Human Papilloma Virus Vaccine
Donald Aulds, M.D.
Cervical cancer is the only cancer in humans that has been shown to be caused by a virus. Human papilloma virus has been noted to be the cause of cervical cancer. It was not until recent years that the virus could be grown in cell culture and researchers were able to identify that the virus was present in cancer cells. There are more than 100 different types of viruses in the HPV family but only about a dozen of the viruses are associated with cervical cancer. Types 16 and 18 have been associated with over 70% of cervical cancers while types 6 and 11 have been shown to cause genital warts.
In early June, 2006, the Food and Drug Administration approved the new HPV vaccine called Gardisil. The vaccine is designed to build immunity against types 6, 11, 16 and 18. Studies done in Europe and the US have shown that the immunity could prevent 70% of cervical cancers and up to 90% of genital warts.
How big is the cervical cancer problem in the US?
Recent studies in the United States revealed that over 6.2 millions new cases of HPV are diagnosed annually. The American Cancer Society reported approximately 9,700 new cases of cancer in 2005 and 3700 deaths from cervical cancer. The use of the yearly Pap smear tests and follow-up can prevent most cases of cervical cancer. The Pap smear can detect cell changes in the cervix before the changes can turn into cancer. The changes can be detected at an early, curable stage. Studies have shown that over 90% of cervical cancers in the US were in women who had never had a pap smear or had not had a pap smear in over the last five years.
Who is recommended to receive the vaccine?
The Advisory Committee on Immunization Practices recommends that the vaccine should be given to all young women age 9 to 26. Since most cases of cervical cancer occurs in women over 40, it may be 25 years or more to see if the vaccine will drastically reduce cervical cancer. The vaccine is recommended to be given if possible before the young women are sexually active. In women who have never been exposed to HPV, the vaccine has been shown to be close to 100% effective in preventing pre-cancers of the cervix and vagina. In women who have already been exposed to or diagnosed with HPV, the studies have shown that the vaccine may be less effective.
What are the details of the vaccine?
The vaccine is recommended to be given over a six month period with the second injection given two months after the first injection and the third given at six months. The retail price of the vaccine is $120 per injection and it should be given in the upper arm. The reports show that there is no mercury or trimerosal in the vaccine. The vaccine is made from proteins from the outer coat of the virus, so no infectious material is used.
It is recommended that all women receiving the vaccine should continue regular cervical cancer screening. The vaccine will not protect against all types of HPV that might cause cervical cancer. Some women may not get all required doses of the vaccine and therefore may not get the full benefits of protection.
Also the vaccine may not be as effective if given after the women have acquired the HPV virus. At present, it is uncertain whether insurance companies will cover the vaccine. The vaccine is not recommended to be given to pregnant women and if it is administered to a woman before that pregnancy is diagnosed it must be reported to a national registry.
Before receiving the vaccine, discuss it with your physician in detail and understand what benefits are expected and any limitations of the vaccine.
More about Dr. Aulds
Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.
Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.
Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.
