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    Monday, February 05, 2007

    Texas 1st to Require HPV Vaccine

    Friday I was greeted by some good news after finishing my practice physical exam. Texas is requiring all girls entering sixth grade to be immunized for HPV.

    HPV stands for Human Papilloma Virus--a sexually transmitted virus that causes genital warts. This disease is especially interesting because it doesn't ALWAYS cause disease.

    While at BYU, I collaborated with Dr. Meyers of Penn St. Medical School who is very well known in HPV research. His research focused on elucidating the lifecycle of the virus. He was interviewed by WPSU (Penn State Public Broadcasting) about the vaccine and disease.

    One of the problems with studying HPV is that it's lifecycle has different stages in different tissues. That made studying it in vitro almost impossible until Dr. Meyers perfected a method of creating an organotypic skin culture--pseudoskin--to study it. The other big problem is that HPV has numerous different strains. Each strain behaves similarly, but not identical, to others. While many cause genital warts, the nature of the virus may lead it to latent infections, and some strains lend themselves to that more than others. This means it can be transmitted very easily because many people--especially men--may not know they have it because they won't have any symptoms.

    HPV has an interesting secondary disease. According to Dr. Meyers,
    "Certain types of the virus that infect the cervix or anal-genital region can cause cancer."
    In fact, about 90% of all cervical cancers have HPV as a cause. According to Dr. George Ort, on the same radio show, cervical cancer causes about 25% of cancers in women worldwide. Hence a vaccine that could prevent 90% of those cancers would be incredibly important.

    The vaccine, Gladasil by Merckx, doesn't quite get 90%, but it is very good. Dr. Meyers said,
    "there are over 15 human pap virus types that cause cancer, and the vaccine is directed against the two major types that cause cancer--and about 70% of cancer are caused by these two types--so its effective for 70% on that basis."
    However, although this vaccine looks so good, it has caused a lot of controversy.

    In Texas, a very conservative and strongly religious state, many people and groups argue (like when arguing birth control in schools) that requiring this vaccine will give a green light in girls' minds to have more sex. Others are not properly educated on the vaccine because it is so new. My mother worried about the vaccine on Friday. She remarked that she had raised my sister right, and didn't worry about her being at risk for getting HPV, so why spend the money? Why have the chance to get the virus?
    It is imperative that pap smear education go hand in hand with HPV vaccine distribution

    Well, giving the vaccine to 9 year old girls, or girls entering 6th grade, will not give them the greenlight to have more sex anymore than preaching safe sex in schools will. Surveys are showing sexuality rates declining among high school students, giving fodder for the view that possibly sexuality has more to do with culture and less to do with the availability for sexual education in schools. Moreover, students are required to get many shots before school anyway, and few know what the shots are for. Adding one more shot to the barrage placed before them will be accepted as a fact of life, with little care into what disease it will prevent and therefore minimally impact behavior.

    Secondly, people can raise their chlidren "right," in the sense that those children might not be sexually active during their teenage years or before marriage, but that never decreases the probability for rape or abuse. Unfortunately, raising your child right doesn't mean others raised their children correctly, and nobody wants their daughter to develop cervical cancer after being raped.

    Thirdly, the vaccine is not the virus. Dr. Meyers described it as,
    well this is a very simple little virus, and with all viruses theres a nucleic acid--either dna or rna inside. And what they did was they made empty viruses, so there's no dna inside these particle, so there just empty little particles, and when they inject that into a woman, the woman's immune sys sees them as a virus even though their empty, and so it mounts a response and creates protection against infection by that virus."
    So if a person gets the vaccine, there is NO CHANCE she could get infected by the virus.

    One problem with the vaccine is that it only protects 60-70% of cervical cancers, so some health professionals fear that vaccinated women will stop getting regular pap smears (that test for cervical cancer). It is imperative that pap smear education go hand in hand with HPV vaccine distribution.

    The shocking thing is that Texas is the first state to require students to get the vaccine. Governor Rick Perry did an end-around republican state legislators and the inevitable fight it would have received in this conservative state, and passed it by executive order. According to the Los Angeles Times, Perry side-stepped part of the backlash by saying that parents who don't want the vaccine for their children because of reasons of conscience can opt out of it. However, human nature is such that most parents won't object, because it's just one more shot.

    Having just returned from the Texas Medical Association Winter Conference, I can say that this was the news of the meeting. Over the two days I was in Austin, both doctors and medical students were discussing this, and I heard 100% happiness that Gov. Perry took this step. Although controversial among social conservatives, he has the backing of the medical community, and that might be most important of all.

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