CDC Recommends HPV Vaccination for Young Girls

Published August 1, 2006

The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) voted June 29 to recommend that a vaccine for the human papillomavirus (HPV), approved by the Food and Drug Administration (FDA) earlier in the month, be routinely administered to girls as young as age 9.

Gardasil–the vaccine manufactured by Merck–was found by the FDA on June 8 to effectively guard against four types of HPV, which together account for 70 percent of cervical cancer cases and 90 percent of genital warts.

According to the National Network for Immunization Information, based in Galveston, Texas, HPV comes in more than 120 varieties, ranging from the relatively harmless causing plantar warts to the cancer-causing. It generally spreads through skin-to-skin contact. According to the CDC, HPV is the most common sexually transmitted disease in the nation, infecting 6.2 million Americans annually. Each year, it causes about 9,700 new cases of cervical cancer and kills 3,700 American women.

Though the FDA and ACIP both found the vaccine effective and safe for girls as young as 9 and for sexually active women up to age 55, both agencies stopped short of making any recommendations on whether the vaccine should be required for school attendance–an idea that has worried social conservatives for the past year.

Vaccinating Children

The Center for American Progress (CAP), a left-leaning public policy think tank in Washington, DC, hailed Gardasil as “one of the greatest public health victories since the polio vaccination” in a June 8 news release.

“My hope is that we will mandate HPV vaccination for school attendance the way we do other vaccinations,” said Dr. Jonathan Moreno, the group’s bioethicist. “It’s a problem that there’s this anti-vaccine movement. If the tradeoff is sex or death, I realize for some of these folks premarital sex is spiritual death, but most people don’t feel that way. It’s clearly better that kids are protected as much as possible. Public health is imperfect, so you need to do the best you can.”

Moreno was referring to socially conservative groups such as the Focus on the Family ministry in Colorado Springs and the Family Research Council (FRC), a nonpartisan think tank in Washington, DC. Though both groups applauded the vaccine as a scientific breakthrough, they said vaccination decisions are best made by parents.

Influencing Behavior

Last year, an FRC representative discussing Gardasil in a media interview raised the question of whether vaccinating 9-year-olds for an STD could lead to earlier onset of sexual activity. Peter Sprigg, FRC vice president for policy, said the media misinterpreted the remark, leading to several erroneous stories suggesting FRC opposed the vaccine.

“The bottom line is that we support the vaccine. We think this can be a great advance for public health,” Sprigg said. “But we do continue to emphasize that abstinence until marriage and fidelity within marriage is the best formula for sexual health. We don’t think it’s justified to make this vaccine mandatory for school attendance. The strains of HPV that contribute to cervical cancer, which are being targeted by this vaccine, are sexually transmitted.”

Merck, Sprigg pointed out, answered FRC’s hypothetical question about the vaccine’s impact on behavior with an internal study, and concluded vaccination does not lead to sexual disinhibition.

“As we’ve looked at it closely, we believe it all depends on a company’s information in administering the vaccine,” Sprigg concluded. “If it’s used as an opportunity to talk about sexual health and the range of risks that can come from sexual activity, there’s a potential it could have a positive impact on people’s sexual behavior and lead them to be more careful. We believe it’s important for parental decision-making to be maintained rather than imposing some sort of mandate.”

Making Policy

Clinical data suggest the vaccine is most effective when administered at young ages–before girls are exposed to HPV through sexual activity–but is also helpful for sexually active adults. Men do not appear to be negatively affected by HPV as often as women.

The question of whether the vaccine will become mandatory for school attendance may be settled later this year, after the influential American Academy of Pediatrics weighs in on the matter. At press time, the group said it was still writing its policy and would publicize it this autumn.

Karla Dial ([email protected]) is managing editor of Health Care News.