HPV vaccine for 6th graders??

[Mrs.JLam]

Hi all. Just wanted to get your thoughts on the potential Michigan legislation to require 6th grade girls to get an HPV vaccine before enrolling in school (added to the list of all the other vaccines kids need). I'm not sure exactly how I feel about it.

On one hand, I think it is a great move towards fighting a very deadly form of cancer. About a third of women who get cervical cancer die from it. And, it's something that can easily go undetected if you aren't getting regular exams, etc. So if it was my kid, even if I did think they weren't having sex or in sexual contact with other kids, I would probably be all for it. I would want to protect my child to the fullest extent.

But on the other hand, I'm not sure it's right to make it a requirement by LAW. It seems like parents should be given the option, and that the vaccine should be made readily available (a la the flu vaccine). However, to REQUIRE a parent to vaccinate their child against something that is only contracted by sexual contact is a bit presumptuous in my opinion. This isn't the same as measles or chicken pox that simple require you're in talking range with an infected child.

What are your thoughts???

[Skeptic Ginger]

Despite the terminology, required vaccines can still be declined without consequence unless an outbreak requires an unvaccinated child to stay home.

The system is geared for vaccines that prevent diseases kids spread to each other and classrooms are prime locations. So when the system of requiring vaccines for schoolchildren was initiated, the vaccines were important in that setting. Religious exemptions have always been allowed but if an outbreak of that disease occurred, your susceptible child would be kept home.

Recently a couple of vaccines have been added to the list that are for sexually transmitted infections like hepatitis B and now the HPV vaccine. Public health officials know if vaccines are not given as a required childhood vaccine, many many people just never bother to get them, even when they don't object. Since we all pay for the cost of the disease burden in various ways, it is in the public's interest to get as many kids vaccinated as possible.

So, anyone not wanting their child vaccinated can decline. Better to make declining the choice than to make accepting the choice. Makes a big difference. I'm probably going to ask if my HMO will let my son have the vaccine to protect any future partners.

[a_unique_person]

Originally Posted by Mrs.JLam

But on the other hand, I'm not sure it's right to make it a requirement by LAW. It seems like parents should be given the option, and that the vaccine should be made readily available (a la the flu vaccine). However, to REQUIRE a parent to vaccinate their child against something that is only contracted by sexual contact is a bit presumptuous in my opinion. This isn't the same as measles or chicken pox that simple require you're in talking range with an infected child.

What are your thoughts???

Well, of course, our kids could never get infected with HPV, they are good children.

[Jaggy Bunnet]

Originally Posted by skeptigirl

So, anyone not wanting their child vaccinated can decline. Better to make declining the choice than to make accepting the choice. Makes a big difference.

Provided the first sentence is true with no adverse consequences, I completely agree with the second sentence.

[Boo]

HepB is NOT an STD. Primary mode of infection is through blood and body fluids. Intercourse is but one means of acquiring but not the primary. It also happens to be very contagious, much more so then HIV.



Boo

[Jaggy Bunnet]

Originally Posted by Boo

HepB is NOT an STD. Primary mode of infection is through blood and body fluids. Intercourse is but one means of acquiring but not the primary. It also happens to be very contagious, much more so then HIV.



Boo

Out of interest, what is the primary means?

[Katana]

The HPV vaccine is one of the biggest developments in preventive health that we have seen in a long time. It would be silly to avoid taking advantage of it because the organism that it protects against is, in most cases, sexually transmitted. A young woman can be as responsible as she wishes, but she has no control over who her partner has been with even if she waits until marriage. This could save her from not only cervical cancer but from all of those pre-cancerous changes that send her for pap after pap and, potentially, treatments that could compromise her fertility down the road.

The argument that it may cause young women to be more promiscuous only holds water if you think that the threat of HPV is actually a deterrent, and I seriously doubt that it is. The theat of herpes and HIV, both incurable, would still be out there anyway.

[ponderingturtle]

Originally Posted by Mrs.JLam

Hi all. Just wanted to get your thoughts on the potential Michigan legislation to require 6th grade girls to get an HPV vaccine before enrolling in school (added to the list of all the other vaccines kids need). I'm not sure exactly how I feel about it.

On one hand, I think it is a great move towards fighting a very deadly form of cancer. About a third of women who get cervical cancer die from it. And, it's something that can easily go undetected if you aren't getting regular exams, etc. So if it was my kid, even if I did think they weren't having sex or in sexual contact with other kids, I would probably be all for it. I would want to protect my child to the fullest extent.

But on the other hand, I'm not sure it's right to make it a requirement by LAW. It seems like parents should be given the option, and that the vaccine should be made readily available (a la the flu vaccine). However, to REQUIRE a parent to vaccinate their child against something that is only contracted by sexual contact is a bit presumptuous in my opinion. This isn't the same as measles or chicken pox that simple require you're in talking range with an infected child.

What are your thoughts???

As there are other required vacines to attend school why do they have different legal standards?

[Beth]

Originally Posted by Mrs.JLam

Hi all. Just wanted to get your thoughts on the potential Michigan legislation to require 6th grade girls to get an HPV vaccine before enrolling in school (added to the list of all the other vaccines kids need). I'm not sure exactly how I feel about it.

On one hand, I think it is a great move towards fighting a very deadly form of cancer. About a third of women who get cervical cancer die from it. And, it's something that can easily go undetected if you aren't getting regular exams, etc. So if it was my kid, even if I did think they weren't having sex or in sexual contact with other kids, I would probably be all for it. I would want to protect my child to the fullest extent.

But on the other hand, I'm not sure it's right to make it a requirement by LAW. It seems like parents should be given the option, and that the vaccine should be made readily available (a la the flu vaccine). However, to REQUIRE a parent to vaccinate their child against something that is only contracted by sexual contact is a bit presumptuous in my opinion. This isn't the same as measles or chicken pox that simple require you're in talking range with an infected child.

What are your thoughts???

Same as yours.

[Roboramma]

There was a thread about this issue not too long ago. One of the points that I took away from it was the importance of herd immunity.

The more people are vacinated, the safer the non-vacinated become.

[mumchup]

I don't think the general mode of transmission should be the primary focus in this issue. The fact is that this vaccine can save people from a potentially fatal cancer. It's not like the vaccine is only good for a year. If your daughter becomes sexually active at 16, or 20, the vaccine she got in middle school will still protect her.
I am reluctant to agree that the govenment should be passing laws to force us to protect ourselves from harm but this case is a little like seatbelt laws: I find it kind of strange that anyone would disagree with taking advantage of something so convenient that could save their lives.

[ponderingturtle]

Originally Posted by Roboramma

There was a thread about this issue not too long ago. One of the points that I took away from it was the importance of herd immunity.

The more people are vacinated, the safer the non-vacinated become.

That is actualy why there is reduced danger for the anti vacination crowd because so much of the population is insulating them from their own stupidity,

[Zombified]

If I recall correctly, sexual contact is not the only means of HPV transmission (although it is the easiest). Anyone know more about this than me?

Also, sadly, contact and possible transmission is not always the girl's choice.

To me, the HPV vaccine is as valuable as any other vaccine, possibly more than many if you consider the possible consequences. To the extent that you're for vaccines in general you ought not exclude HPV.

Legally mandated vaccines vs. personal liberty is really something of a seperate issue; if its not right for HPV its pretty questionable for anything else. It only seems touchier in the case of HPV because some people freak out about sex and that makes the issue more emotional.

[Beth]

Originally Posted by Zombified

Legally mandated vaccines vs. personal liberty is really something of a seperate issue; if its not right for HPV its pretty questionable for anything else. It only seems touchier in the case of HPV because some people freak out about sex and that makes the issue more emotional.

I agree legally mandated vaccines vs. personal liberty is a seperate issue. However, I feel the primary method of transmission makes a big difference in discussing that issue. There is a very reasonable public health argument for mandating vaccination of the more casually transmitted diseases that does not apply to STDs.

[rebecca]

I totally got bloggy on this subject awhile back. I feel the same way today: children should not be forced to suffer and die for their parents' unsubstantiated beliefs.

[ponderingturtle]

Originally Posted by rebecca

I totally got bloggy on this subject awhile back. I feel the same way today: children should not be forced to suffer and die for their parents' unsubstantiated beliefs.

How else are parents supposted to win darwin award though?

[rebecca]

Originally Posted by ponderingturtle

How else are parents supposted to win darwin award though?

A little preplanning will allow them to take the castration route before the spawn are hatched.

[Beth]

Originally Posted by rebecca

I totally got bloggy on this subject awhile back. I feel the same way today: children should not be forced to suffer and die for their parents' unsubstantiated beliefs.

Indeed! How many children will suffer and die from cervical cancer before parents come to their senses? Given that cervical cancer is NOT a childhood disease, it seems to me your argument doesn't apply very well to this situation.

[mumchup]

I understand that it can be hard for parents to consider that some day in the future their little girl will be all grown up, doing grown up things. But the reason to give the HPV vaccine at such a young age is to ensure that everyone gets it BEFORE they might need it. Sure, middle school girls aren't getting cervical cancer, but without a vaccine some of those girls WILL get it in the following years.
As far as the idea that parents should wait and let the girls make that decision for themselves: When is that likely to happen? In high school when some of the more sheltered girls think that you can't get pregnant if it's your first time? In college when they're getting their first taste of complete freedom but their sense of mortality hasn't caught up yet?
It's just a vaccine... against a deadly cancer. I can't see how the STD angle could convince any parent not to take advantage of that opportunity to protect their child.

[Boo]

By mandating it by law allows for gov't subsidy for the cost of the vaccination. If it were optional odds are it would be priced beyond the means of most. This way it is available to all young girls.



(Primary mode of infection for HepB is blood)



Boo

[jmercer]

What Boo said.

(Beat me to it, Boo!)

[Beth]

Originally Posted by Boo

By mandating it by law allows for gov't subsidy for the cost of the vaccination. If it were optional odds are it would be priced beyond the means of most. This way it is available to all young girls.



(Primary mode of infection for HepB is blood)



Boo

This makes sense. It is the best argument for mandating it I've seen. I think it would be better to subsidize it without the mandate, but realisitically, that might not happen.

[bluess]

Having just jumped into parent mode, I think the advantage to a number of the mandated vaccines is giving new parents the knowledge they exist. I had NO idea there was an anti-chickenpox shot until the County gave me the listing of required vaccines. (Yeah, yeah, I don't know my medical terminology). I'm still not sure why there was a bout of chickenpox at Blue2's school, but she didn't get it.

And, yes, when she turns 11, she gets the new HPV vaccine. But it would nicer if it were funded by the state.

[Zombified]

I did a bit of Googling. Apparently there's some controversy over exactly how HPV can be transmitted other than sexually. Although HPV is basically an STD, some of the stuff I found indicated that HPV could be spread via non-penetrative sexual contact, because virus can be found externally. Some studies suggested that HPV could be found on hands and can be transmitted by non-sexual contact.

Here's one example page. I don't about this site but it references its sources. http://www.health-science-report.com...s=1&article=51

[Beth]

Originally Posted by Zombified

I did a bit of Googling. Apparently there's some controversy over exactly how HPV can be transmitted other than sexually. Although HPV is basically an STD, some of the stuff I found indicated that HPV could be spread via non-penetrative sexual contact, because virus can be found externally. Some studies suggested that HPV could be found on hands and can be transmitted by non-sexual contact.

Here's one example page. I don't about this site but it references its sources. http://www.health-science-report.com...s=1&article=51

The point, for me at least in regards to mandating vaccines, is not whether it's possible to transmit via non-sexual routes, but whether it is transmitted via easily communicable channels. If the primarily transmission is via a casual contact, I think there is a reasonable public interest regarding whether children are vaccinated before being allowed to attend public schools.

But when the simple act of attending school by an infected individual is not putting other children at risk, I don't feel there is a reasonable basis regarding the public interest over private choices to mandate the vaccine in order to attend school.

However, as someone pointed out above, if it's simply changing the default option to 'vaccine' and parents can opt out if they chose to - for whatever reason, be it religious beliefs, concern on low probability adverse effects, or whatever, well, then the advantages cited make a reasonable argument for mandating it. I'll mull it over for awhile. Thanks for the food for thought.

[Zombified]

Originally Posted by Beth

The point, for me at least in regards to mandating vaccines, is not whether it's possible to transmit via non-sexual routes, but whether it is transmitted via easily communicable channels. If the primarily transmission is via a casual contact, I think there is a reasonable public interest regarding whether children are vaccinated before being allowed to attend public schools.

I think its more a question of whether casual transmission is a significant measurable risk or not, even sexual contact remains the primary transmission vector. It appears on a cursory search that the jury's still out on this point, I'm not asserting that there's a risk from casual contact. But the risk seems at least plausible and worthy of further investigation. And I'm only commenting on the science of transmission here, not the legal issue.

[Skeptic Ginger]

Originally Posted by Boo

HepB is NOT an STD. Primary mode of infection is through blood and body fluids. Intercourse is but one means of acquiring but not the primary. It also happens to be very contagious, much more so then HIV.



Boo

How did HIV get into this discussion?

Hep B is indeed an STD. According to the CDC:

Quote:

In the United States, the most important route of transmission is by sexual contact, either heterosexual or homosexual, with an infected person. Fecal-oral transmission does not appear to occur. However, transmission occurs among men who have sex with men, possibly via contamination from asymptomatic rectal mucosal lesions.

Just because it is spread by other means does not mean it isn't spread by sexual intercourse.

[Skeptic Ginger]

Originally Posted by Beth

The point, for me at least in regards to mandating vaccines, is not whether it's possible to transmit via non-sexual routes, but whether it is transmitted via easily communicable channels. If the primarily transmission is via a casual contact, I think there is a reasonable public interest regarding whether children are vaccinated before being allowed to attend public schools.

But when the simple act of attending school by an infected individual is not putting other children at risk, I don't feel there is a reasonable basis regarding the public interest over private choices to mandate the vaccine in order to attend school.

However, as someone pointed out above, if it's simply changing the default option to 'vaccine' and parents can opt out if they chose to - for whatever reason, be it religious beliefs, concern on low probability adverse effects, or whatever, well, then the advantages cited make a reasonable argument for mandating it. I'll mull it over for awhile. Thanks for the food for thought.

I am glad people understood my point so well about opting out rather than opting in, though Jaggy seemed to doubt one could opt out of vaccine requirement. I suggest those concerned enough check with their state law as school vaccine requirements are mandated under state and not federal law.

As far as deciding what is and what isn't reasonable criteria for mandating childhood vaccines, just using transmissibility in the classroom is a pretty narrow criteria. Public health mandate is to promote public health decisions that are in the public's best interest.

Here are some considerations for these vaccine law decisions.
Percent of people who will get vaccinated
The benefit of herd immunity
Cost of the disease burden
Ideal time to vaccinate which includes vaccine effectiveness and getting the vaccine before the risk
Numbers of people who are or will be susceptible to the infection
Risk/cost of the vaccine vs risk of the disease


Similar considerations occur when laws are passed about such things as seatbelts, rental's having working smoke alarms, helmets and so on. You may feel it's your choice to not wear a seatbelt, but we all pay the medical cost of your decision. The landlord may feel the renter should get the smoke alarm but the law assumes the landlord is in a better position to be designated as the responsible party and so on. I think we are reasonably free in this country. But every individual choice is not without an impact on another.

[Boo]

Originally Posted by skeptigirl

How did HIV get into this discussion?

Hep B is indeed an STD. According to the CDC: Just because it is spread by other means does not mean it isn't spread by sexual intercourse.

Never said it wasn't spread through sexual contact. I said it's not an STD. HepB is most infectious through other body fluid exposures and is more virulent then HIV. Which is why health care workers were receiving the HepB vacc series before the general public. They were at greatest risk.


Of course that could just be the load of hurse puckry they fed us to explain why we had to get it.



Boo

[Skeptic Ginger]

Originally Posted by Boo

Never said it wasn't spread through sexual contact. I said it's not an STD. HepB is most infectious through other body fluid exposures and is more virulent then HIV. Which is why health care workers were receiving the HepB vacc series before the general public. They were at greatest risk.


Of course that could just be the load of hurse puckry they fed us to explain why we had to get it.



Boo

Boo, Hep B is an STD. I think you are confusing a few things in your rationale there.

The first population to receive hep B vaccine en masse actually was the general public in Taiwan. Next were high risk groups in the USA which were mainly men having sex with men and spouses of hep B carriers. Third was high risk health care workers, then all health care workers who had some risk then it was recommended for all kids, with children born to infected mothers squeezed in there somewhere.

In the 70's it wasn't known how extensive the spread of hepatitis B was via heterosexual intercourse. (The vaccine was introduced in Taiwan in 1978.) We did know hep B was spread by occupational exposure to blood in a big way. (The vaccine was given to large numbers of healthcare workers in the US starting in 1982.) The rate of infection in health care workers was high because they have high blood exposure rates. But that doesn't mean the rate of spread via intercourse isn't more common. It means needle sticks are more common in health care workers.

It has only been in the last 20 years that the role of sexual transmission of hepatitis B has been fully appreciated. You may be surprised to know it was only discovered in the late 50s that TB, which we knew was contagious and airborne, was a risk to health care workers. The reason for the later revelations about how these diseases were spreading was it took lab and other diagnostic tests to discover the true epidemiology of diseases which had either high rates of asymptomatic infection, or very long or widely variable incubation periods.

When you only have active cases of disease to investigate and do contact tracing, there are huge holes in your data with diseases like hepatitis B, C and TB. So, of all the health care workers exposed to active TB patients, the ones who actually get sick don't reveal how many actually get infected. So it looks like the disease isn't spreading.

Same thing happens when you have sporadic cases of acute hepatitis B. It can be darn hard to find the source when it was someone who had a casual sexual encounter with the patient 6 months earlier, who has no symptoms, who isn't infecting everyone they sleep with, and of those that do get infected from that source, a few contract chronic hep B with no symptoms, a very small number get acutely ill, and 85% resolve the infection and never have any symptoms.

It took more modern epidemiology techniques and blood tests to discover how frequent hep B was spread as an STD.

[Jaggy Bunnet]

Originally Posted by skeptigirl

I am glad people understood my point so well about opting out rather than opting in, though Jaggy seemed to doubt one could opt out of vaccine requirement.

I don't doubt it, was simply including it for clarification as it is key to my position.

In a previous thread on this, some advocated a no vaccine = no school position.

[Skeptic Ginger]

I see.

[Steven Howard]

Originally Posted by Beth

Indeed! How many children will suffer and die from cervical cancer before parents come to their senses? Given that cervical cancer is NOT a childhood disease, it seems to me your argument doesn't apply very well to this situation.

It's my understanding that the vaccine is significantly more effective if given before the girl becomes sexually active.

Here's the CDC page:

Quote:

Why is the HPV vaccine recommended for such young girls?Ideally, females should get the vaccine before they are sexually active. This is because the vaccine is most effective in girls/women who have not yet acquired any of the four HPV types covered by the vaccine. Girls/women who have not been infected with any of those four HPV types will get the full benefits of the vaccine.

Will sexually active females benefit from the vaccine?
Females who are sexually active may also benefit from the vaccine. But they may get less benefit from the vaccine since they may have already acquired one or more HPV type(s) covered by the vaccine. Few young women are infected with all four of these HPV types. So they would still get protection from those types they have not acquired. Currently, there is no test available to tell if a girl/woman has had any or all of these four HPV types

[Steven Howard]

Originally Posted by skeptigirl

I'm probably going to ask if my HMO will let my son have the vaccine to protect any future partners.

From that same CDC page:

Quote:

What about vaccinating boys?
We do not yet know if the vaccine is effective in boys or men. It is possible that vaccinating males will have health benefits for them by preventing genital warts and rare cancers, such as penile and anal cancer. It is also possible that vaccinating boys/men will have indirect health benefits for girls/women. Studies are now being done to find out if the vaccine works to prevent HPV infection and disease in males. When more information is available, this vaccine may be licensed and recommended for boys/men as well.

[Steven Howard]

Originally Posted by Beth

But when the simple act of attending school by an infected individual is not putting other children at risk, I don't feel there is a reasonable basis regarding the public interest over private choices to mandate the vaccine in order to attend school.

How do you feel about the government mandating iodine in table salt, niacin in flour, or fluoride in tap water?

[hopping llama]

One important thing to remember is that although the jab prevents some cervical cancers, it won't stop all, so keep having the pap smears girls.

Here in Australia, it isn't funded by the gov and isn't required. It costs approx $350.

[Beth]

Originally Posted by Steven Howard

How do you feel about the government mandating iodine in table salt, niacin in flour, or fluoride in tap water?

I'm not aware of the government mandating iodine in table salt or niacin in flour. At any rate, I know that I can purchase salt without iodine if I like. I presume I can do the same with flour, though I don't pay attention to that. As far as flouride in tap water, my local area doesn't floridate. Though about once a decade there is discussion of it but we keep voting against it here.

[Beth]

Originally Posted by skeptigirl

Similar considerations occur when laws are passed about such things as seatbelts, rental's having working smoke alarms, helmets and so on. You may feel it's your choice to not wear a seatbelt, but we all pay the medical cost of your decision. The landlord may feel the renter should get the smoke alarm but the law assumes the landlord is in a better position to be designated as the responsible party and so on. I think we are reasonably free in this country. But every individual choice is not without an impact on another.

In the same sense, everyone pays the medical cost of the alcoholic's drinking problem. But prohibition turned out to be very costly. Everyone pays the cost of the smokers decision when they contract lung cancer too, but it doesn't mean it's a good idea to outlaw smoking. Personally, I vote against those sort of laws whenever I'm given the opportunity. I feel that the government should not be legislating such decisions. Just because something is the "right" decision doesn't automatically mean our society needs to impose it by law on everyone. At least, not in my opinion.

I think it boils down to personal values. We all accept the loss of some freedoms to live together in one cohesive society, but where the line should be drawn between personal freedoms and social resposibilities is a constantly moving target. We all push in the direction we want our society to be in. Me, I would prefer more personal freedom than we currently have, so I tend to be against laws that are primarily designed to protect people from making bad choices if they are the ones most likely to be hurt rather than others. Others are more concerned with other issues, and are willing to sacrifice some of their personal freedoms for a feeling of greater security or well-being for society at large.

[Kevin Levites]

I find all of this debate about the HPV vaccine to be very strange.

As a paramedic and/or EMT (depending upon the circumstances and jurisdiction), I can't begin to tell you how often young girls get raped and sexually molested through no fault of their own. Just recently here in Florida, a scumbag silenlty broke into someone's house, abducted a little girl, and kept her prisoner and raped her repeatedly before burying her alive.

There are a lot of sick people out there.

I don't see why some parents choose to view this vaccine as a tacit admission that prebubescent sex is okay, instead of viewing it as a kind of protective insurance against the unthinkable.

Just my two cents.

All the best,

---Kevin Levites

[Beth]

Originally Posted by Kevin Levites

I don't see why some parents choose to view this vaccine as a tacit admission that prebubescent sex is okay, instead of viewing it as a kind of protective insurance against the unthinkable.

Just my two cents.

All the best,

---Kevin Levites

I think you're in the wrong thread. I haven't seen anybody here arguing that line of thought.