FYI: HPV Vaccine

[brynndragon]

(Disclaimers: I am not a doctor, nor do I play one on TV. I have been doing cancer research for 6 years and I most recently worked for a biotech company that is not working on an HPV vaccine.)

A lot of folks I know are looking into getting Gardasil, Merck's partial[1] HPV vaccine. If you’re not amongst them, you should be – by the time you hit 50 years old or 10 partners (whichever comes first) you have an 80% chance of having some form of genital HPV, and we’ve determined that HPV is the source of cervical cancer, which is the second most common cancer amongst women. Even if you’re not a woman, new information had come to light regarding non-gender-specific cancer caused by HPV (namely throat cancer from HPV spread by oral sex), so you’re also at risk. Here's what I've been able to figure out about it, split by gender and age:

• If you're under 27 years old and female, it's not only highly likely to actually take but your insurance company will more than likely pay for it. Getting cancer really sucks and almost all cervical cancer is caused by HPV - talk to your doctor about Gardasil already!


• If you're under 27 years old and male, you should know that preliminary studies show that Gardasil is effective for you as well (clinical trials are currently being carried out). I feel that it's worth it for you to look into having it done for two reasons: men can also get cancer from HPV (penile, anal, and/or throat) and men are the Typhoid Mary of cervical cancer (caused almost entirely by HPV) - you often don't have symptoms and there's currently no good way to test for it. Do it for yourself, for someone you love, and for someone you will love down the line, regardless of your sexuality.


• If you're between 27 and 55 years old and female, you might be better off waiting for GSK's Cervarix, another partial HPV vaccine, to come on the market. Gardasil is much less likely to take in someone over 26 according to Merck's preliminary studies, which is why they didn't do the larger clinical trials with women over that age. GSK has sent in all the FDA-approval studies and paperwork for Cervarix, which is effective in women up to age 55, and it looks like it'll be released between October 2007 and January 2008. At this point, if you go through the time required to get the vaccine and get a titer[2] to see if it took, Cervarix will likely have already been released. Between the greater chance that it'll be effective (meaning you won't have to go through and pay for a second round of the vaccine) and the good chance that it'll be covered for women who fall within the recommended age range, I'm going to wait. But talk with your doctor about Cervarix vs. Gardasil anyway - at least s/he'll know that you're looking to get it when it comes out if you decide to wait for Cervarix.


• If you're between 27 and 55 years old and male, I'm honestly not sure what to tell you. It looks like GSK hasn't bothered testing Cervarix in men at all and isn't planning on doing so (that could change if there's more demand amongst men in this age range for an approved HPV vaccine), so I can't even begin to predict how effective it would be. My apologies, but it looks like you have a much more difficult choice than any of the previously mentioned groups. A discussion with your doctor is definitely in order.

A vaccine that protects you from even a few forms of cancer is one of those things we've been dreaming about for years. Please don't let it pass you by.

[1] There is no vaccine for all forms of HPV, just like there's no flu shot for all forms of the flu. Both Gardasil and Cervarix are focused on cancer-causing strains of HPV, but Gardasil does cover some wart-causing strains as well (there is overlap between strains that cause warts and cancer). It looks like both vaccines help prevent strains beyond the ones they specifically grant immunity for, but we don't really know how much help they are.
[2] For the love of God, whatever age or gender you are, get a titer. I can not emphasize this enough: you do not know that you are actually protected until you get a positive titer result. This is doubly important for people who get a vaccine off-recommendation, but everyone should have it done. I found out when I got a Hepatitis B titer about a year ago that I did not have immunity, despite getting the series done entirely according to the book when I was in high school. Get a titer!

Comments

[dragontdc.livejournal.com]

What the hell is a titer? I've not heard that term before.

[benndragon.livejournal.com]

It's a blood test to see if you have at least the minimum concentration of antibodies required for an effective immune system response (a titer of those antibodies) to prevent a disease someone has been vaccinated against. A positive result means you're set, a negative result means you need to redo the vaccination.

[mr-teem.livejournal.com]

Thanks for writing this up. (I haven't heard about a titer before, either.)

[kgola.livejournal.com]

I second this, thanks.

Titers absolutely

[astarteljb.livejournal.com]

I got retitered for everything before we went to Dominican Republic this year to see if I needed a booster for any of my childhood vaccines. you need to get updated on a bunch of them, Elie needed a MMR shot that he didn't know about. And this year we discovered that my pneumovax had lost its effectiveness sevearl years early. Titers are important!

Also, make sure you've had your adult shots! They're way cheaper at the adult clinics sometimes. (Elie's hep A & B were like $40 a shot cheaper!)

-l.

[rigel.livejournal.com]

Both Gardasil and Cervarix are focused on cancer-causing strains of HPV, but Gardasil does cover some wart-causing strains as well (there is overlap between strains that cause warts and cancer).

I thought the news I saw was that HPV 6 and 11 cause warts but /not/ cancer.

[benndragon.livejournal.com]

My point was more that assessing one's level of HPV-based risk of cancer based on the presence of absence of warts can be misleading, rather than a specific strain is or is not wart or cancer causing. That said, HPV 6 and 11 are low-risk, meaning they very rarely cause cancer, but it could happen. They also cause prominent "cauliflower" warts, but high-risk forms such as 16 and 18 do cause flat nigh-invisible warts as well. (from here).

[null4096.livejournal.com]

You have a very good point. The strains that make the big warts aren't the same as the ones that'll give you cancer.

[rigel.livejournal.com]

Also, source? I just spoke to a nurse in gynocology at my medical facility and she said she'd never heard that the shot didn't take in women over 26.

[benndragon.livejournal.com]

I remember back when the vaccine was still in clinical trials and I was watching the HPV vaccine news with baited breath that the reason Merck made the cut-off at 26 was their preliminary studies (nowhere near clinical-trial-sized n) showed the efficacy started dropping off significantly right around there. Sadly I can't find the links I read back then, so it's entirely possible I got bad info. What I can find is that Merck's clinical data is for women age 16-26 and boys and girls age 9-15, meaning they either don't have any data for women and men older than that or they don't have data that supports their product for women and men older than that; I can't tell you which is the case. (A an aside, the science geeks might enjoy actual data in PDF format).

Incidentally, GSK is making a big deal out of the adjuvant used in Cervarix, AS04, which is considered more effective than the one used in Gardasil (better immune response, much less likely to need a booster shot in the future). There is also a Cervarix vs. Gardasil study being conducted by GSK, so confident they are in their beloved adjuvant.

[null4096.livejournal.com]

There are quite a few vaccines that don't work if the person is already infected; it's hard to imagine a vaccine for herpes simplex digging the virus out of the neurons where it's lying dormant. The assumption might be that by 26 odds are you've already been infected.

[rigel.livejournal.com]

Sorry, wasn't talking about in the case of previous infection. I know about that bit already. I was talking about what brynndragon addressed in her reply to me.

[null4096.livejournal.com]

Sorry. I still haven't gotten the hang of the reply structure on lj.

Evidence!

[benndragon.livejournal.com]

It's been a while, but a random search lead me to this abstract from _Vaccine_ which states the following: "Antibody titres following vaccination in girls 12–16 years have been shown to be significantly higher than in older women, favouring vaccination in early adolescence prior contact with the virus." Sadly I'd have to buy the full paper to get more details than that, but at least I know I didn't pull that statement out of my butt :).

[null4096.livejournal.com]

The only thing I can say is that I'm 100% sure I don't have HPV, and I know that in the worst possible way.

[wispfox.livejournal.com]

At least according to my Ob/Gyn's place, there _is_ no titer for Gardasil yet. (ok, well, I think that's what I'm getting, since I think the other isn't available yet)

[benndragon.livejournal.com]

I just couldn't believe that, since titres are used to get efficacy data in clinical trials of vaccines. My suspicion is confirmed by this paper in Vaccine: "Antibody titres following vaccination in girls 12–16 years have been shown to be significantly higher than in older women, favouring vaccination in early adolescence prior contact with the virus." I could accept "it's really expensive and not covered by insurance so our lab doesn't do it" or a variation on that theme, but I think your doctor (or their office) either stated it poorly or is just repeated what the lab told them without contemplating what it means. You might want to dig a bit deeper with your doctor to figure out what's really going on - if you do, please let me know!