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The HPV Vaccine: Risks, Benefits and Alternatives |
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By Sarah Cimperman, N.D.
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In June 2006, the United States Food and Drug Administration (FDA) approved the Gardasil® vaccine, designed to prevent infection by certain strains of the human papillomavirus (HPV). That same month, a federal advisory panel on immunization practices recommended that all eleven- and twelve-year-old girls receive the vaccine.
But before girls and their parents can make informed decisions, it is important to understand the possible risks and potential benefits of Gardasil, as well as alternative options for increasing immunity and reducing risk of infection.
Human Papillomavirus and Cervical Cancer
There are more than one hundred strains of the human papillomavirus, and at least forty can be transmitted through sexual contact, affecting both men and women. According to the National Cancer Institute, fourteen of these sexually transmitted HPV strains have been associated with a high risk for developing cervical cancer. Two of these, 16 and 18, are associated with seventy percent of all cases.
According to the FDA, HPV infection is very common, and it is rare for HPV infection to lead to cervical cancer, especially in women under the age of thirty. In fact, ninety percent of cervical HPV infections become undetectable within two years. When cervical cancer is diagnosed, it is one of the most treatable cancers. According to the American Cancer Society, invasive cervical cancer diagnosed in its earliest stage has a five-year survival rate of ninety-two percent.
Immunization Basics
Gardasil, manufactured by Merck, is currently the only available vaccine against HPV, specifically strains 6, 11, 16 and 18. To measure the effectiveness of the vaccine, trials conducted by Merck assessed prevention of pre-cancerous lesions, not cervical cancer. Therefore, predictions about the ability of Gardasil to prevent cancer are speculation, as the majority of pre-cancerous lesions revert to normal without treatment and only a minority develop into cancer.
Merck researchers concluded that the vaccine was ninety-nine percent effective in preventing infection and pre-cancerous lesions caused by HPV strains 6, 11, 16 and 18 in women who had not been exposed to these viruses before immunization. The vaccine did not protect against infection or pre-cancerous lesions in women who had already been exposed to HPV. Because more than half of all men and women are exposed to HPV within one year of becoming sexually active, the vaccine is most effective when administered before the onset of sexual activity.
According to the CDC, approximately thirty percent of cervical cancers are caused by HPV strains not covered by Gardasil, and women who receive the vaccine are still at risk for cervical cancer. The vaccine does not treat existing HVP infections and does not prevent cervical cancer caused by existing infections.
The vaccine has only been tested by Merck, only for four years, and only in girls and women between the ages of nine and twenty-six. There is no long-term safety data about the vaccine and no information about its use in girls less than nine years old and in women above the age of twenty-six.
Adverse Effects
According to Merck's clinical data, adverse effects after immunization most commonly included pain and inflammation at the injection site, fainting, dizziness, fever and nausea. Other side effects were rare, but some were very serious, including asthma, lymphadenopathy, Guillain-Barré syndrome, and systemic autoimmune disorders such as rheumatoid arthritis, juvenile arthritis, and systemic lupus erythematosis.
According to Merck, Gardasil has not been studied for its potential to cause cancer or birth defects. However, during clinical trials, women who became pregnant within thirty days of receiving the vaccine had more "serious adverse experiences during pregnancy,"— including "congenital abnormality,"— compared to women who received a placebo. Additionally, cases of acute respiratory illness were higher in the infants of breastfeeding women who had received the vaccine within the previous thirty days, compared to infants of breastfeeding women who received the placebo.
Risky Behavior
One alternative to the HPV vaccine is behavior modification. Because HPV strains 6, 11, 16 and 18 are transmitted by sexual contact, discretion in sexual activity can be more effective in preventing infection and associated pre-cancerous lesions. When abstinence is not realistic, other behaviors can reduce the risk: delaying the onset of sexual activity, reducing the number of sexual partners and using condoms during sexual activity. Condoms can reduce transmission of the human papillomavirus, but only to and from the areas they protect: the cervix, vagina, penis, anus and rectum. Condoms do not prevent HPV transmission to and from other areas, including the vulva and perineum.
Regular Screening
Because HPV has a slow growth cycle, most associated cases of cervical cancer are slow to develop and slow to progress. For this reason, annual Papanicolaou tests, also known as pap smears, are important tools of prevention. Pap smears can catch cellular abnormalities that may lead to cancerous changes before they occur, and can detect early stages of cancer while still highly curable. An additional HPV test, administered at the same time as the pap test, can determine if a woman has been infected with a high-risk strain. As a result of regular testing, the death rate from cervical cancer continues to drop approximately four percent every year.
Girls and women who are immunized with Gardasil still require yearly pap smears because the vaccine does not protect against all HPV strains associated with cervical cancer, nor does it protect against other causes, including genetic defects and exposure to carcinogenic compounds in cigarette smoke.…
Read the rest of this article, including sections about probiotics and lifestyle factors in the September/October 2008 issue of the Well Being Journal. For annotations, see September/October,
2008, Volume 17, #5. Order online or purchase by
phone at 775-887-1702 M-F between 9am and 3pm PST.
Sarah Cimperman, N.D., is a doctor of naturopathic medicine in private practice in New York City. She specializes in nutrition, botanical medicine, homeopathy and detoxification. For more information, call 646-234-2918 or visit www.drsarahcimperman.com
Rebounding can help your immune system ward off all sorts of infections too. For information on rebounders, click here.
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