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Clinicians not recommending HPV vaccines enough to satisfy the CDC

The MPR Daily Dose website had an article on Sunday, July 27, 2014 titled Clinicians Not Recommending HPV Vaccine Enough to Parents. The article starts with a statement that doctors that have the opportunity to recommend the HPV vaccines are not promoting the available HPV vaccines to young females or males.

The debate continues regarding the safety of HPV vaccines
Photo by Handout/Getty Images

It may be that the medical profession is being more cautious than the FDA or the pharmaceutical manufacturers in promoting the vaccination designed to prevent the HPV virus from causing cancers in both females and males. There is clinical evidence that the probability of having a serious adverse reaction from the HPV virus may exceed the likelihood of getting cancer due to presence of HPV.

There is a high incidence of HPV in the US population. The following summary information is provided by the Center for Disease Control and Prevention (CDC) regarding the HPV virus. The CDC recommends that this vaccine be administered to girls and boys.

Approximately 79 million Americans are infected with human papillomavirus (HPV), and approximately 14 million people will become newly infected each year. Some HPV types can cause cervical, vaginal, and vulvar cancer among women, penile cancer among men, and anal and some oropharyngeal cancers among both men and women. Other HPV types can cause genital warts among both sexes. Each year in the United States an estimated 26,000 new cancers attributable to HPV occur, 18,000 among females (of which 11,500 are cervical cancer) and 8,000 among males (of which 5,900 are oropharyngeal cancers).

The CDC has a reporting system that identifies particular adverse effects from FDA approved drugs. Vaccine Adverse Event Reporting System (VAERS) has published the following data.

As of May 13, 2013, VAERS had received 29,686 reports of adverse events following HPV vaccinations, including 136 reports of death, 7, as well as 922 reports of disability, and 550 life-threatening adverse events.

One of the major issues with Merck’s testing done prior to the release of the HPV vaccine Gardasil was that it was not tested in combination with other vaccinations being done at the same time. The recent article complains that doctors are not taking advantage of the ability to administer HPV vaccine when doing other vaccinations.

Merck’s data used to get the initial approval of its HPV vaccine showed that women exposed to the specific strains of HPV that the vaccine treated were more than 44% more likely to get precancerous cervical lesions than those that did not have the HPV type 16 and type 18 strains. The FDA does not require pretesting of HPV strains before the three vaccinations for HPV are administered.

The CDC summarizes their position on Gardasil in a web posting of Frequently Asked Questions (FAQs).

Have FDA and CDC changed any recommendations for the use of HPV vaccines based on their vaccine safety monitoring?

Yes. When fainting (or syncope) was found to happen after vaccination, FDA changed Gardasil®’s prescribing information to include information about preventing falls and possible injuries from fainting after HPV vaccination. CDC consistently reminds doctors and nurses to share this information with all their patients.

CDC and FDA have reviewed all of the safety information available to them for both HPV vaccines and have determined that they are both safe. Gardasil® is safe to use for preventing HPV types 6, 11, 16, and 18, and Cervarix® is safe to use for preventing HPV types 16 and 18.

CDC continues to recommend the vaccination of 11 and 12 year old girls with 3 doses of vaccine to prevent the types of HPV that most commonly cause cervical cancer and genital warts. The vaccine is also recommended for girls and women ages 13 through 26 who did not get any or all of the doses when they were younger.

Additionally, Gardasil® protects males against most genital warts. This vaccine is also recommended and available for boys and men, 9 through 26 years of age.

The original article quoted by the electronic version of the MPR presents the pharmaceutical view of the problem with Gardasil. The adverse events reported after the administration of HPV vaccines is leading to the reluctance of doctors to recommend the HPV vaccine. There is a continuing debate regarding whether forced vaccinations should be administered despite parental opposition or without parental consent. The doctors are exercising their goal of doing no harm, and the continued evaluation of the risk versus the benefits of the HPV vaccine continues.