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By Norma Erickson Are HPV vaccines a viable option in your personal war against cancer? It is very difficult to make an informed choice about Gardasil or Cervarix when you receive only part of the available information. The time has come to take a critical look at the facts behind recent HPV vaccine news reports. In June 2006, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination with 3 doses of Gardasil for females aged 11 or 12 years and catch-up vaccination for those 13 to 26 years old. In October 2009, this recommendation was updated to include Cervarix as an option for HPV (human papillomavirus) control. The theory behind these two vaccines is: by reducing infections with the two high-risk types of HPV associated with an estimated 70% of cervical cancer cases globally, there may be a reduction in the number of cervical cancer victims. However, until such time as a verifiable reduction in the number of cervical cancer diagnoses is reported, this theory remains unproven.
Any article published without providing a way to check facts and verify data is nothing more than free advertising for HPV vaccine manufacturers. Is this the purpose of the Press?
102 linear array tests, 61% of the results did not match.6 Can you trust medical research based on 39% accuracy? With these limitations in mind, lets take a look at a few recent headlines touting the phenomenal success of HPV vaccines.
be exposed to HPV. This disparity alone could account for some of the decline in HPV prevalence. Look at the data below from Table 3 of the study, where those who were not sexually active were excluded. Note: those who were not vaccinated experienced a larger decrease in HPV prevalence than those who were vaccinated in all but one category. So, why does the vaccine get the credit? Table 3: HPV Prevalence Among Sexually Active Females Aged 14-19 Years, Overall and by Vaccination History HPV Type Vaccination History Any HPV Overall Vaccinated Unvaccinated Vaccine Type HPV Overall Vaccinated Unvaccinated High Risk non-vaccine type Overall Vaccinated Unvaccinated Alpha-9 species Overall Vaccinated Unvaccinated Alpha-7 species Overall Vaccinated Unvaccinated 12.4% NA NA 11.1% 15.0% 8.9% 12.9% NA NA 12.0% 17.8% 8.4% 33.5% NA NA 29.1% 35.2% 25.3% 19.4% NA NA 9.0% 3.1% 12.6% 53.1% NA NA 42.9% 50.0% 38.6% 2003-2006 (736 subjects) 2007-2010 (358 subjects)
It is interesting to note there is some evidence indicating potential type replacement demonstrated by the increased prevalence of high-risk HPV types which are not vaccine-
relevant in those who were vaccinated. These high-risk types include alpha-7 and alpha-9 species. Vaccinated subjects experienced an increase in all three of the high-risk categories. HPV vaccine reduces cancer virus in girls by 56%, by Elizabeth Weise, USA Today, June 19, 2013 states: Doctors aren't sure why the decline is so great, given that only 46% of young women have received at least one dose and only 32% have received all three. It could be what's called herd immunity, in which the vaccinated women lower the overall amount of the virus in the population, thus lowering infection rates for everyone, said Lauri Markowitz, lead author of the study. Facts: First, medical professionals and consumers need to understand that the quote above is referencing two different sources of data. The HPV vaccine uptake rates are from a document produced by the CDC entitled, National and state vaccination coverage among adolescents aged 13 through 17-United States, 2010. (MMWR 2011;60:1117-23). This document has nothing to do with the HPV vaccine uptake rate in those included in the NHANES data. Among those counted in the NHANES data, the uptake rate for HPV vaccine uptake rate was only 34% receiving one or more doses. Those who were fully vaccinated represented only 19% of the age group in question. With all due respect to author Elizabeth Weise, you cannot compare apples to oranges and make any sort of valid scientific conclusion. According to Vaccines and Public Health, the CDC and WHO have estimated what vaccine coverage needed in order to confer herd immunity for the following diseases: Diphtheria 85% Pertussis 92-94% Polio - 80-86% Measles 83-94% Mumps 75-86% Rubella 83-85%
How can a representative of the CDC, or anyone else for that matter, even infer that a vaccine uptake between 19-34% would confer any sort of herd immunity? It works: HPV vaccine reduces infections by 56%, CDC says, by Karen Kaplan, the Los Angeles Times, June 19 2013 states: Altogether, a total of 8,403 teens were tested for the four types of HPV -- HPV-6, HPV-11, HPV-16 and HPV-18 -- that are targeted by the vaccines. The 56% drop in HPV infection was found for females between the ages of 14 and 19.
Facts: 8,403 people were included in the complete study from 2003-2010 ages from 14 to 59. Nearly half of those were not tested for type-specific vaccine-relevant HPV, the 4150 subjects from 2003-2006. The other 4253, from the 2007-2010 surveys, only included 740 teens. There is evidence that a reduction in HPV infections did occur. Whether or not it had anything to do with HPV vaccines remains to be seen. New study shows HPV vaccine helping lower HPV infection rates in teen girls, by Division of News & Electronic Media, Office of Communications, CDC press release quotes Dr. Tom Frieden, CDC Director, as saying: This report shows that HPV vaccine works well, and the report should be a wake up call to our nation to protect the next generation by increasing HPV vaccination rates, said CDC Director Tom Frieden, M.D., M.P.H. Unfortunately only one third of girls aged 13-17 have been fully vaccinated with HPV vaccine. Countries such as Rwanda have vaccinated more than 80 percent of their teen girls. Our low vaccination rates represent 50,000 preventable tragedies 50,000 girls alive today will develop cervical cancer over their lifetime that would have been prevented if we reach 80 percent vaccination rates. For every year we delay in doing so, another 4,400 girls will develop cervical cancer in their lifetimes. Facts: This report shows nothing of the sort. This report raises more questions than answers. Respectfully, Dr. Frieden: the 50,000 preventable tragedies you speak of would never occur if women would go for their pap tests as recommended. Pap tests detect cervical cell changes BEFORE cancer begins to develop. You mention Rwandas better than 80% uptake on HPV vacc ines, but make no mention of any demonstrated reduction in the prevalence of vaccine-relevant HPV in that country. If the United States HPV study you reference is accurate, Rwanda should have already eliminated nearly all vaccine-relevant HPV. Assuming this is true, it will still take another decade or two to determine if there is any impact on cervical cancer attributable to HPV vaccination programs. Should all high-risk types of HPV be completely eliminated, that would simply mean one risk factor for cervical cancer would no longer be a part of the cervical cancer equation. The remaining risk factors would still be present. Eliminating one risk factor does not justify the adverse events being experienced after HPV vaccines. In the interest of public health and safety, the very least the CDC should do is be honest about the potential risks and refrain from exaggerating the potential benefits of HPV vaccines.
References: 1) Reduction in Human Papillomavirus (HPV) prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 2003-2010, JID, Laurie E. Markowitz et al. 2) National Health and Nutrition Examination Survey homepage 3) NHANES Participant Information and NHANES Participant Video 4) NHANES Surveys and Data Collection Systems and Human Papillomavirus (HPV) DNA Results from Vaginal Swab Samples: Digene Hybrid Capture and Roche Linear Array and NHANES Mobile Examination Center 5) Accuracy and Interlaboratory Reliability of Human Papillomavirus DNA Testing by Hybrid Capture, Journal of Clinical Microbiology, Mar. 1995, p. 545550 6) Comparison of DNA Sequencing and Roche Linear Array in Human papillomavirus (HPV) Genotyping, Laura Giuliani et al, Anticancer Research 26: 3939-3942 (2006)