HPV FAQ

Contents

What diseases can HPV cause?

HPV is known to cause several diseases: and is suspected of involvement in other diseases:

How did the FDA decide to approve the vaccine?

Gardasil went through the usual phases of clinical trials. Merck conducted six phase I and phase II clinical trials starting in 1997, and two large phase III trials (FUTURE I and FUTURE II) between 2002 and 2007.

The FDA reviewed the clinical trial results for safety and efficacy, and approved Gardasil for use against cervical cancer and genital warts in women in 2006, and against anal cancer in anyone aged 9 through 26 in 2010.

How safe is the vaccine (Gardasil)?

Four large studies of about 100,000, 190,000, 200,000, and 300,000 vaccinated women have been done since the vaccine was approved. None of the studies found any significant safety problems with the vaccine.

Since fainting is possible after any vaccination, patients should sit for 15 minutes after being vaccinated.

The shot often hurts for a few days. A study on tolerability which emailed questionnaires to 3552 girls after each dose found that about 1 in 8 respondants said they experienced pronounced pain, stiffness, or swelling that started within 3 days and lasted about 1 to 5 days.

About 1 in 100,000 people may have an allergic reaction to the vaccine. Most recover without incident.

The lifetime risk of contracting cervical or anal cancer (1 in 152 and 1 in 500, respectively) is much higher than any of the serious risks indentfied so far with the vaccine.

See hpv.kegel.com/safety for more info on hpv vaccine safety.

Who should be vaccinated?

The following two groups get the most benefit from the vaccine:
  1. Boys and girls between about age 10 and age 14 have not yet been infected ( girls vaccinated by age 14 have about 75% fewer abnormal pap smears at first screening, whereas older girls, who have presumably already been infected, get less benefit).
  2. Women who are being treated for abnormal pap smears (since the vaccine has been reported to reduce recurrence).
But people outside these groups may still benefit, and vaccine is approved in the US for people up to age 26. See the CDC/ACIP recommendations.

Who should not be vaccinated?

If you had hives or some other allergic reaction within a week or so of receiving the first or second dose of an HPV vaccine, you probably want to avoid taking any further doses, just in case.

According to Merck,

"Gardasil is contraindicated in individuals with hypersensitivity, including severe allergic reactions to yeast, or after a previous dose of Gardasil."

According to Glaxo,

"You should not get Cervarix if you have or have had an allergic reaction to a previous dose of Cervarix, or an allergy to any of the ingredients in Cervarix (listed below)."

Is the new cobas HPV test going to replace Pap tests? Is that good?

No, it won't quite replace Pap tests, but there will be fewer of them.

The proposed new test starts off by checking for HPV16 and HPV18 individually, as those are the two highest risk strains. It also checks for all other high risk strains as a group. It doesn't check for low risk strains, which is fine, as they generally don't cause cancer.

Here's how the test is supposed to be used:

"In women 25 years and older, the cobas HPV Test can be used as a first-line primary cervical screening test to detect high risk HPV, including genotyping for 16 and 18. Women who test negative for high risk HPV types by the cobas HPV Test should be followed up in accordance with the physician's assessment of screening and medical history, other risk factors, and professional guidelines. Women who test positive for HPV genotypes 16 and/or 18 by the cobas HPV Test should be referred to colposcopy. Women who test high risk HPV positive and 16/18 negative by the cobas HPV Test (12 Other HR HPV positive) should be evaluated by cervical cytology to determine the need for referral to colposcopy."
In other words, if it finds the highest risk strains (HPV16 or 18), your doctor will have you get a colposcopy; if it finds other high risk HPV, your doctor will give you a Pap test.

According to the FDA review packet, the new test finds more cancer using fewer colposcopies than does current standard practice.

Do I need to keep getting screened after being vaccinated?

Yes. Current vaccines only prevent 50%-70% of cervical cancers, so you still need to get a pap test every three years as recommended by the CDC.

Since I need to keep getting pap tests anyway, why do we even bother with the vaccine?

Pap tests, even when combined with HPV tests, can only detect cervical cancer, and only in women eligible for screening (in the UK, women under 25 are not screened). But according to the CDC, only 11,500 of the 25,900 HPV-caused cancers annually in the US are of the cervix. For those other cancers, pap smears are not an option, and the vaccine is likely to offer good protection.

See also "Prophylactic HPV Vaccines: Current Knowledge of Impact on Gynecologic Premalignancies" by Diane Harper, which points out

"While Pap testing is effective, there still remain five specific challenges. First, screening must be done repeatedly over most of the woman's lifetime. Second, false negatives can occur; 30% of women developing cervical cancer having had a history of normal cytology screens (Sawaya and Grimes, 1999). Third, abnormal cytology causes much anxiety for many women (Rogstad, 2002). Fourth, for those women whose screening leads to a diagnosis of CIN 2/3, treatment with loop electrosurgical excision procedure (LEEP) can lead to an increased risk in subsequent pregnancies of preterm delivery, low birthweight infants, premature rupture of membranes, and operative delivery at a rate of 70-300% increase (Arbyn et al., 2008). Lastly, there is no lifetime protection from future HPV infections from her natural infection, leaving a woman at a 3-12 fold increased risk of other anogenital cancers about 10 years later (Edgren and Sparen, 2007)."
(Note: that paper also contains a much lower estimate of what portion of HPV-caused cancers are noncervical (12% vs. 55%). The difference may be explained in part by our greater knowledge since then of the role of HPV in throat cancer.)

How long does the vaccine protect against HPV?

A trial of Gardasil in 654 women shows that vaccine still works after 6 years.

A trial of Cervarix in 436 women (pdf) shows that vaccine still works after 8.4 years.

So far, none of the studies has found when the vaccines really wear off, but long-term studies are continuing, and eventually we may know how long it lasts.

Booster shots are not currently recommended, but if it turns out that protection wears off after ten years, that may change. There is some evidence Gardasil works as a booster after 5 years and after 8.5 years.

See also:

How many girls need to be vaccinated to prevent one case of cancer?

The number of girls vaccinated per prevented case of cervical cancer was estimated by one paper to be between 250 and 600, and by another paper to be between 324 and 480. (These studies were for the US and Canada; in the developing world, where screening is less widespread, the number is probably lower.)

Do condoms prevent HPV infections?

If used every time, they can cut risk by 25% to 50%.

"Condom use and the risk of genital human papillomavirus infection in young women" found

In women reporting 100 percent condom use by their partners, no cervical squamous intraepithelial lesions were detected in 32 patient-years at risk, whereas 14 incident lesions were detected during 97 patient-years at risk among women whose partners did not use condoms or used them less consistently.

"Determinants of prevalent human papillomavirus in recently-formed heterosexual partnerships: A dyadic-level analysis" found

Dyads that always used condoms with previous partner(s) were 27% (95% CI: 9-42%) less likely to have HPV.

My son or daughter is not yet sexually active. Why does he or she need the vaccine?

The vaccine requies three doses over six months to reach full protection. When romance strikes, it happens in a hurry, and you want to already be protected by then.

Girls vaccinated by age 14 had about 75% fewer abnormal results at their first pap test as their unvaccinated peers... but girls vaccinated by age 15 were only half as well protected.

Since the virus can be transmitted by just touching an infected area, you don't have to have "sex" to catch it. Two studies found between 2% and 46% of young women already had HPV by the time they first have intercourse. You can even catch HPV from open-mouth kissing. So even kids whose parents don't consider them sexually active are at risk.

Virginity pledges don't seem to protect against STDs such as HPV, either; see "After the promise: the STD consequences of adolescent virginity pledges" (full text).

Is vaccination cost effective?

It depends on how much the vaccine costs, how long it protects, and how broad the protection is. "Modeling cervical cancer prevention in developed countries" said
"Under assumptions of lifelong vaccine immunity, the vast majority of published cost-effectiveness analyses have suggested that targeting pre-adolescent girls (ages 12 or younger) with an HPV-16/18 vaccine is very attractive in the context of current screening."

Is it safe to get the HPV vaccine if you already have HPV?

Short story: Yes, the vaccine is still safe, and will still protect you against the strains it covers that you haven't had yet.

Long story: "CDC HPV Vaccine Information for Young Women" says

Ideally females should get the vaccine before they become sexually active and exposed to HPV. Females who are sexually active may also benefit from vaccination, but they may get less benefit. This is because they may have already been exposed to one or more of the HPV types targeted by the vaccines. However, few sexually active young women are infected with all HPV types prevented by the vaccines, so most young women could still get protection by getting vaccinated.

Has Gardasil already begun lowering the prevalence of HPV infections?

Yes.

Both the US and Australia have done studies to measure what percent of girls and women have HPV before and after the vaccine was introduced.

The United States has recommended vaccinating girls since 2006. A study of the National Health and Nutrition Examination Surveys from 2003 to 2010 said

Results: Among females aged 14-19 years, the vaccine-type HPV prevalence (HPV-6, -11, -16, or -18) decreased from 11.5% (95% confidence interval [CI], 9.2-14.4) in 2003-2006 to 5.1% (95% CI, 3.8-6.6) in 2007-2010, a decline of 56% (95% CI, 38-69). Among other age groups, the prevalence did not differ significantly between the 2 time periods (P> .05). The vaccine effectiveness of at least 1 dose was 82% (95% CI, 53-93).

Conclusions: Within 4 years of vaccine introduction, the vaccine-type HPV prevalence decreased among females aged 14-19 years despite low vaccine uptake. The estimated vaccine effectiveness was high.

Australia has been actively vaccinating girls since 2007. "Fall in Human Papillomavirus Prevalence Following a National Vaccination Program" says

HPV genoprevalence in women aged 18-24 years attending family planning clinics in the prevaccine period (2005-2007) was compared with prevalence among women of the same age group in the postvaccine period (2010-2011). ... The prevalence of vaccine HPV genotypes (6, 11, 16, and 18) was significantly lower in the postvaccine sample than in the prevaccine sample (6.7% vs 28.7%; P < .001), with lower prevalence observed in both vaccinated and unvaccinated women compared with the prevaccine population (5.0% [adjusted odds ratio, 0.11; 95% confidence interval, 0.06-0.21] and 15.8% [adjusted odds ratio, 0.42; 95% confidence interval, 0.19-0.93], respectively).

Has Gardasil already begun lowering the incidence of genital warts?

Yes.

In Denmark, about 80% of girls born since 1993 have been vaccinated. A study of all girls born in Denmark from 1989 to 1999 found

The relative risk of GWs among girls who had received at least 1 dose of vaccine compared with unvaccinated girls was 0.12, 0.22, 0.25, and 0.62 for those born in 1995-1996, 1993-1994, 1991-1992, and 1989-1990, respectively (P for trend <.0001). No GWs occurred among vaccinated girls in the youngest birth cohort (1997-1999).

Conclusions: The strong, highly significant reduction in the occurrence of GWs among vaccinated girls indicates an early and marked population effect of the national HPV vaccination program and may forecast a similar effect on cervical precancerous lesions.

For more data, see HPV and Warts.

Has Gardasil already begun lowering the incidence of abnormal pap smears?

Yes.

We already knew that HPV vaccines are effective against CIN2 and CIN3+ in clinical trials. Now, three studies have measured how effective they are in real world national immunization programs:

These studies were not large enough to measure the vaccine's benefit precisely, but it's safe to say that vaccination reduces the risk of CIN3 by about half, and that vaccinating by age 14 gives even more protection.

Since CIN2 and CIN3 are treated by surgically removing part of the cervix, an operation that carries risks of complications, women will directly benefit from this reduction.

Since about 50% of untreated CIN3 progresses to cervical cancer, preventing CIN3 is quite likely to prevent some cervical cancer. And since about half of all cervical cancer in the US occurs in women who haven't been properly screened, this is true even in countries with screening programs.

Has Gardasil already begun lowering the incidence of cervical cancer?

Not yet.

We should see something noticable at least by the time the first group of girls to be vaccinated hits age 27 or so. (That's because cervical cancer rates jump to high levels at about that age.) That should happen about the year 2022. If we're lucky, we'll see proof before then.

But we are already seeing a drop in precancerous lesions (see above).

Is there any point to getting vaccinated after you have been treated for an abnormal Pap?

Yes.

Vaccination after LEEP procedures has been reported to cut the risk of reinfection by about half. See "Is vaccination with quadrivalent HPV vaccine after loop electrosurgical excision procedure effective in preventing recurrence in patients with high-grade cervical intraepithelial neoplasia (CIN2-3)?" and "Effect of the human papillomavirus (HPV) quadrivalent vaccine in a subgroup of women with cervical and vulvar disease: retrospective pooled analysis of trial data".

Has diet or nutrition been shown to lower the incidence of cervical cancer?

Not yet, but there are hints that frequent consumtion of some fruits and vegetables may help the body fight off an HPV infection.

One team found that, among HPV-positive women, those with abnormal pap smears and those with persistent HPV infections were less likely to eat papaya or oranges every week than those without.

Another study found that, among HPV positive women, those who cleared their HPV infections were more likely to eat vegetables every day than those who didn't.

Will new kinds of HPV viruses spring up to replace those wiped out by the vaccine?

Potentially, but we haven't seen that for sure yet.

"Cross-protective efficacy of two human papillomavirus vaccines: a systematic review and meta-analysis" found only slight protection for HPV types not targeted by either vaccine, so one would not expect current vaccines to have much impact on high risk strains beyond HPV-16 and 18.

This seems to be borne out by two studies of what has happened to the prevalence of HPV types after the introduction of national vaccination programs.

In England, after two to four years of national Cervarix vaccination, among a representative sample of 16-18 year old sexually active girls (65% of whom had been fully vaccinated), HPV-16 and 18 declined by about two thirds, other high-risk types as a whole were roughly unchanged, and HPV-6 and 11 increased by about a third.

In the United States, after zero to four years of national Gardasil vaccination, among a representative sample of 14-19 year old sexually active girls (about 32% of which had been fully vaccinated), HPV-16, 18, 6, and 11 declined by about half, and there were no other significant changes.

"Vaccine-type human papillomavirus and evidence of herd protection after vaccine introduction" reported

the prevalence of high-risk, nonvaccine-type HPV increased 7.6% (48.6%-56.2%, P = .0038) for all participants, and the increase was significant (13.6%, P < .0001) for vaccinated but not for unvaccinated participants... A possible explanation for the finding that nonvaccine-type HPV prevalence increased in vaccinated but not in unvaccinated young women is that their risk for HPV may differ. Vaccinated versus unvaccinated girls did not differ in number of recent and lifetime sexual partners; however, they were more likely to be African American (84% vs 54%, P < .0001) and reported, on average, an earlier age of first sexual intercourse (mean = 14.6 vs 15.3 years, P = .0007), both of which have been associated with higher rates of HPV infection."

Vaccines covering more types of HPV are currently under develoment. In particular, Merck's v503 targets nine strains of HPV (HPV-16, 18, 31, 33, 45, 52, 58, 6, and 11). It has completed stage 3 clinical trials (see Nov 4 2013 press release, Oct 24 2013 press release). Merck may apply for approval for V503 in 2014.

Further out, vaccines based on chimeric L1/L2 protein combinations (pubmed 23752042) or L2 proteins alone may offer even wider coverage in the future.

Does the vaccine work for African American women?

"Human papillomavirus genotypes in high-grade cervical lesions in the United States" found
"Among 4,121 CIN2+ cases reported during 2008-2009 in 18- to 39-year-old women 3058 (74.2%) were tested... HPV 16/18-associated lesions were less common in non-Hispanic blacks (41.9%) and Hispanics (46.3%) compared with non-Hispanic whites (59.1%) (P < .0001)"

However, "Comparison of HPV type distribution in high-grade cervical lesions and cervical cancer: a meta-analysis" found

"HPV16, 18 and 45 were each more prevalent in SCC than HSIL"
Thus frequency of HPV types in CIN2+ probably don't translate to frequency of HPV types in cancer.

Some people say that there's no evidence HPV vaccines can prevent cancer better than screening.

Short answer: Vaccination and cervical cancer screening together are more effective than either by themselves. The vaccine can also prevent other kinds of cancer (e.g. anus, throat, vulva) which are on the rise. And it can protect age groups not usually screened.

Long answer:

"Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost-effectiveness analysis" (full text) estimated that vaccination and screening together reduced the lifetime risk of cancer to about half that of screening alone.

"Beyond cervical cancer: burden of other HPV-related cancers among men and women" said

In the United States annually (1998-2003), up to ... 4,753 noncervical cancers among men, and 4,128 noncervical cancers among women are potentially attributable to HPV infection. ... incidence rates for anal, oropharyngeal, and vulvar cancers have increased substantially in recent years.
The vaccine has been reported to be effective against early stages of anal and vulvar cancer.

"Effectiveness of cervical screening with age: population based case-control study of prospectively recorded data" says

Cervical screening in women aged 20-24 has little or no impact on rates of invasive cervical cancer up to age 30.
Accordingly, the UK does not screen women under 25 for cervical cancer. But a few women under that age do die of cervical cancer, and vaccination can prevent many of those deaths.

Some people say that Gardasil KILLS GIRLS!

Short story: The virus HPV causes diseases that kill about one person every 82 minutes in the United States. (You can read a few of their stories here.) By comparison, there are no deaths confirmed to be caused by the vaccine so far. So getting vaccinated is much safer than not getting vaccinated.

Long story: As of September 2011, about 40 million doses of Gardasil had been distributed in the US, and there were 71 reports of death; only 34 of these could be confirmed at all, only 23 of these reports look reputable and have no obvious cause, and there is no discernable pattern in the causes of death.

For more data, see HPV vaccine safety.

Some people say the risk of serious adverse effects from the vaccine is about the same as the risk of cancer!

Short story: The reporting rate for Gardasil for serious adverse reactions is about 230 times lower than the lifetime risk of developing cervical cancer. For death from vaccination vs. death from cervical cancer, it's about 2300 times lower.

Long story: "Postlicensure Vaccine Safety Monitoring, 2006-2013 - United States" said

From June 2006 through March 2013, approximately 56 million doses of HPV4 were distributed in the United States... During June 2006-March 2013, the Vaccine Adverse Event Reporting System (VAERS) received a total of 21,194 adverse event reports occurring in females after receipt of HPV4; 92.1% were classified as nonserious. ... during the last 7 years, reporting patterns have remained consistent with the 2009 published summary of the first 2.5 years of postlicensure reporting to VAERS.
i.e. there were 1674 serious reactions reported out of 56 million doses distributed. That's a reporting rate of serious reactions of .0029%, i.e. 3 in 100,000.

The lifetime risk of cervical cancer in the United States is about 1 in 152, or about 660 in 100,000.

So (if one trusts statistics from VAERS, which one should not do), the serious adverse reaction reporting rate from Gardasil is about 230 times lower than the lifetime risk of developing cervical cancer.

Looking at death: the reporting rate for death according to the 2009 summary was about 0.1 per 100,000. The lifetime risk of dying from cervical cancer in the United States is about 1 in 435, or about 230 in 100,000.

Again, the vaccine is safer, by a factor of 2300.

Some people say vaccinating against HPV makes girls more promiscuous and more likely to get pregnant or get VD!

This is not supported by the evidence. "Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds" says
Previous surveys on hypothesized sexual activity changes after human papillomavirus (HPV) vaccination may be subject to self-response biases. To date, no studies measured clinical markers of sexual activity after HPV vaccination. This study evaluated sexual activity-related clinical outcomes after adolescent vaccination. ... Conclusions: HPV vaccination in the recommended ages was not associated with increased sexual activity-related outcome rates.
"Human Papillomavirus Vaccine Increases High-Risk Sexual Behaviors: A Myth or Valid Concern" also found no evidence of sexual practices differing between vaccinated and non-vaccinated college women.

Some people say Gardasil caused some girls to go sterile!

They're referring to "Premature ovarian failure 3 years after menarche in a 16-year-old girl following human papillomavirus vaccination" by Dr. D. Little and H. Ward, and/or "Human Papilloma Virus Vaccine and Primary Ovarian Failure: Another Facet of the Autoimmune/Inflammatory Syndrome Induced by Adjuvants" by S Colafrancesco, Lucija Tomljenovic et al.

There are several problems with the paper by Little and Ward.

First: the authors have an axe to grind. They are pro-life activists; Dr. Little serves on the board of advisors of Family Life International, a Catholic group which claimed as in 2007 (and still claims today) that the vaccine promotes promiscuity and VD, which is not supported by the evidence. This should have been disclosed as a conflict of interest in the paper.

Second, the paper claims to have ruled out all causes other than Gardasil for the problem... but they didn't check (as far as I know) for the specific mutations estimated to account for 20%-25% of the risk for premature ovarian failure.

Third, premature ovarian failure happens in unvaccinated girls at a significant rate -- about one in ten thousand girls per year from age 15 up. If there are about 6 million 16 year old girls in the US, that paper predicts roughly 600 cases of premature ovarian failue per year among them -- with or without vaccination. So hearing about two or three girls with premature ovarian failure is not a sign of trouble; hearing about ten thousand might be.

The paper by Colafrancesco and Tomljenovic has similar problems; it lists a case of two sisters with premature ovarian failure. When two sisters both come down with a genetically linked disease, it's even more likely that a bad gene is the cause, but that was not mentioned in the paper.

So these case studies don't show that Gardasil is dangerous, they don't show that the four cases were not caused by a genetic problem, and they don't account for the fact that we don't know why the majority of cases of this problem occur with or without Gardasil.

( Thanks to Respectful Insolence for posting excerpts of the second paper. )

Some people say an ingredient in Gardasil caused rats to go sterile!

Short story: at much higher doses than in the vaccine, and given to newborn instead of teenage rats, yes. More research would be needed to know for sure.

Long story: Newborn rats injected with the equivalent of the amount of Polysorbate 80 in about 60 doses of Gardasil were found to grow up to be sterile in one experiment in 1993.

Because this was such a high dose, given so early in life when the rats were still developing, it's very hard to say this means Gardasil is risky. Further studies would be needed to establish the level of risk with certainty.

This might need to be rexamined especially if the vaccine is considered for administering to younger children.

Some people say that getting the vaccine if you already have HPV increases your chance of cancer!

Short story: Those people are looking at a very small study that was probably statistically unbalanced. This group had about twice as many positive pap smears as the controls. Because the vaccine doesn't protect you if you already have HPV, you would in fact expect the group that was sicker before vaccination to be sicker after vaccination. And that's just what happened. A second, larger study found no such increase in cancer after vaccination.

Long story: The Phase III trials of Gardasil enrolled thousands of healthy women, checked whether they had HPV at the start, vaccinated them, and then looked at how many of them went on to develop disease. There were two big studies: Study 13, and Study 15. Mostly they analyzed the data from women who didn't have HPV before vaccinating, but they also analyzed the data from women who very definitely had active HPV at the start of the study (about 293 women in Study 13, and 828 women in Study 15).

Because the vaccine works by preventing HPV infection, the expectation was that vaccination wouldn't have any effect on cancer rates.

Here are the results:
HPV+ Women who developed CIN 2/3 or worse by end of study / total women
PopulationGardasilPlacebo
HPV+ at start of Study 1331/15619/137
HPV+ at start of Study 1542/39848/430
In Study 15, about as many vaccinated as unvaccinated women got cancer, as expected, but in Study 13, surprisingly many vaccinated women got cancer.

When they looked closer at the data, they saw that the women who were HPV+ at start of Study 13 weren't randomized very well:
Study 013 subgroupGardasil Placebo
Current smoker at start of study34.6%31.4%
History of cervicovaginal infection or STD at start of study 35.9% 32.1%
Pap test with HSIL at start of study6.5%3.7%
Not only was the rate of positive Pap tests before vaccination among those randomized to the Gardasil group was almost twice that among those randomized to the placebo group, other risk factors were higher in the Gardasil group as well. This probably explains the surprising result from Study 13.

(See Tables 17, 18, and 20, and the conclusion on page 15, of the Phase 3 study summary.)

I heard Japan and some other countries banned Gardasil!

As far as I know, no country has banned Gardasil. Here are some countries rumored to have banned it, and the actual situation:

Japan

In June 2013, reacting to reports of adverse effects, Japan's health ministry announced that it would stop promoting it, pending investigation, but that the vaccine would continue to administered free of charge. The investigation is now complete; "Summary of the Report on the Surveillance Results of HPV Vaccines" says "the available evidence was insufficient to suspend the marketing authorizations for the HPV vaccines." The Japanese government is now considering whether to resume active recommendation for HPV vaccination.

The vaccine is still recommended in Japan; see Hachinohe City Routine Immunization Schedule (Nov 2013), Vaccination Schedule Recommended by the Japan Pediatrics Society (Jan 2014), and Immunization Schedule, Japan 2014 (as of April 1, 2014)

(See also HPV vaccination programme in Japan, Lancet, Aug 2013.)

Israel

On 3 September 2013, Israel considered cancelling their free school-based HPV vaccination program, but less than a week later, decided to go ahead with it. Also, it remains on the schedule of recommended vaccines.

India

On 4 July 2008, India's DCGI approved Gardasil for use in India. In 2009, a demonstration project was started which immunized girls in two states. In 2010, responding to public pressure, India suspended the demonstration project. However, the vaccine itself is still approved in India, and appears on the IAP's 2013 recommended schedule of vaccination.

I heard the lead developer of Gardasil now says it's a deadly scam!!

Dr. Diane Harper, who helped test Gardasil and researches HPV prevention, was in the news in 2009, and was misquoted as being against the vaccine. In an interview to clarify her position, she said
"Duration of efficacy is key to the entire question. If duration is at least fifteen years, then vaccinating 11-year-old girls will protect them until they are 26 and will prevent some precancers, but postpone most cancers. If duration of efficacy is less than fifteen years, then no cancers are prevented, only postponed."
She then wrote an article laying out her position in detail. (That article was written back when we thought 88% of all HPV-caused cancers were cervical cancer; according to the CDC, the current figure is 45%. Also, that article assumed that HPV vaccination only reduced abnormal pap smears by 10%, but a more current figure is 47.5%.)

More recently, she wrote

"US health policy preferences push achieving a high coverage rate of young women instead of relying on possible herd immunity from both sexes of a partially vaccinated population...

A majority of adolescents appear to participate in long chain networks of relationships... Interruption by HPV vaccination may reduce this spanning network into smaller isolated groups, thereby preventing a majority of HPV infections... young men are responsible for infection propagation twice as often as young women[5]. Perhaps... to see a more cost-effective reduction in HPV infections, we should turn our attention to targeting boys before high school entry."

On January 5th, 2013, I had the following email conversation with her:
From: Dan Kegel
To: Diane Harper

Hi Dr. Harper,
recently on TV you said
"I looked at the fact that Gardasil doesn't last long enough to
prevent cervical cancer..."
...
I think you meant to say "We don't know yet whether Gardasil lasts
long enough to prevent cervical cancer without a booster shot", right?

From: Diane Harper
To: Dan Kegel

...
you are correct, I should be quoted as saying

"We don't know yet whether Gardasil lasts
long enough to prevent cervical cancer without a booster shot", 

So I do give you permission to print that in your blog!
In other words: she is a (very) cautious advocate for the vaccine, and has never said it should not be used.

See also:

Other HPV FAQ pages

Related pages


Corrections and suggestions welcome, please send them to dank at kegel com.

Copyright 2013, 2014, Dan Kegel
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