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									                           Pediatric Points
                                                               By Carolyn Roy-Bornstein, MD

                           Making the Case for the HPV Vaccine
                       Tw e n t y       is currently recommended for girls      bacco use and use of birth control
                       years ago,       aged 11 to 12 and protects against      pills, both of which increase your
                       if you had       HPV types 16 and 18, as well as         risk of clotting.
                       told me          against types 6 and 11, which are
there would be a vaccine against        responsible for 90% of genital          As of June of 2008, 31 cases of
cancer, I may not have believed         warts. (Cervarix is another shot        Guillain-Barré Syndrome have
you. But today, the new vaccine         that just protects against types        been reported. GBS is a rare neu-
against Human Papillomavirus            16 and 18 and is not yet licensed       rological disorder that causes vary-
(HPV) is just that.                     in this country.)                       ing degrees of paralysis, usually
                                                                                temporary. Some of these cases
HPV is the most common sexu-            In trials where Gardasil was given      turned out not to meet criteria for
ally transmitted infection. By two      to young women proven by blood          the diagnosis. Some of the girls re-
years after first having sex, nearly    tests and cervical cultures not to      ceived the Gardasil shot along with
40% of young women are infected         be infected with HPV, it was 100%       the meningococcal vaccine, which
with one or more types of these         effective. 100% effective! How          may actually be associated with a
viruses. Young women are more           many other things can we say that       minimally increased risk of GBS.
susceptible to infection with HPV       about? This efficacy goes down          The incidence of GBS in Gardasil
for several reasons, including a        when women already infected             turns out to be no more frequent
lack of adequate cervical mucus         are vaccinated since the vaccine        than what would be expected in
production and incomplete im-           is prophylactic, not therapeutic;       the general population.
mune systems. The good news is          that is, it is designed to prevent,
that they will very often clear these   not treat, infection.                   I have spoken to just a handful
viruses on their own. But for young                                             of parents who are reluctant to
women in whom infection persists,       Fortunately, major side effects         have their daughters vaccinated
the risk of eventually developing       from the vaccine are rare. Pain         against HPV specifically because it
cervical cancer increases.              and redness at the injection site       is a sexually transmitted infection.
                                        are the most commonly reported          There seems to be some feeling
Cervical cancer is the second-          reaction. Fever and nausea were         that recognizing the reality of teen
leading cause of cancer deaths          also seen in the clinical trials but    sexuality somehow endorses it or
among women worldwide. Over             no more frequently than with a          that protecting girls from a sexu-
one quarter of a million women          placebo shot.                           ally transmitted infection actually
die from this disease each year.                                                encourages them to have sex. This
Seventy percent of all cases of         Gardasil’s side effects continue to     has not been found to be the case
these cancers are caused by two         be monitored. There is a volun-         when girls’ sexual behavior rela-
especially high-risk types of HPV,      tary reporting system called the        tive to HPV vaccination has been
numbers 16 and 18. And now              Vaccine Adverse Effect Reporting        scientifically studied. I had one
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