Just when my now teenage daughter thought she was finished with shots, BOOM, another one!!  I do a thorough evaluation of new immunizations before giving to my children or my patients because I know that like any medication or procedure, there are risks. The Human Papilloma Virus vaccine was introduced in 2006 and the current recommendation from the Center for Disease Control (CDC) is that boys and girls should be given the shot series at 11 years old.  What is HPV and what diseases are associated with it? Are there different kinds of HPV vaccines?  What are the safety concerns for the vaccine?  At what age should you give your child the HPV vaccine?

1.  What is HPV?

HPV stands for Human Papilloma Virus. It is the most common sexually transmitted infection.  Approximately 20 million Americans are currently infected with HPV. It is so common that at least 50% of sexually active individuals will be infected at some point in their lives.  Certain types of HPV can cause cancer, including: cervical, vulvar, vaginal, penile, anal, and oropharyngeal (base of the tongue, tonsils and back of throat) cancers. HPV is also responsible for most cases of genital warts in men and women.  HPV is the main cause of cervical cancer in women which causes about 4,000 deaths in women each year in the United States.

There are two HPV vaccines currently licensed for use in the U.S., Cervarix and Gardisil.  Gardasil protects against more of the HPV types and can be used in boys. More information can be found on the CDC’s website.  

2.  What is the current CDC recommendation for HPV vaccine?

CDC recommends that all 11 or 12 year old girls get 3 doses of one of the HPV vaccines (either Cervarix or Gardisil).  A girl or young woman can be vaccinated through the age 26 if they have not received any or all doses when they were younger. CDC recommends Gardasil for all boys aged 11 or 12 years, and for males aged 13 through 21 years, who did not receive the vaccine when they were younger. The vaccine may be given to young men age 22-26 based on their doctor’s discretion.

3.  I don’t plan on my child engaging in sexual activity at 11, why not wait until they are older?

There are a few considerations when you are deciding what age to give the HPV vaccine.  First, all three shots should be given well before any sexual activity begins. Remember that oral sex can also transmit HPV.  Additionally, a better antibody response is achieved when given early.  Some parents worry that giving the HPV shot is giving their child permission to have sex.  I think that as long as you have had an active dialogue regarding the risks of sexual activity (pregnancy, other sexually transmitted diseases, emotional vulnerability) then your young adolescent will understand that this is only one aspect of protecting themselves.  If you need help with this conversation visit my post, “The Time for the Talk is NOW!”.

4.   What are the risks of the HPV vaccines?

The HPV vaccine safety evaluations were based on over 23 million patients who had received the vaccination. The most common adverse reactions are:

• Fainting
• Local reactions at the site of immunization (pain and redness)
• Dizziness
• Nausea
• Headache

Some of the data suggested an increased incidence of blood clots for individuals receiving the HPV vaccination. Of the people who had blood clots, 90% had a known risk factor for them, such as smoking, obesity or taking birth control pills.  Studies are ongoing to determine if this is a causal relationship.

An evaluation of 600,000 people who received Gardisil determined that there was not significant increase in  Guillain–Barré Syndrome (GBS), stroke, appendicitis, seizures, syncope, allergic reactions, or anaphylaxis after vaccination.

Vaccine reporting systems are inherently flawed because they rely on self reporting and do not prove causality.  However there was a very large study review done that compared data between women that received vaccine and women who did not.  This study review showed no increase in adverse events.  You can read the original study here.  However, I found this visual representation very clear and concise. (Look under “It’s the needle people”).

More on safety.

5.  If my adolescent practices safe sex practices, will they be protected?  

Ok, let’s be honest, what percentage of people (especially adolescents) practice safe sex ALL the time for their WHOLE life.  Even if you think you know your partner and your partner’s sexual history, your partner can be infected with HPV (and spread it to you) without even knowing it!!  This includes both sexual intercourse and oral sex. Additionally, condoms do not completely protect from transmission of HPV.

What is the bottom line for me?

Bottom line is that NO vaccine is completely risk free.  When I look at the numbers and compare the risks of the vaccine to the lifetime risk of genital warts and cancers associated with HPV, I am willing to give the vaccine to my children.

Related articles

• Teens who don’t have sex still at risk for HPV (msnbc.msn.com)
• HPV and head/neck/throat cancer [erv] (scienceblogs.com)
• Herd Immunity In Action: HPV Vaccine [erv] (scienceblogs.com)
• Oral HPV More Common in Men than Women (New York Times)