The following is a cut & paste of yesterdays' e-newsletter I received from Dr. Erika. These are HER words, not mine. _______________________________________________________ I’ve been inundated with questions about the new HPV vaccine. Most e-mails and calls come from mothers of young girls who are confused about what to do with their daughters. It seems that the pediatricians have picked up the drug companies’ baton and are out to immunize every young girl in sight. Should you vaccinate or shouldn’t you? I know the CDC in conjunction with the American Cancer Society have been quite diligent about providing FAQs and other informational pamphlets on the topic of the HPV vaccine, its use and recommendations. However complete and detailed these materials are, keep in mind the final decision is a personal decision and in the case of the HPV vaccine, it falls all in the lap of the parents. As a parent and a physician I’d like to give you some insight into my own understanding and position on this issue. As a parent, my daughters are 22 and 29 and thus I need not make this difficult decision but as a caring and honest physician I can promise you that my advice is given to you as I would for my own girls. Relevant Background HPV is considered as common as the common cold virus by most practicing physicians in the US. It is that common and that innocuous. There are more than 100 strains of HPV 60 cause regular non-genital skin warts 40 cause genital warts. 6 million people get infected yearly with this virus that we know of 70% of those infected are clear of any sign of the infection within a 1 year 90% have no sign of infection by 2 years. HPV viruses that are associated with a high incidence of cancer (by the way, no one really knows the true statistics of infected healthy people without immune system problems) include HPV 16, 18, 31, 35, 45, 51, 52, 58 and others. You cannot distinguish the type of HPV causing a particular infection with normal blood testing The HPV vaccine was approved by the FDA a couple of months ago so it has no track record of safety or long term side-effect evaluation The vaccine protects from 2 high risk HPV viruses-#16 and 18 which cause 70 % of cervical cancers and HPV #6 and 11, the strains that cause 90% of genital warts We do not know anything about the vaccine’s long term effectiveness or dangers in general and in specific on American girls. Before its approval by the FDA the vaccine was tested in other countries around the world for only 5 years. Now that you are a little less scared about being non-compliant by keeping your daughter away from the vaccination, let’s look at a couple of more issues. So who is at highest risk of getting cervical cancer caused by HPV virus? Young women- teen to early twenties with multiple sex partners who lack access to preventive and regular Pap smears and routine check-ups. Let me make it a bit clearer: if my daughters were in the HPV immunizable age group I would not have them immunized with the HPV vaccine. The reason: Once they became sexually active my daughters started going for regular Pap smears. Pap smears diagnose HPV related problem early and the gynecologist then treats the problem and prevents it from becoming cancer. Cervical cancer is a disease created by lack of preventive care. If our girls have routine Pap smears once they are sexually active, they are okay. If your daughter may not have access to consistent preventive care, if you cannot afford it or you are not sure you can help your daughter get into a supportive and protective health environment, then protect her by immunizing her. If your daughters are going to get routine PAP smears once they are sexually active, if they are going to be supported and given encouragement and example to help them develop self-esteem and self-confidence, they will become self- protective and care enough about their bodies and their health not to lead risky lifestyles that expose them to STDs or other abusive situations. In this case they will not need the HPV vaccine. Besides my concerns with the long term effect of the HPV vaccine I have one last nagging concern I want to share with you. What message are we giving our daughters if we immunize them at the age of 9 against a sexually transmitted disease? Are we giving them a false sense of security and implicit encouragement for reckless sexual behavior? You make that decision and don’t let the doctor, the school nurse, the drug rep or your neighbor tell you what to do!