Does anyone know about HPV shot?

[Bellatrix]

Earlier today I was dicussing some health concerns with a friend who has a seventeen year old. Her daughter wanted to get the HPV vacine, but the doctor said he could't give it to her becouse she's not a virgin. It seems a little odd to me that if she's clean she can't get this shot and save her self some heart ache and possiably cancer. Does anyone know if there is a way my friend or her daughter can fight this?

[skeptigirl]

What a poorly informed doctor. Was he being moralistic or what?

HPV vaccine main page, CDC (http://www.cdc.gov/nip/vaccine/hpv/default.htm)

ACIP -> HPV (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5602a1.htm?s_cid=rr5602a1_e)

The ACIP is the national Advisory Committee for Immunization Practices, which is the vaccine authority for the USA.


HPV Prevalence and Incidence in the United States

Overall in the United States, an estimated 6.2 million new HPV infections occur every year among persons aged 14--44 years (1). Of these, 74% occur among those aged 15--24 years. Modeling estimates suggest that >80% of sexually active women will have acquired genital HPV by age 50 years (56).

Routine reporting of HPV does not exist in the United States. Information on prevalence and incidence has been obtained primarily from clinic-based populations, such as family planning and sexually transmitted disease or university health clinic patients. These evaluations have documented prevalence of HPV DNA ranging from 14% to 90% (57). Prevalence was highest among sexually active females aged <25 years and decreased with increasing age (31,32,58,59). Data from a multisite, clinic-based study of sexually active women in the United States indicated that prevalence was highest among those aged 14--19 years (60).

Two studies have reported prevalence in representative, population-based samples. In a study of sexually active women aged 18--25 years, prevalence of any HPV was 26.9% (33). Prevalence of types 6 or 11 was 2.2%, and prevalence of types 16 or 18 was 7.8%. In a study of females aged 14--59 years during 2003--2004, the prevalence of any HPV was 26.8% (61). Prevalence was highest among women aged 20--24 years (44.8%). Overall, prevalence of types 6, 11, 16, and 18 was 1.3%, 0.1%, 1.5%, and 0.8%, respectively.

Few data exist on cumulative risk for HPV infection. Detection of HPV DNA indicates infection and does not provide information on women who were infected but cleared the HPV. Seroprevalence data can provide a better estimate of cumulative risk but will also be an underestimate, because not all persons with natural HPV infection have detectable antibodies. In a representative sample of women aged 20--29 years in the United States, HPV 16 seroprevalence was 25% (62). Because as few as 60% of those infected with HPV have detectable antibodies, the seroprevalence is an underestimate, and true exposure to HPV 16 could be as high as 41% among women in that age group. Data also are available from the quadrivalent HPV vaccine phase III trials, in which both HPV PCR assays on cervical specimens and serologic tests were performed at enrollment. Participation was restricted to sexually active women who had no more than four lifetime partners or were planning sexual debut. Among 5,996 North American females aged 16--24 years, 92% were sexually active, and the median number of lifetime sex partners was two; 24% had evidence of previous or current infection with HPV 6,11,16, or 18 on the basis of serology and/or PCR at the time of enrollment; four (0.1%) had evidence of infection with all four vaccine types (Merck and Co., unpublished data, 2006).

Studies of incident HPV infection that have evaluated HPV DNA detection over time demonstrate that acquisition occurs soon after sexual debut. In a prospective study of college women in the United States, the cumulative probability of incident infection was 38.9% by 24 months after first sexual intercourse. Of all HPV types, HPV 16 acquisition was highest (10.4%); 5.6% had acquired HPV 18 (26).

HPV infection also is common among men (63--67). Among heterosexual men in clinic-based studies, prevalence of genital HPV infection often is >20% and is highly dependent on the anatomic sites sampled and method of specimen collection (64,66,67).


Efficacy in Females with Current or Previous Vaccine HPV-Type Infection

Because participants were enrolled into the clinical trials even if they were HPV DNA or antibody positive, evaluating efficacy in females infected with a vaccine HPV type at the time of vaccination was possible. Overall, 27% of the study population had evidence of previous exposure to or infection with a vaccine HPV type. Among these participants, 74% were positive to only one vaccine HPV type and did not have evidence of infection with the other three types. Among participants positive to one or more vaccine HPV types, the vaccine had high efficacy for prevention of disease caused by the remaining vaccine HPV types (112).

The vaccine's impact on the course of infection present at the time of infection was evaluated using data from four clinical studies (protocols 005, 007, 013, and 015). Three different groups were analyzed on the basis of antibody and HPV DNA detection at the time of vaccination (Table 5). Among persons seropositive to the relevant HPV type but HPV DNA negative, efficacy against CIN 2/3 or AIS caused by that type was 100% (CI = -63.6%--100%). Among women who were HPV DNA positive but seronegative, efficacy was 31.2% (CI = -4.5--54.9). Among women who were both seropostive and HPV DNA positive, efficacy against CIN 2/3 caused by that type was -25.8% (CI = -76.4%--10.1%). Because of the small numbers and wide confidence intervals around efficacy estimates, limited conclusions can be drawn from these estimates.


Catch-Up Vaccination of Females Aged 13--26 Years

Vaccination also is recommended for females aged 13--26 years who have not been previously vaccinated or who have not completed the full series. Ideally, vaccine should be administered before potential exposure to HPV through sexual contact; however, females who might have already been exposed to HPV should be vaccinated. Sexually active females who have not been infected with any of the HPV vaccine types would receive full benefit from vaccination. Vaccination would provide less benefit to females if they have already been infected with one or more of the four vaccine HPV types. However, it is not possible for a clinician to assess the extent to which sexually active persons would benefit from vaccination, and the risk for HPV infection might continue as long as persons are sexually active. Pap testing and screening for HPV DNA or HPV antibody are not needed before vaccination at any age. Prevalence might differ in different countries but the recommendation is to vaccinate even if previously exposed. And a 17 yr old is a PRIME CANDIDATE for the vaccine, especially one who is sexually active. That is the age many infections are acquired. The parents should not wait another day. And they should take the ACIP recommendations in to the Dr's office and educate that provider.

Is your friend in the US? If so, the doctor is negligent if not following the ACIP guideline. Other countries have their own rules obviously. If they are not comfortable telling the doctor he is wrong, and they are in the US, I recommend letting the local Public Health infectious disease department know the doctor is incorrectly following the ACIP and ask them if they might send correct information to the doctor.

BTW, I'm debating suggesting my son get the vaccine. Unfortunately the reason it isn't yet recommended for boys is there hasn't been the studies done yet so there is essentially no data to make a recommendation on. But theoretically, it should be beneficial to vaccinate males. I'm not suggesting anyone else follow that plan, people need to decide for themselves. But I thought I would share my thoughts on it.

[UnrepentantSinner]

Does anyone know if there is a way my friend or her daughter can fight this?

Yes. Go find another doctor... Alternately contact Planned Parenthood.

[Katana]

I have nothing to add to what skeptigirl posted except to say that your friend's daughter is certainly a candidate for vaccine. That she is not a virgin is a ridiculous justification for denying it to her. I'm wondering what type of doc this is - is it an ob/gyn, pediatrician, or family doc? I would hope that an ob/gyn would know better, but you never know.

Your friend could always go back with the info that skeptigirl provided. Ideally, she would be doing a favor to the doc's future patients provided that the information actually influences him/her.

Or, as US suggested, she could find another doc. At 17-years-old, your friend's daughter should probably establish care with an ob/gyn anyway if the doc in question is of from another field.

[Bellatrix]

Thanks for the information! I'll be sure to give the information that skeptigirl provided to my friend. Urepentant and Katana thanks to you too. :)

[Bellatrix]

Thanks for the information! I'll be sure to give the information that skeptigirl provided to my friend. Urepentant and Katana thanks to you too. :)

sorry double post.