Thursday, December 14, 2017

Gardisil–It’s Not Just for Girls Anymore


by Terence Chu, M.D.
May 2012

It was just about 5 years ago when I had written an article for SOCPA that included information about a new vaccine for girls and young women called Gardasil. Gardasil is a vaccine against a virus called Human Papilloma Virus (HPV). HPV is the most common sexually transmitted viral infection and causes genital warts, cervical cancer, vaginal cancer, oropharyngeal cancer, anal cancer, and penile cancer. Initially it was tested in girls and women and was found to be very effective in the prevention of genital warts and the anogenital cancers in females. Of most benefit was and is the prevention of cervical cancer. We have been giving the vaccine to our adolescent female patients since 2007.

However, during this past year, it was finally recommended by the ACIP (Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention) and the AAP (American Academy of Pediatrics) to routinely vaccinate all boys starting at age 11 or 12 and to catch them up with the vaccination at ages 13 through 21 if they have not been vaccinated yet. We as doctors expected that this would eventually be recommended and were waiting for it. Why vaccinate the boys? There a few reasons. 1) The vaccine has been shown to prevent genital warts in both boys and girls. The vaccine protects against the strains of HPV that cause 90% of the genital warts. 2) The vaccine also has been shown to help prevent anal cancer in boys. While it is likely that it will also provide protection against oropharyngeal cancers and penile cancers in boys, these are not clinically proven indications for the vaccine yet. 3) We want to develop as much “herd immunity” as possible. In other words, the more kids/adolescents/young adults that are immunized, the less HPV will be spread and in turn, the less HPV related diseases will occur. Even though the vaccine has been recommended for females since 2007, there are still large numbers of unvaccinated teenage females (more than 60% have not been vaccinated). So by giving the vaccine to the boys, we can help ensure that the unvaccinated girls will not be infected.

Why vaccinate at age 11 or 12? Well the vaccine is actually approved down to age 9, so it can be given even earlier safely. Also earlier vaccination means earlier protection. The majority of HPV infections occur in adolescence and young adulthood. While we as doctors and parents want and teach our children to be abstinent for a long, long time and if not abstinent then to use condoms; we know that does not always happen. Therefore it is in our young people’s best interest to get them vaccinated early before the onset of sexual activity (which unfortunately sometimes occurs early in adolescence). Even if your child has no sex before marriage, that does not mean his/her marriage partner did the same. Additionally, higher antibody levels are obtained when the vaccine is given between 9 and 15 years of age. This higher antibody level may give a longer time of protection in adulthood. Therefore protect your child/adolescent now to prevent disease in him/her now.

Of note, Gardasil is a 3 dose series. It is given at time 0, then at 1-2 months after time 0, and then again 6 months after time 0. If a dose is missed, the series does not have to be restarted. There is another HPV vaccine called Cervarix, however this vaccine is only approved for females and does not include the strains that cause genital warts.

We encourage you to talk to your child’s doctor about the vaccine at your next appointment.

The contents of this web site are provided as an informational tool. This is not intended to replace medical advice or care administered by a healthcare professional. Common sense should always be used when referencing this site. If, at any time, you feel your child is experiencing a medical emergency, call 911 immediately.