Noli Irritare Leones

As I mentioned in my earlier post about the new HPV vaccine, which would prevent cervical cancer, the question of whether to vaccinate infants against a largely sexually transmitted disease has actually come up before, when the ACIP and AAP recommended universal vaccination against hepatitis B. Hepatitis B, though more contagious than AIDS, is still mainly transmitted by sex. In this it is not to be confused with hepatitis A, which is spread through contaminated food and water. So, why is it recommended universally? Here, I’m going to quote from my own childhood vaccination FAQ:

Q3e.10 Why did the ACIP and AAP change their recommendation about the hepatitis B vaccine?

Up until 1992, the recommendation was that hepatitis B vaccine be given only to people in high risk groups for hepatitis B: people whose professions exposed them to blood, people at extra risk due to their sexual practices or intravenous drug use, and certain populations (such as Southeast Asian immigrants) with a high incidence of the disease. The chief reason was cost; it was felt to be not cost-effective to vaccinate low-risk groups.

Unfortunately, this policy was not successful in checking the spread of hepatitis B. It proved difficult to identify high-risk people, and high-risk people did not volunteer in large numbers to be vaccinated. For this reason, in 1992, the ACIP recommendation was switched to vaccination of teens and adults in high-risk groups and universal vaccination of infants. The AAP made a similar recommendation but would also like to extend hepatitis B vaccination to all adolescents, if possible.

The American Liver Foundation also supports hepatitis B vaccination of infants, and their pamphlet on the subject suggests a variety of ways in which even young children could come in contact with the virus (through contact with blood, etc.). Though young children are at low risk of catching hepatitis B, their risk of developing the chronic form of the disease if they do catch it is higher than for adults.

Sara has pointed out that HPV is also implicated in rectal and penile cancer. Medscape has an article about the Human Papillomavirus Vaccine (registration required, but it’s free, and Medscape is a really good net source of peer reviewed medical information). This article reports that:

Genital HPV infection (Fig. 1) is the most common sexually transmitted viral disease, with prevalence ranging from 10% to 50% in sexually active women.[1,9] The wide prevalence range is due to differences in the amount of sexual activity and in the method of determining prevalence. Because genital HPV infection is not a reportable disease, reliable estimates of its prevalence are difficult to obtain. However, the number of cases appears to be increasing. In 1990, the Centers for Disease Control and Prevention estimated that more than 1 million new cases of genital warts were diagnosed in the US,[10] compared with fewer than 200,000 cases in 1966.[11]

In up to 90% of women with cervical cancer, HPV DNA of high-risk type can be detected by polymerase chain reaction (PCR). Some investigators propose that high-risk types of HPV are the direct cause of all cervical cancer.[2,12] HPV is also linked to a majority of other anogenital tumors including penile, vulvar, vaginal, and anal cancers.[13]

So, Sara is right; HPV does pose some risk to men as well. Apparently not as much risk, on average, as it poses to women, but very likely more risk than is posed by the vaccine.

This entry was posted on Saturday, October 8th, 2005 at 3:31 pm and is filed under HPV vaccine, Health and Medicine, Sexuality. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.