HPV vaccine

By now you’ve probably heard that there’s a new vaccine for girls that can prevent some cancers of the cervix. But how do you explain its purpose to a young teen?

First, you’ll want to be able to explain to her how it all works. Cancer can be triggered by various things, explains Robert Bortolussi, who is chair of the Canadian Paediatric Society’s immunization and infectious diseases committee, and some — like cervical cancer — can indeed be caused by a virus. “Virtually all cervical cancer is associated with virus infections that occur early in the woman’s life — in her teens or 20s — although the cancer may not develop until she is 50 or 60.”

The culprit is the human papillomavirus (HPV), a very common virus with more than 30 different types. The new HPV vaccine targets those types mostly likely to cause cancer and genital warts.

Your daughter’s next question might be: So how do you get HPV? It’s almost entirely sexually transmitted, explains Bortolussi. That means you get it by having sex with someone who already has the virus (and may not even know it).

Here’s where the vaccine (marketed as Gardasil) comes in.

Bortolussi says: “For the immunization to work, it needs to be given before the person is exposed to the virus — that’s why it’s recommended for preteen and young teen girls, before they become sexually active.”

The Canadian Paediatric Society is still reviewing the research, but hopes to have a statement of recommendations published by early 2008.

Monique MacFarlane Conrad, a medical student in Halifax, recently did a research study on public opinion about this vaccine. She found reports from the US suggesting some parents have been concerned that the vaccine would encourage sexual activity in teen girls. But in her research, Canadian parents rarely expressed these fears.

“Overall, 78 percent of parents said they’d approve of the HPV vaccine if the doctor recommended it, and 72 percent of the teens we surveyed said they’d be interested in getting it,” says MacFarlane Conrad. “Most of the rest were ‘maybes’ — people who wanted to have more information about the safety and effectiveness of the vaccine before making a decision.”

This can also be an opportunity for you to open a conversation with your daughter about sexually transmitted diseases in general. While it may feel awkward to discuss these issues, it’s often easier at this early age, before she’s sexually active and taking it all more personally.

One point to emphasize: The vaccine isn’t a perfect preventive. Even if she’s immunized against HPV, it won’t eliminate your daughter’s need for Pap smears and regular gynaecological checkups as she gets older.

And what about vaccinating boys? While HPV infections in boys don’t cause cancer as commonly as in girls, Australia is also vaccinating boys against it, in the hopes that this will lower the rate in girls. However, to date there has not been enough research done to show that the vaccine is effective in boys.

Bortolussi expects that the CPS will be recommending the vaccine for girls aged nine to 13, and adds that research shows this gives full antibody protection for at least 10 years. “That takes them through the prime years for getting the infection,” he comments. A booster shot may be needed after 10 or 15 years if ongoing studies show the antibody levels waning.

While Canadian recommendations may not be finalized, MacFarlane Conrad feels this is an exciting step forward. “I’ve seen women in their 20s and 30s with cervical cancer, and I think if we can prevent some of these cases, it’s a very positive thing.”

Updating the recommendations

To see current recommendations for the vaccine in Canada, check:
phac-aspc.gc.ca/naci-ccni Scroll down to see a link to the report on HPV research.
cps.ca The Canadian Paediatric Society site will have information for parents as the research is reviewed.