harper on the benefit-risk balance of screening-vaccination -- I'm sure the other poster won't mind. I think they're very interesting.

"" The Benefits of Pap Screening:
? Individual benefit to detect early precancers.
? Public health benefit: Only when 70% of the population has been screened will the population incidence of cervical cancer drop.
? Pap tests do not kill or handicap.

The Harms of Pap Screening:
? Screening must be repeated throughout a woman's life. One screen is not sufficient to protect her from cervical cancer.
? False negative rate of cytology screening: Among the women who develop cervical cancer in the U.S., 30% are women who have been routinely screened, and all their Paps have been normal.
? False positive rate of cytology screening: Women who screen abnormal are psychologically upset, anxious and left doubting the medical process (i.e. Her Pap was abnormal, but her colposcopy and biopsy were normal, with no explanation why her Pap was abnormal).
? Quality of life harms: Women with abnormal Paps have anxiety as high as women diagnosed with cervical cancer undergoing their surgical treatment. The stress of going to colposcopy and biopsy can be high for many women. The contemplation of a cervical biopsy and a scraping of the endocervical canal can lead to fear of pain.
? Relationship harms: Once women are told they have an abnormal Pap and that the Pap is abnormal because of a STD called HPV, most relationships are stressed as the partners attempt to understand who brought the infection to the relationship.
? Excisional treatments for detected precancerous lesions cause preterm deliveries in subsequent pregnancies, with concomitant low birth weight infants (which puts the infant at risk for life). In addition, scarring from the treatments lead to an increased cesarean section delivery method (as the cervix does not dilate normally due to scarring from prior excisions). These reproductive morbidities occur between 70%-300% more often in women with excisions.
? Recurrence of HPV associated cervical/vaginal/anal cancers at a rate of 3-12 times higher than those women who never had a cervical cancer precursor or cancer. These recurrences happen around ten years after treatment with peak recurrences between ten and twenty years from the initial treatment.

The Benefits of HPV vaccination:
? Cervarix protects against five cancer-causing types of HPV, which lead to CIN 2+ (precancers and cancers).
? Gardasil protects against three cancer-causing types of HPV, which lead to CIN 2+ (precancers and cancers).
? Cervarix induces antibody titers for HPV 16 and 18 that are at least ten fold higher than natural infection titers; the antibody titers for the other three cancer causing types (HPV 31, 45, 33) are also significantly higher than natural infection titers, and the titers stay high for at least 7.4 years - lasting the longer of either vaccines.
? Gardasil only maintains antibody titers for HPV 16 (not 18, not 11, not 6) at five years, making the true long lasting (five years) coverage of Gardasil only for one type of cancer causing HPV.
? If vaccination occurs within one year of the onset of sexual activity, there will be 57/1000 cases of all CIN 2+ types and persistent HPV 16/18 infections prevented, as compared to only 17/1000 cases prevented if virgins are vaccinated.

The Harms of HPV Vaccination:
? Duration of efficacy is key to the entire question. If duration is at least fifteen years, then vaccinating 11-year-old girls will protect them until they are 26 and will prevent some precancers, but postpone most cancers. If duration of efficacy is less than fifteen years, then no cancers are prevented, only postponed.
? Safety: There is at least one verified case of auto-immune initiated motor neuron disease declared triggered by Gardasil [presented by neurologists at the 2009 American Neurological Association meeting in Baltimore, Maryland). There are serious adverse events, including death, associated with Gardasil use.
? No population benefit in reduction of cervical cancer incidence in the United States with HPV vaccination as long as screening continues.
? Incidence rate of cervical cancer in the United States based on screening is 7/100,000 women per year.
? Incidence rate of cervical cancer if women are only vaccinated with Gardasil is 14/100,000 per year (twice the rate of cervical cancer if young women vaccinated with Gardasil do not seek Pap testing at 21 years and the rest of their life).
? Incidence rate of cervical cancer with Cervarix vaccination is 9/100,000 per year-- better than with Gardasil, but still more than with screening alone.
? Incidence of cervical cancer without screening and without vaccination is nearly 90/100,000 per year. The combination of HPV vaccine and screening in the U.S. will not decrease the incidence of cervical cancer to any measurable degree at the population level. Those women who do not participate in Pap screening, and who are vaccinated, will have some personal benefit for five years for Gardasil and 7.4 years for Cervarix (maybe longer), but they will not affect the population rates.

Boosters for Gardasil after antibodies wane makes the cost of vaccination escalate significantly, and cause implementation challenges to reach those women who might want to be revaccinated."

With thanks to that poster. This appears on the other HPV thread running at the moment.

AW dam right my DD will be responsible for her own sexual health! Just as my DS will be for his, in whatever form that takes.

I look forward to when the HPV vaccination will be offered to both, just as the Rubella is offered to both now, to protect unborn babies. But I don't see an issue with the delay...there's been a backlog of girls!

Erm, so blueberries, so young girls should have the vaccine but be also told to have regular smears....... yes isn't that what Pims has been arguing?

If I had girls, I'd get them vaccinated but also encourage them not to be sexually promiscuous, practise safe sex and have regular smears.

This is an article from Medscape. I'm so sorry I have to have this long post - but I've realised the Medscape link doesn't work unless you're a member. It's easy and free to join if you want to read it "in situ".

Please note: some of this article will refer to Gardasil: however I've deleted a large section referring to criticism of aggressive Gardasil marketing as it's irrelevant to the UK.

HPV Vaccine: Debate Over Benefits, Marketing, and New Adverse Event Data
Zosia Chustecka

Download NowAugust 18, 2009 ? The benefit of vaccinating against human papilloma virus (HPV) to prevent cervical cancer is questioned in an editorial in the Journal of the American Medical Association.

"The theory behind the vaccine is sound: if HPV infection can be prevented, cancer will not occur," writes editorialist Charlotte Haug, MD, PhD, from the Journal of the Norwegian Medical Association. "But in practice, the issue is more complex."

HPV is the most prevalent sexually transmitted infection, "but the virus does not appear to be very harmful because almost all HPV infections are cleared by the immune system," she explains. In a few women, the HPV infection persists, and some women may develop precancerous cervical lesions and eventually cancer, Dr. Haug writes, "but it is currently impossible to predict in which women this will occur."

The net benefit of the HPV vaccine to a woman is uncertain.
"The net benefit of the HPV vaccine to a woman is uncertain," Dr. Haug comments. "Even if persistently infected with HPV, a woman most likely will not develop cancer if she is regularly screened [with cervical smear tests]."

Dr. Haug has spoken out against HPV vaccination previously. Last year, she urged caution over widespread vaccination programs in an editorial in the New England Journal of Medicine (2008;359:861?862), as reported by Medscape Oncology at the time.

This latest editorial accompanies 2 articles published in the same issue of JAMA. One of the articles is critical of the marketing of the HPV vaccine Gardasil (Merck & Co) in the United States, and the other details adverse events that have been reported with the vaccine since it was launched there in 2006.

Dr. Haug comments that, in view of the uncertain benefit from the HPV vaccine, "only a small risk of harmful effects from the vaccine" is acceptable.

The balance between the risks and benefits of HPV vaccination should rest only on medical and scientific evidence, Dr. Haug states.

However, she warns that this balance is "easily skewed" if other matters weigh in; for example, profit for a company or gains for physicians ? issues that are explored in the article on marketing.

"The balance will also tilt if adverse events are not calculated correctly," Dr. Haug comments, and her editorial points out limitations of the system used for collecting adverse event reports.

so young girls should have the vaccine but be also told to have regular smears..

Yes, this was pointed out by bubbley quite early on in the thread. Pims later agreed with her but has been insistent that frequent and earlier smears could not have helped her friend.

The point for women who are deciding is that -- given that regular and frequent smears will still be necessary even with the vaccine, and given that risks are still unclear, six monthly smears would be an effective cancer prevention tool.

smears are not offered at 6 monthly intervals on the NHS.

I do not see the objection to a multi pronged attack on HPV.

I do not see that your argument is one against vaccination as such

No, absolutely, they aren't offered. They're not offered now until 25. This is very likely because of the protection it's believed the vaccine offers. However as Cervarix in particular protects against only two strains it will still sadly be possible for a woman to contract HPV, develop pre-cancerous cell changes, develop cancer and die before she is offered her first smear.

As I said, way, way back in this thread I am lucky enough to be able to pay for smears for my daughter if they aren't available at six monthly intervals "on demand".

This is really an explanation of why I'm not choosing vaccination for my daughter. I'm not one of those who tells people what to do - you'll never see me saying "if you love your daughter please, please don't give her this jab". It seems intrusive. However there ought to be more of a balance of information out there so that women know that they're making a fully informed choice.

Migrating : wrt your last comment. I'm against the aggressive mass marketing of this vaccine and the apparent rationing of service which appears to be operating alongside it. If people want to vaccinate their daughters it's not up to me to tell them not to: but I will say - I would and will not do that and this is why. It's not really anti-vaccine: it's against the emotional blackmail, aggressive mass distribution and failure to investigate adverse events reports.

Sorry I mean - no they're not offered at 6-monthly intervals, and not offered at all until the age of 25.

but there was always an age at which it was offered, starting in the early twenties, even back when I was younger. Nothing to do with the vaccination IMO.

I can understand people imploring parents to have the vaccination if, like many here, they have been through some personal experience of the horrors of cervical cancer.

And people also have the right to implore, given this was invited by the OP in the first place.

We all have a right to express our own opinions here and respect all others who express theirs, even if they differ.

It was recommended when I was at university, so from eighteen. It has been pushed back. Not sure why you think that is nothing to do with the vaccination?

I agree with your last statement: I think it's probably better addressed to Pims, Bimbo, and Whatmeworry, who have to be asked repeatedly not to bring threads down into personal abuse and insult and move back to the topic.

Of course people have the right to implore: it's a free country and an open forum. And this would also give me the right to say that "if you love your daughter, please, please vaccinate her" constitutes emotional blackmail. I doubt me saying "please for God's sake if you love your child don't vaccinate her" would be construed as anything other than irresponsible.

And I think, migrating, that you seem to be breaking your own rules. Better to stick on topic.

If my DD hadnt of died of cancer I would have her vaccinated.

sorry, you lost me there on your last post. I was simply responding to this in your post:

I'm not one of those who tells people what to do - you'll never see me saying "if you love your daughter please, please don't give her this jab". It seems intrusive

Op invited opinion, is all I am saying. But we seemed to be agreement on the idea of informed debate...so lets leave it there.

Yes sure. I don't have a problem with people giving their own stories, of course not - in fact I've said many times on this thread and previous threads that personal experience is very valuable in decision-making of this kind. But that's different to telling people what to do and saying that if they don't, they can't love their children.

And yes, I thought your post earlier was a good one although we seem to be on different sides of the fence.

Mrs dVere I'm very sorry about your daughter, a terrible sorrow to bear, unbearable.

It was recommended when I was at university, so from eighteen. It has been pushed back. Not sure why you think that is nothing to do with the vaccination?

because I think its to do with general NHS cutbacks and balancing limited funds

Actually we are both wrong, it seems.

"In 2003, screening in England was moved to start at 25 as it was felt it did more harm than good in younger women."

ex BBC