Gardasil and Tweens - The Debate About the Vaccine

Source: Beth Ann Ditkoff, MD

(18 ratings)

To vaccinate or not to vaccinate? Today's parents are overwhelmed with medical decisions regarding vaccinations for their children, and the Gardasil vaccine to prevent cervical cancer is just one example. After recent news articles reporting on the death of a European girl who received the European cervical cancer vaccine, Cervarix, parental concerns have multiplied exponentially. According to the Centers for Disease Control (CDC) website, more than 26 million doses of Gardasil have been distributed in the United States as of September 1, 2009. In addition, over 15,000 adverse events have been reported. Ninety-three percent of these events were minor including swelling at the injection site, pain, headache or fever, but 7% of these events were major-including 44 deaths. However, just as in the European death, we cannot draw a conclusion that the vaccines caused the deaths, only that the vaccines were given sometime before the children died. There is currently no known causal association between the vaccine and death. For example, if a girl received the Gardasil vaccine and then was killed in an automobile accident, her death would still be reported to the Vaccine Adverse Event Reporting System (VAERS)-an early warning public health system that aids the CDC and U.S. Food and Drug Administration (FDA)--even though the vaccine itself did not cause her death.

Although there are many different types of human papilloma viruses (HPV), there are four types that are the most important in human disease. Types 16 and 18 cause 70% of cervical cancer cases and Types 6 and 11 cause 90% of genital warts in females. Gardasil vaccine, produced by Merck & Co., is the only cervical cancer vaccine approved in the United States that protects against these four types of HPV and the diseases that they cause. The vaccine is given as three shots over 6 months, and it is critical to have all three injections in order to get the full effect of the vaccination.

Since the vaccine is only efficacious if given before your daughter is sexually active, it is recommended for girls and young women ages 9 to 26 years. You may feel uncomfortable talking to your young tween about such serious topics as sex, sexually transmitted diseases and cancer while they are still playing Barbies and Webkins. If you have not yet had the "birds and the bees" talk with your child, you can introduce Gardasil as another necessary vaccine given by the pediatrician to keep your daughter healthy-like a tetanus shot. If your child already knows about sex from you and/or from the school's health curriculum, you can use the Gardasil vaccine as an opportunity to discuss sexually transmitted diseases and ways to prevent them including abstinence and condoms.

In September 2009, an FDA advisory committee voted to recommend Gardasil vaccine for boys and young men ages 9 to 26 years, not to prevent cancer, but to reduce the spread of HPV and to prevent genital warts. In the future, you may have to have this talk with your tween sons as well as daughters!

So, should you have your daughter vaccinated with Gardasil? Several national organizations like the American Academy of Pediatrics, Centers for Disease Control and Prevention, American Academy of Family Physicians and American College of Obstetricians and Gynecologists have all recommended the HPV vaccination. The CDC's website states that prior to licensing the vaccine, it was studied in 5 clinical trials including more than 21,000 girls and women. The safety of the vaccine continues to be monitored by the VAERS public health system (as described above) as well as the Vaccine Safety Datalink (VSD) Project and the Clinical Immunization Safety Assessment (CISA) Network which look at potential vaccine side effects and adverse events. Talk to your child's pediatrician and check the CDC's website, www.cdc.gov for the very latest vaccine information reports so that you can make a decision about what is best for your child's health.

Beth Ann Ditkoff, MD, author of Why Don't Your Eyelashes Grow? Curious Questions Kids Ask About the Human Body (Avery 2008)