Magazine article Clinical Psychiatry News

Panel Advises CDC on Gardisil Vaccination Criteria: Agency Told HPV Vaccine Should Be Given to Girls at Age 11-12 and to Unvaccinated Females Aged 13-26

Magazine article Clinical Psychiatry News

Panel Advises CDC on Gardisil Vaccination Criteria: Agency Told HPV Vaccine Should Be Given to Girls at Age 11-12 and to Unvaccinated Females Aged 13-26

Article excerpt

ATLANTA -- The quadrivalent human papillomavirus vaccine should be given to all girls at age 11-12, and to all females aged 13-26 who have not been previously vaccinated, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices voted at its June meeting.

The vaccine, Merck's Gardasil, was licensed in early June. It is indicated for the prevention of disease caused by HPV types 16 and 18, which are associated with about 70% of cervical cancer, as well as types 6 and 11, both associated with genital warts. However, the decision to vaccinate should not be based on Pap testing, HPV DNA testing, or HPV serologic testing, and no changes are recommended in current guidelines for cervical cancer screening, ACIP said.

The CDC is not obligated to follow the advisory committee's advice, but it usually does.

Although the vaccine should be administered prior to the initiation of sexual activity, females who are already sexually active should still be vaccinated.

Use of the vaccine in young women has been strongly endorsed by the American College of Physicians, Dr. Kathleen M. Neuzil, ACP liaison, said in an interview. "We're thrilled that the recommendation includes young adult women. We're currently working on education efforts," said Dr. Neuzil, senior clinical advisor on immunizations for PATH, an international nonprofit health organization based in Seattle.

Dr. Lauri Markowitz of the CDC's National Center for HIV, STD, and TB Prevention provided background data and guided the ACIP through a series of votes on the use of the vaccine.

A national survey conducted in 2002 found that 26% of girls in the U.S. have had vaginal sex by age 15; the figure rises to 77% by age 19. Once sexual activity begins, the incidence of HPV infection rises to 40% within 2 years and to more than 50% within 4 years, she pointd out.

However, serology and PCR testing conducted by Merck showed that, among females aged 16-26 years, 76% were still naive to all four of the HPV types in the vaccine and less than 1% had evidence of past or present infection with all four types. Therefore, among those infected with one, two, or three HPV vaccine types, the vaccine would still be expected to protect against disease caused by the other types.

"Although overall vaccine effectiveness would be lower, most females will still derive benefit from vaccination," Dr. Markowitz said.

In a separate vote, ACIP also recommended vaccination for women with an equivocal or abnormal Pap test, those who have tested positive for HPV infection using the Hybrid Capture II, and for those with genital warts. However, these patients should be told that they may be already infected with one or more vaccine HPV types and that data do not indicate that the vaccine will have a therapeutic effect on existing cervical lesions, warts, or HPV infection.

Women who are lactating and those who are immunosuppressed can receive the vaccine, which is not made from live virus. However, administration should be delayed among women with moderate or severe acute illness, and those with a history of immediate hypersensitivity or severe allergic reaction to yeast or any vaccine component should not receive it, ACIP recommended.

Administration of the vaccine should be delayed until after completion of a known pregnancy. If a pregnancy is revealed after a woman has received one or two doses, the rest of the series should be postponed until after the pregnancy. …

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