In the recent issue of Pediatrics, scientists published the results of an ten year follow-up study on a population of kids who received an HPV-9 vaccine during the original clinical trials. The primary outcome of interest was HPV related cancer diagnosis. The secondary outcome was the incidence of persistent HPV related outcomes.
So what did they find?
Among females, the incidence in PPE analyses of the composite endpoint of HPV6/11/16/18/31/33/45/52/58-related 6-month persistent infection and disease was 52.4 per 10 000 person-years (persistent infection: 52.4 per 10 000 person-years; disease: 2.2 per 10 000 person-years; Table 2). There were no cases of high-grade CIN and no cases of VIN and VaIN related to vaccine-targeted HPV types. One case of cervical intraepithelial neoplasia grade 1 (CIN1) tested positive for HPV16, HPV39, and HPV59 by PCR at month 84 (Supplemental Appendix 1); cervical cytology results were negative at subsequent visits….
Among males, the incidence in PPE analyses of the composite endpoint of HPV6/11/16/18/31/33/45/52/58-related 6-month persistent infection and disease was 54.6 per 10 000 person-years (persistent infection: 54.6 per 10 000 person-years; disease: 0 per 10 000 person-years; Table 2). There were no cases of disease related to vaccine-targeted HPV types.
Results were similar when effectiveness was analyzed in the HN-TS population (Supplemental Table 14). There were no additional cases of disease endpoints in females or males in the HN-TS population.
10 years of follow-up from initial vaccination shows one, low grade, cancer in the entire population. The expected rate of cervical cancer is about 8 per 100,000 person years. This study shows over a 75% decline in incidence of cervical cancer.
So what does it mean!
First WOW. Vaccines are weirdly incredible. This is an awesome result. Teens should be vaccinated for the biggest impact on both personal protection and population health. Secondly, we are in an era where basic public health policies and programs are highly politicized. We’re seeing lower vaccination rates for the recommended kindergarten disease menu. COVID is the clearest examine where partisanized identity has led to massive vaccine preventable excess deaths.
HPV has always been a politicized vaccine because it acknowledges that most teens at some point will be sexually active either today or sometime in the next few decades. We as a society don’t do a good job thinking about teen sexual autonomy and health and we do a piss poor job as a society respecting teen woman and gender minority sexual health and autonomy in particular.
The only question I’ve had with my 14 year old on the HPV vaccine is whether they preferred ice cream or a Frappuccino afterwards. The last two choices have been fancy coffee-like drinks as a reward. My 11 year old prefers ice cream as their post vaccine incentive. And I assume that the kids of most of my friends and peers either are, in the process of, or will be vaccinated against HPV. However if we move thirty miles down the road, that assumption weakens substantially.
We’re building future health disparities by our choices today.
On The Road – Dagaetch – World Tour Part 5B – New Zealand
Josie
Good for you, Dad, for respecting your women – all your women.
BellyCat
Science is amazing. Let’s hope it survives human stupidity.
Chris T.
What’s a “PPE analysis”?
(Likely answer: Personal Protective Equipment. But you should define your acronyms…)
Wag
Vaccination is fucking amazing. Am I sad that evangelicals aren’t vaccinating their children against HPV? Yeah, but their self inflicted diseases (COVID, HPV, MMR, etc.) are further dividing them from societal advancement, and if we can further marginalize them (thank you young people across the country) we may have a future that finally rolls back the Reagan era excesses.
Ohio Mom
Oh yeah, I remember the right-wingers going nuts about vaccinating their innocent teens. I am beginning to think it’s not just sexuality they are weird about, it’s also dealing with expert authority. They have a permanent case of adolescent “you can’t tell me what to do.” Applied inconsistently, as teens do.
Ohio Son’s pediatrician wanted to give him the vaccine so I said yes even though he’s pretty asocial (as fitting his um, neurological difference). Call it an act of extreme optimism.
I don’t remember him having any reactions. Though after my shingles shots, I am careful to schedule shots for when there is a free day afterwards.
Really, when you think of all the discomfort doctors can be the source of, being vaccinated is the least of it.
AM in NC
I think you’re right, David. Both my boys got the HPV vaccine when recommended by their pediatrician, and there was such positive discussion among the parents in my friend group about this vaccine!
Go one county to the west, however, and it’s a different story. We are sorting ourselves in so many ways these days, it seems. I just feel bad for the kids being endangered by their ignorant /fearful parents. And I LOATHE the powerful people doing everything they can to keep those parents scared and ignorant.
lee
My oldest was just old enough to get the vaccine when it first rolled out. The pediatrician walked in with a handful of brochures and you could tell she was winding up for a ‘conversation’.
As soon as she said the words ‘HPV vaccine’ my wife said ‘Yes’. She chuckled and said ‘I didn’t think y’all were going to be a problem, but I have to come prepared’. At the time our area was very very Republican.
When I posted about it on FB I got some push back from the various nutters. Now whenever a new study comes out about how amazingly effective the vaccine is, I make sure to post it on FB. I also add that my daughters are protected against a common type of cervical cancer because of the vaccine that so many refused.
Barbara
Two daughters and son are all vaccinated. I struggle to think what the world would be like if this extreme degree of skepticism had prevailed two generations earlier. My best friend’s mom contracted polio as a teenager after her father refused to let her and her sister get vaccinated. She’s had a great life but it has definitely been accompanied by a lot of physical challenges. My friend’s grandfather never forgave himself and took the really useful and practical road of becoming an extreme alcoholic as a result. There are all kinds of ways to try to escape responsibility for your actions.
jonas
Well, if you have to orphan your kids to pwn the libs, then that’s what it takes, I guess.
lowtechcyclist
I had no idea they gave the HPV vaccine to boys as well as girls. The kiddo is 16, and I think I would have remembered if he’d gotten it. I’ll ask our pediatrician about this, next visit.
Other than possibly that, he’s fully vaccinated. Including all the Covid shots so far. (Like the rest of you, we’re all waiting for the new one that’s supposed to become available this month.)
Mousebumples
I was just under the max age when it came out, so I got Gardisil 6, I think? (there’s now a 9 strain version) The first 2 shots were no big deal, but the 3rd felt like liquid 🔥 was going into my arm. 15 ish years later, no cervical cancer, yay!
jonas
@lee: Yeah, I remember too at the time that conservatives were all up in arms about the “slut shots”, as though Jeebus was enough to protect your sweet, perpetually virginal daughters from cervical cancer. I think it was Michelle Bachmann who jumped all over Rick Perry at a GOP primary debate for mandating HPV vaccines in Texas. He had to walk that back so fast it slowed the earth’s rotation briefly.
Who knew back then that the idiocy was just beginning…
Barbara
@lowtechcyclist: The recommendation to vaccinate boys was issued well after the recommendation for girls, but my 17 year old son definitely got the first round no later than the age of 12. So definitely ask.
@Mousebumples: When I received my second shot for the most recent shingles vaccine, I told the nurse that it was quite a bit less painful than the first, and she told me that the pain associated with a lot of vaccines was due to the fact that they had to be refrigerated, and that she always tried to take it out of the refrigerator and let it warm up for a few minutes before administering it, which made it less viscous and thus less painful.
Pittsburgh Mike
Imagine being so into owning the libs that you’d greatly increase the chance that your daughter will get cervical cancer.
Noname
David, missed your anniversary post yesterday. You are making people’s lives better, including mine. Thank you.
stinger
@Chris T.: That acronym appears to come from a quoted portion of a journal article that David did not write. Presumably the authors spelled out PPE on first usage, in a portion of the article not quoted here. David isn’t responsible for any of that. And “PPE” is an easy google — first result.
JKC
HPV vaccine really is a modern success story. All three of my kids received the series as soon as possible.
I’ve seen a lot of HPV-mediated cancers in my career. I wouldn’t wish it on my worst enemy.
ginkgo
The Gardasil vaccine is absolutely amazing. It is not only for cervical and oral HPV cancer, but also for genital warts. I have been a practicing Ob/Gyn for 38 years and I have seen the changes that came w/ the development of the vaccine.
I used to see genital warts at least every other day. Not just talking about a few warts. Occasionally I would laser off 100+ warts at a time. Now the only people I see w/ warts are older women and young women whose parents didn’t have them vaccinated.
I have had only two women that required surgery for an abnormal Pap smear who had been vaccinated. Both of these women were immunocompromised and the surgery cured them. You have to think about how many of thousands of women I have seen over the years to appreciate that I have seen only two vaccinated women required treatment.
Ruckus
@BellyCat:
Nothing is stronger than willful stupidity.
Nothing.
When willful stupidity is politicalized it gets worse.
ginkgo
Cervical cancer used to be one of the major causes of death in women until screening w/ Pap smears became available.
Recently had a case that hammered this into me again. Performed a LEEP on an unvaccinated 29 yo woman who had a baby about 8 weeks before. The final pathology report showed CIS of the cervix. This is as close to cancer as you can get without being cancer. Actually, didn’t expected the path report to be this bad based on the cervical biopsies.
I was taking to the patient and her her mother about getting vaccinated at her 2 week postop visit when her mother told her she needed to do her own research. She would probably would have died in a few years leaving a small child without mother if it wasn’t for modern medicine. Patient was only having to deal w/ this now because her mother did not have her vaccinated.
This is absolutely crazy. The mother could have killed her daughter.
My oldest daughter was vaccinated the first month the vaccine was commercially available. Youngest daughter was vaccinated soon after.
As you can tell, I am very strongly provaccine.
glc
[copy edit: examine -> example]
Ruckus
@Barbara:
Those of us who were born before the polio vaccine likely know at least one person with polio. My family took the vaccine the first day it was made available. I know 4 people, 2 of them people my age, 2 of them my friends moms who had polio. The 2 moms had iron lungs in their front rooms. One of my neighbors, my age, now lives in a wheelchair. I don’t know about the other 3, except that everyone who needed an iron lung from polio hitting their chest muscles rather than their legs has long ago past away. No one I knew or saw fought taking that disease. And for all the vaccines there are today, for humans and animals back in the early 1950s when the polio vaccine came out, it was only the second vaccine available, the other being smallpox.
The concept that science can make vaccines that keep people from dying is one of the best things humans have ever done. How many humans on this planet died from Covid before vaccines for it were developed? A hell of a lot, in that one year. We don’t live in a world where we don’t necessarily see anyone else for long periods of time, because there are a hell of a lot more of us now and most of us don’t live 20 miles outside of town. It took until 1820 that the total population of the US became larger than that of Los Angeles County is today. And transmittable diseases transmit a hell of a lot better when we live as close as most of us do at this time. Vaccines are far more important than they were 200 yrs ago. Not less.
Ruckus
@ginkgo:
You will know better than most people how much vaccines have saved humans from dying and killing others with many diseases that vaccines fight. Hell take Covid — Please. This wanton stupidity of many people to see everything modern medicine can do as a horrible thing in the world, that we are supposed to die when something-something happens, it’s some higher power that is smarter, evillier than mankind and we have to give in to that higher power that we can’t understand! The often wanton stupidity of such a large portion of humanity would be literally unbelievable if it wasn’t near as common.
Hob
@Chris T.: PPE is defined in the article that the quoted text is from; in that context, it means per-protocol effectiveness. You can see that article by clicking the link in the first sentence of the post.
StringOnAStick
@ginkgo: Thank you for sharing your professional experiences here! I wish I had been young enough for this vaccine; I had one PAP of severe cell dysplasia, treated, and never again had a bad one, but I was relieved to have a hysterectomy for several reasons and this was definitely one of them! I’m happy to no longer have the organ where this disease develops.
Argiope
@ginkgo: I’m CNM-WHNP faculty. About a decade ago we lost one of my most brilliant students ever to cervical cancer. She left behind a devastated husband and two preschoolers. She would have been an incredible midwife, and her loss is a loss to our profession and the people who would have been her patients, not just to her family and friends. My kid was also fully vaxxed against HPV as soon as she reached eligibility.
Freemark
On a related note on the partisan divide in health. I was surprised something that showed just how bad the GOP is to health was in Politico. But this is an excellent article.
satby
@Freemark: That was excellent, thanks for sharing it!
randy khan
I am interested in this incentive system. I think I should apply it to myself, even though I would get the appropriate vaccines anyway.
narya
As someone who had issues likely related to HPV repeatedly over the years, I would like to take the people who aren’t vaccinating their kids and . . . do something. (I have a no-hitting rule, so a dope-slap upside the head isn’t an option, but damn, if I can come up with a verbal version of it I would.) Last year’s hysterectomy rid me of all of it, but I do mean YEARS of monitoring, worrying, etc.
wmd1961
As a survivor of a HPV caused neck cancer it makes me very happy to see others can avoid the radiation therapy that cured my cancer. 7 weeks and 70 grey of high energy gamma radiation is worth avoiding.