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Thank you for a clear presentation of some of the science behind this new vaccine. I would like to know more about long-term safety studies.
The relationship between estrogen in Hormone Replacement Therapy and birth control pills and increases in breast cancer is clear to us now. Unfortuantely, science about the cancer-causing potency of estrogen only came years after these interventions came on the market with the same kind of ballyhooed, "save the day" rhetoric we are hearing today.
Since these are prepubescent children we are talking about vaccinating in many cases, what has the CDC and Merck done to assure parents that the 10-year-old we vaccinate today will not experience side effects in her childbearing years 10 to 15 years later?
This question is crucial in the case of HPV, transmitted during sex and addressable with the same kind of educational intervention that has made such a decrease in the rate of HIV/AIDS infections.
Until we have such information, no doctor on the order of no BigPharma-backed governor will put a needle in my daughter and inject her with this stuff.
Obama . . . Because!
by wildhand on Sat Feb 03, 2007 at 07:36:39 AM PDT
..to perhaps ease your mind a little on this issue, the kind of vaccine that Gardasil is resembles in every way (kind of inactivated virus)the vaccines we have been using to immunize children against measles and rubella for decades. So far, the only adverse reactions long-term against the measles vaccine was that the old vaccine did not give complete immunity in a fraction of patients. No such long-term effect has been found against rubella. The smallpox vaccine is a live-virus vaccine (using the cowpox virus that causes immunity to both diseases) and there have not been any long-term adverse effects from that vaccine. The long-term use of estrogens and their relation to later cancers is a completely different sort of issue - it has nothing to do with immunity against anything - the hormones used actually stimulate estrogen-dependent cells, and that is one of the reasons that they may increase the incidence of breast cancer
In a time of universal deceit, telling the truth becomes a revolutionary act. - George Orwell
by drchelo on Sat Feb 03, 2007 at 07:41:37 AM PDT
[ Parent ]
My purpose in bring up estrogen was to point to an historical instance when an intervention had unintended, unanticipated long-term consquences in a large population segment.
Regarding the safety of attentuated viral vaccines, do I understand you correctly:
You are comfortable in telling a patient that this Gardasil will likely have a good long-term outcome because other attentuated virus vaccines have?
What about the case of the infamous RotaShield vaccine, which had to be recalled in 1999 (PDF alert) after less than a year on the market for causing intersussception in children. For those unfamiliar with the incident, intersussception is a dangerous, painful condition in which the intestines telescope in on themselves. The vaccine caused children to undergo emergency surgery and, according to some reports, to die.
RotaShield was also modeled on the smallpox vaccine.
by wildhand on Sat Feb 03, 2007 at 07:52:24 AM PDT
You're absoutely right to weigh risks and benefits. Studies were started, I believe, about 10 years ago, and so far no side effects aside from the usual local and very occasional anaphylactic shock (happens with any vaccine, extremely rare), which can be dealt with if in a trained doctor's office.
But you're right. It's a dicey question. Clearly, in some African countries where tens of thousands of women die of cervical cancer every year, the public health issue is easy to decide--this vaccine is a must for those countries.
In this country, with availability of Pap smear and relatively low risk of cervical cancer, the odds are different. However, if you are a young, very sexually active person (I'm old and mongogamous now; very sexual in youth and probably already exposed to all the strains) you might want to consider it.
Bottom line: It's a risk/benefit thing. The worst that can happen is cervical or anal cancer (penbile cancer is extremely rare in US). The next worst is genital warts--painful, sometimes hard to cure (or recurrent). The next issue is what responsibility to you play as a potential carrier to others. I'm not saying I know what the right decision is. As the years go by, we'll find out what the true safety profile is. So far, it's as safe as other similar vaccines.
by MmeVoltaire on Sat Feb 03, 2007 at 08:11:00 AM PDT
I didn't know studies were 10 years old. The oldest I know of are 5 years. I'll look for the decade old ones. Thanks. If you have some linky for us, that would be great.
Your analysis regarding risks/benefits is right on the money and is the sort of process that every parent should go through when making this kind of decision for their child.
I wish that I had been given a chance to go through this kind of analysis before the HepB shot (to prevent another sexually transmitted disease) was given to my son a few hours after his birth in 1999.
by wildhand on Sat Feb 03, 2007 at 08:25:55 AM PDT
The first Phase I trial in humans on pubmed (published in English in a journal they accept) is this:
Muderspach L, Wilczynski S, Roman L, Bade L, Felix J, Small LA, Kast WM, Fascio G, Marty V, Weber J. Related Articles, Links A phase I trial of a human papillomavirus (HPV) peptide vaccine for women with high-grade cervical and vulvar intraepithelial neoplasia who are HPV 16 positive. Clin Cancer Res. 2000 Sep;6(9):3406-16. PMID: 10999722 [PubMed - indexed for MEDLINE]
Theories about HPV viruses and then animal studies began earlier (1993). But you're right--until there are long-term studies in humans, it's all theory.
Thanks for the correction.
by MmeVoltaire on Sat Feb 03, 2007 at 08:54:21 AM PDT
were not live, attenuated vaccines but instead used VLP (virus-like) proteins to basically build their vaccine.
is the merck vaccine unique in that is IT a live, attenuated vaccine? if so, when did they develop the technology to be able to actually culture HPV strains in the lab? that would be amazing if they had, btw.
but if the vaccine is in fact based on the VLP model, aren't the risks associated with it different than say a smallpox vaccine (given that one is an attenuated vaccine, smallpox; the other not)?
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it's their screen name because they couldn't figure out how to spell "moran."
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by dadanation on Sat Feb 03, 2007 at 11:18:51 AM PDT
wide narrow
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