For parents with teenage girls, questions still remain about whether or not to give their daughters Gardasil, the vaccine against human papillomavirus (HPV).
The vaccine made headlines in Massachusetts last July when state Sen. Richard T. Moore, D-Uxbridge, proposed a bill mandating that girls entering sixth grade be vaccinated against HPV, the most common sexually transmitted disease (STD). Certain types of HPV can cause genital warts, while others can cause cancer.
The bill met resistance from several groups who believed its mandate violated parents’ rights. Because HPV is sexually transmitted, some religious and family organizations lambasted the bill as ethically and morally offensive.
As it stands, movement on the mandate appears to have stopped. In February, the Senate sent the bill “to study,” making it unlikely that a vote on the proposed legislation will occur in the 2008 legislative session.
Separate from the Senate, however, study findings released in March by the federal Centers for Disease Control and Prevention (CDC) have unnerved some parents and reawakened debate.
The study found that one in four girls between the ages of 14 and 19 had sexually transmitted infections. African American parents had even more reason to worry: the STD rates for black teen girls (48 percent) were twice as high as their white counterparts (20 percent).
For some physicians that work with teens, the CDC study was a confirmation.
“I wasn’t surprised by the report,” says Dr. Lydia A. Shrier of the Division of Adolescent/Young Adult Medicine at Children’s Hospital Boston. “It’s not just talk. STDs are really an epidemic among young women — particularly African American women.”
The study monitored four of the most common STDs — HPV, chlamydia, genital herpes and trichomoniasis. HPV was most prevalent, at 18 percent.
“The issue for HPV is that so many people have it,” Shrier says. “And you can’t always tell who is going to have it.”
The ethical dilemma
Despite scientific evidence of the widespread dangers of HPV infection, some parents have been reticent to have their daughters vaccinated. Because HPV is transmitted through sexual or intimate contact, parents must weigh the kind of moral and social implications that didn’t enter into the equation when signing children up for inoculations against measles or whooping cough.
Kathleen, a mother of six who requested her last name be withheld, describes herself as devoutly Catholic. She has decided that none of her four daughters — ages 9, 16, 18 and 23 — will get the vaccine.
“It’s like pre-inoculating your child for an immoral lifestyle,” says the New Bedford resident.
She resident says the best protection for teens against HPV and other STDs is abstinence before marriage and fidelity within marriage.
According to the American Cancer Society (ACS), HPV is almost as widespread as the common cold. In the U.S., over 6 million people get an HPV infection every year. Almost half of those infected are between 15 and 25 years old.
Still, Kathleen opposes any effort to make the new vaccine mandatory for entry into middle school, especially because children cannot acquire HPV simply by sharing a public space, like the measles.
Kathleen admits that she doesn’t know whom her daughters will marry and whether or not her son-in-laws will be HPV carriers, but she thinks the HPV vaccine premature.
“The whole basket of negative what-ifs can be dealt with at the appropriate juncture,” she says. “For my adult children, their consciences have been formed and I trust that they will do just fine.”
Fear of the unknown
The CDC recommends vaccinating girls between the ages of 11 and 12, and as early as 9. Because the agency recommends girls get vaccinated before their first sexual encounter, many parents, like Kuae Mattox, realize the clock is ticking.
When Mattox, of Montclair, N.J., took her 11-year-old daughter for a check-up earlier this year, the doctor offered Gardasil. Kuae’s daughter left the doctor’s office with four shots required for middle school. None were for HPV.
“I am actually a little bit hesitant,” says Mattox. “I have never been hesitant in the past about vaccines, but I felt as if I need a little bit of time to pass in order for me to gather as much information as I can about the [HPV] vaccine.”
The CDC’s Advisory Commission on Immunization Practices has declared Gardasil safe, but Kuae says she has concerns when it comes to any brand new medication.
“There are a lot of things people have done in the past and realized down the line that maybe they shouldn’t have done it,” she says.
She cited the recent example of the drug Singulair, an allergy medication she had been giving to her 8-year-old son. Last month, she learned from an NBC newscast that the U.S. Food and Drug Administration was investigating a potential link between Singulair and suicides.
“It’s a classic example,” she says, “of something everyone thought was OK and found out down the line that it may not have been.”
She weighs the risks. One the one hand: Gardasil’s possible side effects. On the other: Cervical cancer.
Haunted by the high numbers of black teens with an STD — nearly one out of every two — Mattox knows she needs to decide fast.
“My girl is going to be a teenager before I know it,” she says. “I am going to need to know that I have done all that I can to make sure that she is covered if she does become sexually active.”
Preventive measures
“Don’t close your eyes,” says Annemienke Buurman, mother of a 15-year-old. “Girls these days are curious, they want to explore.”
Buurman works as a medical assistant at the Mount Auburn Practice for Women in Watertown. She says she sees too many women that come in for a long overdue Pap test, only to discover that they have HPV.
Last year, Buurman’s daughter received the first in a three-dose series of Gardasil shots.
Half of the teens in the recent CDC study reported having had sex. Among those girls, the incidence of sexually transmitted infection was 40 percent. With those odds, Buurman doesn’t want to take any chances.
“I see it like the hepatitis vaccine,” she says. “It’s a precautionary measure.”
The CDC study shows that the risk of infection for all girls, even those with only one lifetime partner, is high. Although most HPV infections clear up on their own, some infections persist over time, placing women at risk for cervical cancer.
The vaccine protects against two types of HPV that cause 70 percent of all cervical cancers, and two types of HPV that cause 90 percent of all genital warts.
A dangerous disparity
The ACS estimates that in 2008, about 11,070 cases of invasive cervical cancer will be diagnosed in the U.S., and 3,870 women will die from the disease. Statistics show that most invasive cervical cancers are found in women who have not had Pap tests in the past five years, or in women who have never had a Pap test.
Elderly, African American and low-income women are less likely to have regular Pap tests.
Because of the alarming rates of STD infection in African American teenagers, Shrier suggests more frequent screening.
“Communities that are predominantly African American should be aware of what their STD rates are,” she explains. “And if rates are high, members of that community need to have screening more frequently, and people who are not screened need to get in.”
Shrier cautions that the high STD rates among African American teenagers in the recent CDC study does not reflect race as a risk factor, but rather a risk indicator.
“The higher rates of infection are not related to biological differences,” she says. “It represents things that we are not testing for, not measuring. It could represent culture, it could represent social networks, it could represent poverty.”
As for the doctor’s take on the HPV vaccine debate?
“Don’t have [sexual] contact if you want something 100 percent [effective],” she says. “And if you are going to have contact, do what you can to reduce your chance of acquiring an infection.”
