CanWest News Service
Wednesday, January 31, 2007
Every nine- to 13-year-old girl in the country should be vaccinated against the sexually transmitted virus that causes cervical cancer, a national expert panel is recommending.
The National Advisory Committee on Immunization says girls and women aged 14 to 26 should also be vaccinated against human papillomavirus (HPV) even if they are already sexually active because they may not yet have been infected.
Even if they are infected, they’re still unlikely to have all four strains of HPV the vaccine covers.
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Dr. Shelley Deeks, executive secretary of the advisory group, said the vaccine is safe and effective.
The question that remains is: who will pay?
Merck & Co’s Gardasil was approved in July, but so far no province has agreed to pay for the shots, which are given in three doses and cost about $135 per injection.
Last week, Virginia lawmakers endorsed legislation requiring girls be vaccinated for HPV before going into Grade 6. At least a dozen other U.S. states are considering similar bills, prompting a push back from some parents’ groups opposed to making the vaccine mandatory.
It’s possible Canada could see school-based HPV vaccination programs, said Deeks, senior medical specialist in the immunizations and respiratory infections division at the Public Health Agency of Canada.
“We’ve been very successful in Canada in our school-based programs. We can look at what happened with hepatitis B and how successful those programs were when considering the potential for HPV programs.”
Studies suggest 10 to 29 per cent of women in Canada are infected with HPV, making it the most common sexually transmitted infection in Canada.
Infants can also be exposed to the virus from their mother’s genital tract.
HPV causes almost all cervical cancers, killing an estimated 290,000 women worldwide, including about 400 in Canada each year. Condoms provide some — but not absolute — protection.
Gardasil protects against four subtypes that together account for 70 per cent of all cervical cancers and 90 per cent of genital warts. It has been shown to be more than 95 per cent effective.
The vast majority of HPV infections clear by themselves, but in women who don’t clear the infection, the virus invades the tissues of the womb.
Pap smears can catch pre-cancerous changes, but screening is spotty, depending where women live.
The advisory committee warns a “sizeable segment of the population goes unscreened or is under-screened.”
As well, about 40 per cent of cervical cancers occur in women undergoing regular screening, every three years or more.
Even with the vaccine, until close to 100 per cent coverage can be achieved for all HPV types, Pap screening “will remain critically important,” the panel says.
The group says girls should be vaccinated between nine and 13 years of age, “which is before the onset of sexual intercourse for most females in Canada.”
It’s also not known how long the vaccine provides protection.
“It makes the most sense to start before the vast majority of them will become sexually active, but not too early,” says Deeks. “It’s a fine line.”
The vaccine isn’t approved for women over 26, because no data for that age group yet exists.
If an individual woman wants the vaccine, she should speak with her doctor, Deeks said.
The vaccine is also recommended for women aged 14 to 26 who have had previous Pap abnormalities, including cervical cancer, or have had genital warts or an HPV infection.
The shots are not recommended for girls under nine because it’s not known how effective the vaccine is in younger girls. The vaccine is also not recommended for boys or pregnant women.
The recommendations are made at a national level but it will be up to the provinces and territories to decide how and whether to make the vaccine available at no cost.
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