HPV Vaccination Should Be Required and Recommended - Research Proposal Example

HPV Vaccination Should be Required and Recommended Total Number of Words: 2,013 Introduction Affecting almost 20 million people throughout the United States, the genital human papillomavirus (HPV) is considered as one of the most common sexually transmitted virus (CDC, 2008b; Centers for Disease Control and Prevention, 2007). Since cervical cancer caused by HPV infection can lead to the untimely death of thousands of women each year, the U.S. government and other related health care authorities should study and consider the need to make HPV vaccination mandatory among the school-age children. After discussing the target audiences and the main purpose of the study, a literature review will be conducted to examine the valid health and safety reasons behind the need to recommend and require each child to receive HPV vaccination. In the process of going through the literature review, the possible adverse health effects of HPV vaccination and the involvement of the U.S. government in terms of rendering financial support to this particular health project will be tackled. Prior to conclusion, a rationale and personal reflection with regards to the need to require each child to receive HPV vaccine will be provided. Target Audiences and Purpose of the Study The target audiences for this study is not limited to health care professionals such as doctors and nurses and medical students but also the young female population regardless of whether they are sexually active or not. HPV is a common sexually transmitted disease that could cause men and women to develop less common types of cancer and/or genital warts. (The George Washington University Medical Center, 2007) In worst cases, cervical cancer in women caused by HPV infection could lead to untimely death (Centers for Disease Control and Prevention, 2007). There has been a controversy as to whether or not to make HPV vaccination mandatory among children because of the fact that teaching children below 18 years old might give them a wrong connotation that becoming sexually active at a very young age is acceptable. (The George Washington University Medical Center, 2007) Likewise, the issue of whether there is a need to mandate each child to receive HPV vaccination is subjected to a lot of debate considering that the market price of HPV vaccine is high (Outterson & Kesselheim, 2008). Without the financial assistance extended by the U.S. government, children belonging to the low- and middle-class families will not be able to comply with the health care requirements even if the local health care authorities implement a list of mandatory guidelines requiring each child to receive HPV vaccination. The main purpose of the study is to gather related literature review to effectively persuade the target audiences with the need to require and recommend HPV vaccination among young girls as early as nine years old. (CDC, 2008b) In line with the importance of HPV vaccine, the best way to prevent the adverse health effects of HPV infection is to educate the young female population, parents, adolescents, policy-makers, and health care providers with the increasing importance of HPV vaccination (Saslow et al., 2007). Literature Review General Information Regarding the Benefits of HPV Vaccination Among the common types of cancers caused by HPV includes cervical cancer (100%), anal cancer (90%), vulvar and vaginal cancer (40%), oropharyngeal cancer (12%), and oral cancer (3%). (Kim & Goldie, 2008; Parkin & Bray, 2006) With regards to the long list of HPV-related cancer, several studies explained that human papillomavirus types 16 (HPV-16) and 18 (HPV-18) are the main causes almost 70% of the HPV-related cervical cancer among the infected women. (CDC, 2008b; Saslow et al., 2007; Clifford et al., 2006; Clifford et al., 2003) Likewise, HPV-16 and HPV-18 also contributes to the development of 50% – 60% precancerous lession (cervical intraepithelial neoplasia [CIN 2 and CIN 3] among women throughout the United States (Saslow et al., 2007). HPV vaccine is a prophylactic vaccination which has been developed to fight against human papillomavirus types 6 (HPV-6), 11 (HPV-11), 16 (HPV-16) and 18 (HPV-18) infections. (Kim & Goldie, 2008; Garland et al., 2007; Devaraj, Gillison, & Wu, 2003) Today, two types of HPV vaccine known as: (1) quadrivalent HPV 6/11/16/18; and (2) bivalent HPV 16/18 which reduces the probability that a sexually active person can develop genital warts by 80 – 90% are available in the market (Stanley, 2008). HPV vaccine known as Gardasil is the first vaccine that has been developed in order to minimize young girls and women’s risk of developing cervical cancer, precancerous genital lesions, and genital warts caused by HPV infection (CDC, 2008b). As long as a young girl has not been exposed to HPV infection, Gardasil is considered safe and effective in terms of preventing at least four different types of HPV infections (CDC, 2008a). The fact that the use of Gardasil vaccination does not protect women from all the different types of HPV that causes cervical cancer, women are still at risk of developing some forms of cancer despite receiving three doses of HPV vaccine as recommended by the FDA (CDC, 2008b). As publicly announced by the Vaccine Adverse Event Reporting System (VAERS)1, 94% out of 10,326 VAERS report that the use of Gardasil vaccination throughout the United States are non-serious adverse effects like fainting, pain, swelling at the injection site, headache, nausea, and fever (CDC, 2008a). Although the remaining 6% or 620 patients who were administered with Gardasil vaccine experienced serious adverse effects like hospitalization, death, permanent disability, and other life-threatening illnesses, there is really no concrete clinical evidences that can prove that these serious negative health effects were caused by the HPV vaccine (CDC, 2008a). Considering that there is no solid clinical evidences that can prove that the administration of Gardasil vaccination, the U.S. Food and Drug Administration (FDA) considered the use of this particular vaccine has as safe and effective (CDC, 2008b). Aside from the fact that HPV vaccine is found to be effective in terms of preventing HPV-16 and HPV-18 infections, cervical abrasions or cancer including the HPV-associated head and neck squamous cell carcinomas (HPV–HNSCC) among the HPV infected population (CDC, 2008b; Ault, 2007; Garland et al., 2007; Paavonen et al., 2007; Devaraj, Gillison, & Wu, 2003), HPV vaccine is also effective in terms of preventing HPV-6 and/or HPV-11 infection which causes the development of plantar, genital warts as well as juvenile- and adult-onset recurrent respiratory papillomatosis (Kim & Goldie, 2008; Lacey, Lowndes, & Shah, 2006; Devaraj, Gillison, & Wu, 2003). Although HPV vaccine is effective in terms of reducing women’s risk of developing cervical cancer, the vaccines does not totally eliminate the fact that sexually active girls and women to develop cervical cancer (Stanley, 2008). Although the duration of HPV protection remains unknown (CDC, 2008b), the effectiveness of HPV vaccine administration is assumed to last for at least 5 years (CDC, 2008b; Stanley, 2008). Since the administration of the HPV vaccine is found to be more effective in preventing the adverse health effects of HPV infections when given to young girls even before they encounter their first sexual contact with the opposite sex (Ault, 2007; Garland et al., 2007; Paavonen et al., 2007), it is highly recommended that the HPV vaccine to be given to young girls at an early age before they enter into a sexual relationship with the opposite sex (CDC, 2008b). The first HPV vaccine is normally given to young girls and women below the age of 26 years old in a series of three injections over a six-month period followed by giving the second and third doses on the second and sixth months after the first injection respectively. (CDC, 2008b) Aside from the health and safety protection associated with associated with requiring the young girls to receive HPV vaccination at an early age, Kim and Goldie (2008) discussed the cost-effectiveness of HPV vaccine administration among 12-year-old girls with $43,000 per quality-adjusted life-year (QALY) as compared to 26 year-old women with $152,700 per QALY. Possible Adverse Health Effects of HPV Vaccination Among the common negative health effects associated with the administration of Gardasil vaccine includes: (1) Guillain-Barre Syndrome (GBS) – a rare physical disorder that causes muscle weakness; (2) blood clots which often occurred in either the heart, legs, and/or lungs; and (3) untimely deaths caused by either diabetes or heart failure, meningitis, blood clots, and seizure disorders among others. (CDC, 2008a) Even though there has been some reports of death few months after the administration of Gardasil vaccine on young women, the test made by the FDA on thousands of women all over the world found no signs of serious side effects except for a brief soreness found on the injection site (CDC, 2008b). The Involvement of U.S. Government in terms of Rendering Financial Support to this Particular Health Project The actual retail price of the HPV vaccine is approximately US$120 per dose or US$360 for the three doses. (CDC, 2008b) Given that not all health care plans cover the HPV vaccines, making the administration of HPV vaccine mandatory can be an added financial burden on the part of the low-income families without the financial support coming from the U.S. government. Since not all individuals who belong to the low-income families are covered with health care insurance, some states provide qualified individuals with free low-cost vaccines in some of the public health department clinics (CDC, 2008b). Reflection Based on the literature review gathered in the study, HPV vaccination or Gardasil vaccination should be required or recommended by the FDA in order to minimize women’s risk of developing genital warts, cervical cancer, and other cancer triggered by HPV infections. Considering that the administration of the existing HPV vaccine is not sufficient in preventing all types of HPV causing cervical cancer and other related diseases, women who are sexually active are still required to go through a regular cervical cancer screening (CDC, 2008a & 2008b). By doing so, young girls and women can easily seek medical assistance and receive necessary treatment in case signs of cervical cancer has been detected at an early stage. With regards to the serious adverse health effects that has been reported VAERS, there is really no clinical evidences that can prove that HPV vaccine caused the untimely death or hospitalization of young girls and women who received HPV vaccination. In order to prevent the risk of serious health consequences of the administration of HPV vaccine, each individual who is about to receive the vaccine should provide a complete details of each individual’s clinical history. As a safety precaution, reporting diseases like diabetes of heart problems will make the health care professionals monitor the health of each patient closely. To ensure that each person who will receive the HPV vaccine is not allergic to the components of Gardasil vaccine, a skin test should be given to patient before they receive each of the three required doses. Considering the high cost of HPV vaccination, not all young girls will be able to financially afford to pay for the three doses as required by the FDA. Aiming to increase the number of young women who are able to receive the HPV vaccination, the U.S. government should increase its financial support on this particular health project. It is a good start knowing that some states are able to provide a free low-cost vaccines to young girls who belongs to the low-income families. (CDC, 2008b) However, there are still a lot of work to be done to enable the U.S. Department of Health (DOH) to be able to extent the provision of free vaccination in all states. Conclusion HPV vaccination should be mandated in order to protect the women’s health and minimize the risk associated with going through the negative consequences of developing genital warts and cervical cancer. For better result, HPV vaccine should be given to young girls as early as nine years old. Since HPV vaccine is not enough to keep women free from cervical cancer, other health prevention such as going through a regular cervical screening is still required. *** End *** References: Ault, K. (2007). Effect of prophylactic human papillomavirus L1 virus-like-particle vaccine on risk of cervical intraepithelial neoplasia grade 2, grade 3, and adenocarcinoma in situ: a combined analysis of four randomised clinical trials. Lancet , 369(9576):1861 - 1868. CDC. (2008). Retrieved November 12, 2008, from Reports of Health Concerns Following HPV Vaccination: http://www.cdc.gov/vaccinesafety/vaers/gardasil.htm CDC. (2008b). Retrieved November 12, 2008, from Vaccines and Preventable Diseases: HPV Vaccine - Questions & Answers: http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm Centers for Disease Control and Prevention. (2007). HPV Vaccine: What You Need to Know. Department of Health and Human Services. Clifford, G., Franceschi, S., Diaz, M., Muñoz, N., & Villa, L. (2006). Chapter 3: HPV type-distribution in women with and without cervical neoplastic diseases. Vaccine , 24(Suppl 3):S26 - S34. Clifford, G., Smith, J., Plummer, M., Muñoz, N., & Franceschi, S. (2003). Human papillomavirus types in invasive cervical cancer worldwide: a meta-analysis. British Journal of Cancer , 88(1):63 - 73. Devaraj, K., Gillison, M. L., & Wu, T. (2003). Development of HPV accines for HPV-Associated Head and Neck Squamous Cell Carcinoma. 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Efficacy of a prophylactic adjuvanted bivalent L1 virus-like-particle vaccine against infection with human papillomavirus types 16 and 18 in young women: an interim analysis of a phase III double-blind, randomised controlled trial. Lancet , 369:2161 - 2170. Parkin, D., & Bray, F. (2006). Chapter 2: the burden of HPV-related cancers. Vaccine , 24(Suppl 3):S11 - S25. Saslow, D., Castle, P. E., Cox, T. J., Davey, D. D., Einstein, M. H., Ferris, D. G., et al. (2007). American Cancer Society Guideline for Human Papillomavirus (HPV) Vaccine Use to Prevent Cervical Cancer and Its Precursors. CA: A Cancer Journal for Clinicians , 57(1):7-28. Stanley, M. (2008, September 22). British Medical Bulletin. Retrieved November 12, 2008, from HPV vaccines: are they the answer?: http://bmb.oxfordjournals.org/cgi/content/abstract/ldn037v1?maxtoshow=&HITS=&hits=&RESULTFORMAT=1&andorexacttitle=and&fulltext=HPV+vaccine+&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT The George Washington University Medical Center. (2007). HPV Vaccination: Should it be Recommended or Required? - Rapid Public Health Policy Response Project. Pfizer. Read More