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New vaccines: Big potential to save lives, and big debate about the risks

April 8, 2007 12:35 am

I'M ALWAYS HESITANT to mention the word "vaccine" in anything I write, because previous columns have resulted in e-mail from all over the country attacking me.

But I want to make sure that people make informed decisions. There are always risks to any medical intervention, but in my mind, the benefits of vaccines outweigh those risks.

This year, there were some changes to the immunization schedules put out by the American Academy of Pediatrics and the Centers for Disease Control that made news. The most notable involve the varicella (chickenpox) booster, the rotavirus vaccine and the hotly debated HPV vaccine.

As more children have been vaccinated, there is less exposure to "wild type" chickenpox, and therefore less natural "boosting" of immunity. This could make people more susceptible to developing chickenpox at an older age, when it can be more serious. Hence, the new recommendation for a booster dose at age 4 to 6 (the first dose is given at 12 to 15 months).

Conveniently, a vaccine became available before this recommendation that includes protection against measles, mumps, rubella and varicella. Since 4- to 6-year-olds had to get the MMR booster anyway, now we can just include the chickenpox booster in the same shot.

The new rotavirus vaccine (RotaTeq) is given orally at 2, 4 and 6 months of age. Rotavirus is the most common cause of vomiting and diarrhea in children, and is a major cause of death due to dehydration in Third World countries.

There was a vaccine for this available about 10 years ago, but it was pulled from the market due to cases of intussusception--or potentially life-threatening intestinal blockages--following the vaccine.

There were some reports recently that there might be a similar situation with RotaTeq as well. However, the CDC's recent review states that children who received the vaccine do not seem to have a higher rate of intussusception than would normally be expected in that age group.

Now for the most controversial new recommendation: Gardasil. This is the vaccine against human papillomavirus, which is the cause of warts. Certain strains are sexually transmitted and have been known for years to be the main cause of cervical cancer.

Last year, a vaccine was approved for use in females ages 9 to 26 that protects against the four strains of HPV most associated with cervical cancer. According to the CDC, 6.2 million Americans become infected with genital HPV each year, and cervical cancer causes 3,700 deaths in the United States annually.

This is 37 times the death rate from rotavirus in the U.S., and 40 times the death rate from chickenpox before the varicella vaccine was available.

So why aren't parents beating down my doors for this HPV vaccine?

Many states are considering legislation, but Texas is the first state to require that the vaccine be given to sixth-grade girls. This has caused an uproar in the media, with articles in every major newspaper (and my favorite medical journal, People magazine). Many religious groups oppose it, saying it will encourage premarital sexual activity.

Virginia's General Assembly passed a bill a month ago to require it starting in 2009. Gov. Kaine originally said that he would sign the bill, but then recently proposed an amendment making it easier for parents to opt out of the vaccination:

"Because the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent or guardian's sole discretion, may elect for their child not to receive the human papillomavirus vaccine."

Even without his amendment, parents have always been able to opt out of vaccines in Virginia by signing a form claiming religious exemption (even though, for most people, its not a religious decision).

Now consider this: From what many of my teenage patients tell me is going on in high schools these days, HPV is communicable in a school setting. Scary, but true.

D.C. Councilman David Catania, who is sponsoring a similar bill, says, "This vaccine no more encourages sexual activity than a tetanus shot encourages you to step on a rusty nail."

I understand not wanting to think about sexually transmitted diseases in your sixth-grader. But all three doses have to be given before they ever have sex in order for the vaccine to work. If we wait until we think they are old enough to have sex, we've missed the boat entirely.

Be aware that 29 percent of ninth-grade girls have already had sex, according to the most recent survey of teens by the Centers for Disease Control and Prevention. Even if you don't think your daughter would ever do that, remember also that 10 percent of teen girls report having been forced to have sexual intercourse at some point during high school.

I don't know whether the state should require it, but my daughters will be getting it as soon as they are old enough.