You may find it difficult to acknowledge that one day your children will be sexually active. However, taking steps to keep them healthy when they are, is an action you can take as a parent. Vaccination against the human papillomavirus (HPV) with Gardasil, provides nearly 100 percent protection against the most common strains of HPV, a sexually transmitted infection (STI) responsible for genital warts and cervical cancer. Despite such powerful numbers, many parents choose not to vaccinate their children. There is no requirement; Gardasil is optional. Virginia law doesn’t mandate this vaccine for a child to attend school, as it does for other vaccines like chicken pox or measles. Reasons against HPV vaccination vary and include the vaccine’s connection to sex, perceived cost versus benefit, concerns about side effects, and concerns about vaccinations across the board. When deciding whether or not to vaccinate your children with Gardasil, information is your best resource.
Connection to Sex
Genital human papillomavirus is the most common STI. The Center for Disease Control reports that at least half of sexually active men and women will have HPV at one point in their lives. Most healthy immune systems fight off HPV naturally; inexplicably, some do not. A few HPV strains lead to warts, while other strains may cause cervical cell changes that lead to cervical cancer. Irregular pap-smears are not uncommon and mean that somewhere in a woman’s sexual history, she was exposed to carcinogenic HPV.
Because people are often asymptomatic, the virus is usually passed unknowingly. In 2010, approximately 12,200 new cases of cervical cancer occurred in the United States, along with 4,210 deaths. Not life-threatening, but certainly undesirable, the CDC reports that at any given time, 1 percent of sexually active adults in the United States have visible genital warts. Gardasil is a fortress against this, actually preventing 90 percent of genital wart cases. Although not associated with the mortality of cancer, genital warts cause major discomfort, embarrassment, and anxiety.
Since the vaccine is associated with sexual transmission, you, as a parent, may feel like consenting to the vaccine implies a free ticket for unprotected intercourse. Or you may simply feel uncomfortable vaccinating a young child or adolescent against an STI.
Pediatrician Warren Snead, MD, with Pediatric Associates of Richmond, explains that parents need to think in practical terms. “Young people don’t always make the best decisions. If a vaccine can prevent everything from an STI to a major illness like cervical cancer, I’m all for it.” Dr. Snead explained that antibody response is strongest in children ages 9 to 15, making this the best time to vaccinate.
Also, you want to administer the drug prior to sexual activity so your child is protected from the start.
As a parent, you may also be reluctant to view your young son or daughter as fitting the profile of someone who ought to be concerned about contracting a sexually transmitted disease. To be frank, this would be naïve. Consider these facts: one in four college students will contract an STI, and HPV is the most common one on college campuses. Although risk increases with the number of sexual partners, the only way to definitively avoid exposure to HPV is to be a virgin who marries a virgin, and remain in that monogamous marriage till death do you part.
Kathy Stewart, CPNP, nurse practitioner at Drs. Meyer, Day and Loving’s pediatric practice states that, “during yearly physical exams, when I have parents reluctant to start the HPV vaccine in elementary school, most parents are receptive to waiting until the first or second year after their daughter’s onset of menses. I try to reinforce that the vaccine isn’t about sex, it’s about health.”
If you feel your child is too young to understand the nature of the vaccine, it’s fine to simply say that it prevents a type of cancer or serious illness. An older teen may benefit from understanding that Gardasil protects against most types of genital warts but offers no protection against other STDs like HIV or herpes. Depending on the child’s age and maturity, the Gardasil vaccine may lead to an important teachable moment about the roles of abstinence, condoms and birth control related to sexual activity.
You may feel that if you teach your child safe sex practices, the risk of acquiring HPV will be low and the need for the vaccine decreased. Sadly, this logic falters. Wish and try as you might, you have no control over the sexual history of your child’s future partner(s). You just can’t predict who will or won’t come in contact with HPV. This is why conversations about sexual health between you and your teen are important, especially before college.
Cost vs. Benefit
Cost may be another factor when deciding to vaccinate. The vaccine is given as a series of three injections over a six-month period for a total of $360, which may not be covered by insurance. Created as a vaccine solely for females, Gardasil is now approved for both genders, allowing 90 percent of all genital wart cases to be prevented. Treatment of these warts can be painful, expensive, upsetting, and damaging to relationships. But, as pointed out by Karin Buettner, MD, of Virginia Women’s Center, “because of cervical cancer risk, HPV vaccination of females is two-to-four fold more cost-effective than vaccinating males.”
Dr. Buettner underscores that women unfairly carry the burden of HPV disease. Persistent viral infection with carcinogenic HPV causes virtually all cancers of the cervix, and most cancers of the vagina and vulva. Dr. Buettner fully endorses protection for girls from these cancers by getting vaccinated at a young age, independent of vaccination of boys. Male vaccination serves to protect more unvaccinated females, but women really need to take matters into their own hands, and be sure.
Although female cancers represent a much smaller percentage of mortal cancers (for example, lung cancer killed 40,000 women in 2010), any cancer that can be prevented is a step in the right direction.
Vaccine Safety
Despite recent media attention questioning the safety of Gardasil, both Dr. Snead and Dr. Buettner recommend it. “The vaccine is well researched and clinically tested, showing a very safe profile record,” reports Dr. Snead. “The main side effect is pain at the injection site. Light-headedness and cases of fainting have also been reported, so patients are asked to sit or lie down for fifteen minutes after receiving the vaccine.”
Some parents refuse vaccines based on misinformation – precisely why it is important to get research from reputable sources and rely on conversations with your health care professional.
“Vaccination is ultimately the parents decision,” states Kathy Stewart, “but it is my job as a pediatric nurse practitioner to make sure their decision is based on accurate research. I sometimes get concerns from parents about mercury in vaccines being linked to autism. Vaccines are now entirely mercury-preservative free.”
When asked his conclusion on Gardasil, Dr. Snead replied, “I don’t see a downside.” He explained that, with approximately 4,000 deaths every year from cervical cancer, and tens of thousands of new cases of cervical cancer every year, the benefits of Gardasil far outweigh the risks.
