HPV Vaccination Recommendation for Boys

The CDC’s Advisory Committee on Immunization Practices (ACIP) released recommendations for boys and the HPV vaccine yesterday. In order to reduce risk of acquiring genital warts, in 2009 the ACIP advised that the vaccine may be administered to males aged 9 through 26, however they did not recommend the vaccine for routine use. The unanimous recommendation now states routine use of Gardasil for 9- 21-year-old males as worthwhile in preventing cancer.

Despite these expert recommendations, debate over the vaccine still exists, even for girls. Fear of short and long-term side effects and efficacy has framed the controversy over the drug, as well as mandate and cost concerns. In fact, the three recommended shots cost $100 each, making it the most expensive immunization currently in use; generic versions are not projected to enter the market until 2015 or later. However, The Affordable Care Act signed into law mandates that immunizations recommended by ACIP prior to September 2009 include no cost-sharing requirements.  Recommendations made after 2009 (including the HPV vaccine for boys) will be required to be covered without cost-sharing in the next plan year that occurs one year after the date of the proposal. The group facing the largest barriers in receiving the vaccine include women 21 years and older, due to the fact that the Medicaid Early and Periodic Screening and Diagnostic Treatment (EPSDT) Benefit is for males and females under age 21. Vaccines covered by Medicaid are decided on a state by state basis (in 2009, only 28 states covered the HPV immunization for women).

Other debates surrounding the vaccine include promoting sexual activity of adolescents, and claims of its safety. The media and incorrect claims made by public figures continue these controversies, despite research proving otherwise. Providing accurate information on the vaccine in addition to the ACIP’s recommendations will help prevent deaths and unwarranted conditions from occurring.  Currently, HPV is the most common sexually transmitted disease with 75% – 80% of females and males in the United States infected at some point in their lives.

From the Lancet: estimated incidence of HPV among men

As several news sources are now reporting, results from a cohort study funded by the National Cancer Institute note that 50% of a recent study’s participants tested positively for HPV at enrollment.

Okay, that’s not quite what they’re saying. But they aren’t epidemiologists, are they?

The cohort study, conducted by researchers at the H. Lee Moffitt Cancer Center and Research Institute, gathered biomedical evidence from 1159 men (aged 18 to 70) living in Brazil, Mexico, and the United States.  I’m not quite sure how they sampled this population — the Lancet article is so fresh-off-the-press (3/1/2011) that I can only access the abstract — but it does suggest a convenience sample, “recruited from the general population, universities, and organised health-care systems” and otherwise healthy.

Researchers assessed this cohort’s health every six months for multiple years, and found an incidence rate of 38.4 per 1,000 person months (CI between 34.3 and 43). Their research also describes risk factors we’ve seen before: HPV was associated with both higher number of lifetime female sexual partners and anal sex with male partners.

If these numbers are an accurate reflection of HPV at the population level — and they probably are –  well, even more reason to have your children (female and male) vaccinated. When will the American Cancer Society, ACOG, and the ACIP update their recommendations accordingly?

You’re getting your flu shot… Right?

With flu season upon us, Adam Ruban’s piece for NPR hit a nerve for this reader. As Ruban notes, “tens of millions” of expired H1N1 vaccine were destroyed this past summer — meaning that millions of Americans decided to forgo vaccination and take their chances with a potentially deadly flu strand. According to the CDC, H1N1 was responsible for approximately 274,000 hospitalizations and and 12,470 deaths between April 2009 and April 2010.

Those of us who chose not to vaccinate — and who were lucky enough not to contract H1N1 — have something called “herd immunity” to thank for our health. Basically, susceptible people rely on vaccinated people to stay healthy. Plenty of healthy people in America are now taking advantage of herd immunity, or at least, trying to.

In 2005, for example, an outbreak of measles — a disease once considered eliminated from America — infected 34 individuals in a small town in Indiana just a few miles from where I grew up. The cost of treating those individuals was $167,685, or $4,932 per patient. In 2008, a child in San Diego inadvertently infected an additional 11 children. The total cost for that outbreak? $10,376 per child.

Clearly, the costs of not vaccinating are high. So why don’t we vaccinate?

Okay, it’s not just Jenny. Although there is no scientific evidence to suggest a link between thimerosal and autism, plenty of parents think otherwise. And media blitzes like this one add fuel to the fire:

It’s playing at movie theaters in big cities starting today — have you seen it yet?

Don’t let the glitzy ads fool you. The flu vaccine is safe. It’s safe for most populations, including infants, pregnant women, and the elderly.

It’s also free for UMN students, staff, faculty — and their families — at Boynton’s convenient walk-in clinics.  So what are you waiting for?

The Vaccine Controversy

Given the increasing number of H1N1 illnesses and associated deaths reported by the CDC–including nine confirmed deaths among children for the week of October 11-17, 2009–this article on swine-flu parties in Bio-medicine sent chills down my spine:

“These are parents who are reportedly arranging swine flu ‘parties’ — similar to chicken pox or measles parties — so their healthy children can be exposed to the virus through kids who are already sick with the H1N1 flu.”

Experts agree that this is a terribly dangerous idea– particularly given the high number of hospitalizations of children with H2N1. For more facts on the swine flu, visit the CDC’s Q&A page (also available in Spanish, French, Russian, and Arabic).

And for a through explanation of vaccine fears, see Wired magazine’s “H1NL Flu Shot: 3 Major Fears Debunked,” available here.