HPV Vaccine Compliance

May 18, 2015

By Steven Novella

There are few home-runs in medicine. Most of our choices have some sort of trade-off – drugs have side effects, interventions have risks, and many treatments have marginal benefits. Sometimes, however, medical science hits one out of the park and develops a treatment that is safe, effective, cost effective, and convenient. Any dispassionate view of the evidence can only lead to one conclusion, leading to the absence of any legitimate scientific or medical debate.

I think the human papilloma virus (HPV) vaccine falls into this category. We have learned that many oral and genital cancers are caused by a sexually transmitted virus, HPV. Getting vaccinated against several strains of this virus prior to becoming sexually active effectively protects against infection by the virus, and dramatically reduces the risk of these cancers. Think about it – we can prevent cancer with a vaccine. This is a no-brainer.

A recent study shows:

HPV DNA was detected in 90.6% of cervical, 91.1% of anal, 75.0% of vaginal, 70.1% of oropharyngeal, 68.8% of vulvar, 63.3% of penile, 32.0% of oral cavity, and 20.9% of laryngeal cancers, as well as in 98.8% of cervical cancer in situ (CCIS). A vaccine targeting HPV 16/18 potentially prevents the majority of invasive cervical (66.2%), anal (79.4%), oropharyngeal (60.2%), and vaginal (55.1%) cancers, as well as many penile (47.9%), vulvar (48.6%) cancers: 24 858 cases annually. The 9-valent vaccine also targeting HPV 31/33/45/52/58 may prevent an additional 4.2% to 18.3% of cancers: 3944 cases annually.

The new 9-valent vaccine covers more strains. The study suggests that there are over 28,000 cases of cancer each year in the US that could be prevented by this vaccine.

Yet, a 2010 survey found that only 11% of 13-17 year olds had received the complete series of three injections, while 25% had received at least one dose. Further, for those who do get vaccinated almost half are starting later than they should or taking longer than they should to complete the series. These figures are improving, however. The latest figures from the CDC for year 2013 show a sharp increase, with 37.6% of girls completing the series, and 13.9% of boys.


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24 comments on “HPV Vaccine Compliance

  • ” Of course, anti-vaccine propaganda will cite the Vaccine Adverse Event Reporting System (VAERS) data which shows reports of 1,671 serious adverse events following HPV vaccines by 2013 (after 67 million doses). The problem with citing this data, however, is that it is not controlled. This is a voluntary reporting system with no filters. It is, in essence, a massive exercise in correlation, without any way to assess causation. ”

    Same with the measles reporting to VAERS. I argued this point about correlation until my fingers cramped at several of my q and a sites. Naturally the dumb antivax brigade could not be convinced of this fact.

    LaurieB. Thanks for explaining how to get that neat color in my quoted paragraph above. Of course you weren’t explaining it to me, but sometimes I pay attention to the strangest things.



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  • fewer partners would support this vaccine in the same way that locking yourself in a filtered room would support flu vaccine, effective but impractical and dull. The point is that this is an amazing advance that could prevent much misery and people opposing it because they like the idea of people being punished for enjoying sex are basically the worst type of scumbags (at that point I almost wanted there to be a virus you could catch from posting anti vac comments with life long consequences that could only be prevented with a vaccine, then I could write ‘maybe fewer comments could help too’ – but that would be a horrible thing to wish for).



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  • You only have to have one, you could for instance be a virgin on you wedding night and you partner may have only had one sexual partner and still get it. Far better to have a vaccine which this is that stops a horrific form of cancer. Slut shaming either in males or females has had thousands of years to run as an experiment, the amount of teenage pregnacy in deeply religious areas is testament to the fact that like the so called war on drugs you’re wasting your time. The Mid East still manages to stone numerous women to death for adultery, I presume they know the penalty, sex has got to be a pretty strong driver to risk being stoned to death for. This is cheap and very effecitve. Great.

    On a side note I noticed in the first few years of this being available in Australian schools only the girls where getting the vaccine. I’m believe the boys are now getting it as well, they may not get cervical cancer but they do carry the virus.



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  • One of the lame counter arguments from the anti-vaxer crowd is that the vaccine only tackles 4% of the 100 or so strains of the virus so why bother risking taking the vaccine?

    They word it in such a way as to not mention that those 4 strains alone (Just 4% of all strains) are responsible for the vast majority of cancers caused by the virus, HPV-16 & 18 account for 70% of cervical cancers, 80% of anal cancers, 60% of vaginal cancers, and 40% of vulvar cancers & HPV-6 & 11 account for 90% of genital warts.

    The anti-vaxer crowd are truly despicable.



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  • Yet, a 2010 survey found that only 11% of 13-17 year olds had received the complete series of three injections,

    This was a surprise. In Australia, HPV Vaccination is routine in all schools, boys and girls. This graph is a State by State analysis of HPV immunization penetration in the community. Up around 80%.

    http://www.hpvregister.org.au/research/coverage-data/hpv-vaccination-coverage-2013

    We may have one of the worlds worst global warming denier governments, but in Australia, both left and right side of politics were united in introducing HPV vaccination across Australia.



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  • The anti vaccine crowd try to make the fact there are so many vaccines required into some sort of plot to kill people. This just means science has progressed to cover more and more diseases. Science did not create the diseases. Perhaps there might be some way to combine shots into one, usable by most people to reduce the number of shots, and shots to keep track of.

    There have to be substantial penalties for not vaccinating.
    1. fine
    2. jail time
    3. exclusion of the child from some places
    Laziness causes people to avoid vaccination. That has to be reversed. We have to make it a major hassle to avoid vaccination.



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  • I think that deciding on how many partners a person has is a “judgement” statement – usually made from some religious dogma. I myself have been monogamous for 28 years or so – and If I had to sample the market so to speak – I would probably use a condom (not for contraception – I had the snip) until I was certain of the persons sexual history and proclivities! But it would be up to me If I felt like sampling several new partners a week for a couple of months. However , currently this is not applicable, but I do not consider “fewer partners” as good advice!



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  • 16
    ad nauseam says:

    I haven’t decided how many partners someone should have, I don’t really care. It is not a judgement statement either, however it is recommended that if you want to reduce your risk of an std (and consequently the spread of disease) reducing your number of partners will help do that (among other things).

    Maybe a source from the CDC would carry more weight: http://www.cdc.gov/std/prevention/

    Nothing about morality or religion…



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  • 19
    ad nauseam says:

    How about less smoking can mean less lung cancer, or less eating can mean less obesity. You can take the extreme examples (like less driving) but I don’t think it is very comparable. It’s probably more like: less careless driving means less preventable accidents.

    Lets say we have a spectrum of sexual activity and on one extreme is constant orgies with everyone you can find and on the other end people cutting their stuff off because they are not going to use it anyway.

    Now on that spectrum, which side will probably have less STDs and cancer from STDs? I’m not advocating for the morality of either extreme or anything in between, I’m just saying the more partners you have the more likely you are to be exposed to an STD and/or cancer causing disease.

    I’ve shared the link from the CDC above, and they recommend reduction of partners among other things.

    The whole idea (and I’m not saying you hold it) that we shouldn’t tell people some abstinence and selectivity of partners may be beneficial to their health is I think a knee-jerk reaction to hyper-conservative views on sex.



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  • You got all that from just my one statement? I didn’t even mention any of the things you posted about.
    All I said was that maybe reducing the number of partners would help lower the spread of disease.

    Hi ad nauseam,

    Yes, but you are getting is arse around backwards. We have had abstinence for thousands of years and the fact that that virus still exists (along with many teenage pregnancies) tells us that a significant proportion of teens will not comply due to any number of factors. Many people even teenagers are careful, but with one shot you can protect that person and all their partners for life from this one negative outcome. Having no sex at all would reduce the risk to zero but I’d argue it is just as naive. Sex is fun, people have it because its fun, if it can be made with lower risk then they can have as many partners as they like. Given that there are many risks (this just fixes one of them) and that some in the community have low impulse control. This is the best solution but I agree not only solution.

    I teach teenagers, these guys are bags full of hormones at the best of times, they are also bags full of personal insecurities. They are not rational actors (even the best of them screw up under extreme circumstances and take risks they should not). Many are not that rational, some live truly hideous, miserable lives. I teach several teenager that spend their childhoods being regularity raped by their fathers, I have taught many more, I have also taught several rapists, 2 murders (and I don’t consider my school particularly rough), and a couple of students who killed themselves, many are regular drug users (currently). So how much do you think those kids are calculating in their misery ridden heads at a brief moment when they have an opportunity for a sliver of pleasure in their lives “maybe reducing the amount of the my sexual partners may reduce my risk of spreading a virus I’ve never even heard of but that in 20-30 years may given the current sexual partner who I don’t even know the name of from getting a cancer”. In between having their bully fathers putting out their cigarette butt on them or hopping from friends house to friends house because both parents are fighting a battle over not having the child these kids are better protected as are all their future partners – even if they get their lives together which many surprisingly do, with a simple jab of a needle.

    I’m sorry if this comes across as too strong, but in the face of my daily teaching kids who’s lives are utter crap, statements like yours are about as useful as telling someone who’s just crashed their car – that perhaps they should have not just crashed their car, or telling them before they crash their car not to. Yes, but just in case you do, how about you first put on this seatbelt.



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  • 21
    ad nauseam says:

    We have had abstinence for thousands of years and the fact that that virus still exists (along with many teenage pregnancies) tells us that a significant proportion of teens will not comply due to any number of factors.

    It’s not really about compliance. I know a lot of people don’t listen (and won’t based on some of the factors you reference), but that doesn’t change the facts. I’m not saying to have zero partners or be completely abstinent. Just that less partners reduces your risk of an std. Sure, it only takes once, but the larger the pool of partners the greater the risk.

    And, with people I know like the kids you describe (especially those who experience sexual abuse), sex was about more than just pleasure, and caused more problems for them (of course it could be different for others).

    Even if the kids that are abused and seek out sexual relationships to fill a void don’t usually listen, it doesn’t mean others (teenagers and adults) won’t. And just because sex is pleasurable doesn’t mean other people can’t make rational decisions. I don’t think you are giving people enough credit when it comes to making decisions.

    Also, I didn’t say don’t take the vaccine, just that having less partners would help too. I don’t understand the almost anti-temperance mindset.

    To tell people about birth control, and condoms, and vaccines but leave out the facts on the number of partners and some abstinence seems to be not that different than the abstinence only crowd.



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  • Well, if it were compulsory for parents to have their children vaccinated and they refused, then before. If however a parent refused to have their child vaccinated where there is no compulsory vaccination policy, then after.

    A parent is responsible for their decisions they make regarding their children.



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  • @ ad-nuseam,

    I think we basically agree. Your first comment probably needed a bit more nuance and I’ve re-read my comments and I feel I definitely over-reacted to you comments. I apologise for any offense caused.

    In teaching you see problems that cannot be solved with absence alone and sometimes people outside of the profession (or similar professions like law enforcement and social services) where you come face to face with some of the rougher edges of society. It means I tend to have a hair trigger to certain statements.

    Again I apologise, and yes we do teach about dangers associated with std’s one of the best I saw was science head of department got half the class wearing rubber gloves on one hand, half without and two kids sitting up the front of the room who were not allowed to participate. He then squirted a different colour of paint in 5 kids hands. The class then had to shake hands with as many people in the class as possible over a 30 second period of time. The kids with gloves then had to take them off and all the kids then had to check their hands. “Okay who has yellow paint on your hands?”, hands go up. You all have gonorrhea, “Who has some red paint?”, “you all have AIDS” and so forth. Interestingly some who had worn gloves had gotten some paint on anyway, and the two kids out the front had got none. Very effective especially when the powerpoint showed pictures of infected genitals and descriptions of the disease symptoms. The condom then came out with the rubber dildo and correct procedure for fitting it was explained and discussed. Yes there were a number of snickers and a couple of religious kids were excused from the class but very effective and powerful explanation of the issues at hand. But in spite of the explanations we had one girl from that cohort get pregnant that year. Some people just behave in risky and foolish ways.

    Regards



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  • We’re making child support payments in our country dependent of getting your children vaccinated (unless medical reasons require otherwise). I was ready to applaud our PM for the first time for making a sensible decision until he started to make religious exemptions for Christian Scientists. Still a step in the right direction at least. I imaging the Christian Science numbers will have begun swelling in numbers.



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