The Gardasil Vaccine We have found the new HPV vaccine, Gardasil, has generated a multiplicity of questions and concerns. Therefore, we would like to take a moment to address this topic. The Gardasil vaccine covers two of the high-risk HPV virus types that cause 70% of cervical cancers and two that cause 90% of genital warts. It is clear that any vaccine that would eliminate 70% of cervical cancer and 90% of genital warts would be of significant value. Currently, the vaccine is recommended for patients in the age range of 11 years to 26 years. The very young girls have been included because studies of the vaccine demonstrate the immune response to be excellent at this age, and it is felt that immunization at that point will probably generate long-term protection. The immune response lessens with progress in age, but studies up to age 26 continue to demonstrate quite a significant response that will probably still result in long-term protection. Studies are ongoing in reference to an immune response in women as their age increases beyond 26. Sometimes we will have requests from women who are over 26 for the immunization. We explain to them the concern about the decreasing immune response, and we also explain that insurances will usually not cover the immunization beyond age 26. However, if they are in a high-risk situation, and if they are extremely anxious, we will supply the vaccine should they be within a few years of the 26 year limit. Many patients and/or their families want to know if the immunization is really needed for a young girl who intends to be sexually abstinent until marriage. We advise them that we still recommend the vaccination because of a number of factors: First, good intentions do not always prevail, or the woman may find herself in a situation that she cannot control. Sadly, date rape and sexual assault are an all too common reality of our society. Secondly, innocence on the part of the lady does not guarantee that her husband will not unknowingly bring the virus to the bedroom. Thirdly, experience with selective immunization of only “at risk” patients has taught us that such an approach does little to eradicate the overall effect of a virus on the general population. An example is hepatitis-B immunization programs. Initially, immunization was recommended only for at-risk populations. Little overall population benefit was noted until a more global approach was undertaken. One problem encountered is the fact that it may be hard to explain to an 11 or 12 year old why they have to have a series of 3 immunizations. For the really young girls receiving the immunization, Dr. Diane Foley (who is a pediatrician with our practice specializing in gynecological issues in girls under 21) does very gentle counseling with sensitivity to the girl’s stage in life, and the counseling is done in conjunction with the girl’s parents wishes. Some have voiced a concern that the protection afforded by the immunization may
“give license” to the person so protected, and that that person may then become sexually active at an earlier age or be more careless in their sexual activity. We feel that few women would actually feel “thus liberated”. Also, we do a thorough counseling visit prior to the injection, and we emphasize that 30% of the high-risk HPV viruses that cause cervical cancer are not covered, and the same holds true for 10% of the high-risk HPV viruses that cause genital warts. We also take this opportunity to discuss the multiplicity of other sexually transmitted diseases that are not caused by these particular viruses and yet are still of great concern. Another common question from patients is whether or not the immunization will help them fight a high-risk virus that they already carry. To date, the research does not indicate such an advantage, though studies are still ongoing in this area. With that being said, we do recommend the immunization for the appropriate age range patients, even if the patient already has a high-risk HPV infection. This recommendation is made because the probability of the patient having all 4 of the high-risk virus types covered by the vaccine is remote, and the patient is still at risk for the remaining covered viruses. If you have any questions regarding the vaccine or any other gynecologic issue, please do not hesitate to give us a call. 719/633-8773. Dr. Diane Foley and the Gardasil Vaccine | 
