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Persistent infection with high-risk human papillomavirus (HPV) is the leading cause of cervical cancer, implicated in more than 99 percent of all cases.
The World Health Organization estimates there are 470,000 new cases of cervical cancer annually.
Screening enables early identification and removal of pre-cancerous lesions, dramatically reducing the incidence and mortality of cervical cancer worldwide. The most commonly used test to detect cervical cancer is the "Pap smear" a€“ but many women ultimately diagnosed with cervical cancer had normal Pap smear results. Of the more than 118 different types of HPV, 13-16 types are currently considered high-risk for the development of cervical cancer and its precursor lesions. HPV types 16 and 18 have been identified as the highest risk genotypes, detected in approximately 70 percent of cervical cancers. The Roche ATHENA trial enrolled over 47,000 women, screening participants for cervical cell changes using both the Pap smear and the HPV DNA Test for 14 high-risk HPV genotypes.
This website contains information on products which is targeted to a wide range of audiences and could contain product details or information otherwise not accessible or valid in your country. Most of these series of images were created with molecular graphics software Qutemol, VMD or Chimera. Most of these images are 1200 x 784 pixels and saved qith Quality 12 (Maximum) from Photoshop.
Permission is granted for the non-profit educational use of the PS10 images in classrooms and seminars. The human papillomavirus virus, also known as HPV, is the most common sexually transmitted infection-both in the U.S.
This virus may lead to several types of cancers in women, including cancers of the cervix, vulva, vagina, and anus. When women die of cervical cancer, it is usually because they have not had a Pap smear in many years, if ever, and their cancer is caught very late.
Gardasil was approved by the Food and Drug Administration (FDA) in June 2006 and received a lot of publicity as “the first cancer vaccine.” Gardasil is approved to protect girls and women, ages 9 through 26, from the two types of HPV infection that are responsible for 70% of cervical cancer cases and two other types of HPV infection that are responsible for 90% of genital warts cases. Several clinical trials have been conducted, but most for under five years and none for 10 years or longer.  We still cannot be certain whether Gardasil will be effective for all women for 5 years, nor do we know what percentage of women will be protected for longer than 5 years.
While no head-to-head studies have been done comparing the overall effectiveness of Cervarix and Gardasil, we do know about some differences. As with any vaccine, it is important to consider the vaccine’s safety and potential side effects. In spite of this finding, there has been some concern about a link between Gardasil and a rare nervous system disorder known as Guillain-Barre syndrome (GBS). Three CDC researchers have criticized Souayah’s study, pointing out that the VAERS database has numerous shortcomings and that the authors used as their denominator the number of doses distributed, divided by 3, even though not everyone receives all three doses.
There are, in fact, problems with VAERS-it is a passive system-but usually the problem is under-reporting. On June 29, 2006, the CDC Advisory Committee on Immunization Practices (ACIP) recommended that Gardasil be given routinely to all 11-12 year old girls. If the goal is to prevent cervical cancer in females, either Cervarix or Gardasil may be used, said the committee, which further noted that one vaccine could be substituted for the other, if needed, to complete the three-dose series. The data that Merck presented to the FDA in 2006 indicated that Gardasil would not be effective against strains of HPV that the women were currently infected with at the time of vaccination. Because HPV exposure may occur even in the first 10 years of life through non-sexual skin-to-skin contact, or while being born, there is no age at which the vaccine will always be effective for everyone. In spite of these unknowns, several states are considering laws requiring HPV vaccines for school attendance.
As with any sexually transmitted disease, all it takes is exposure to one infected partner to acquire HPV. The retail price of the vaccine is about $125 per dose (or $375 for full series), but most large insurers cover the costs of the vaccine, which may be administered by your doctor. There are certainly both benefits and drawbacks for the HPV vaccine, with some people benefiting more than others.


Getting regular Pap smears and screenings and limiting your number of sexual partners are effective strategies whether you are vaccinated or not, so spending money on Pap smears may be the most economical way to protect women against HPV and cervical cancer.
Because the HPV vaccination is provided under VFC, this may eventually reduce differences in HPV and cervical cancer rates by protecting the most at-risk individuals against the four primary HPV types. Bottom line: Like any public health strategy, a vaccine’s risks must be weighed against its benefits. Please be aware that we do not take any responsibility for accessing such information which may not comply with any legal process, regulation, registration or usage in the country of your origin. The virus is transmitted through skin-to-skin contact and is usually sexually transmitted-vaginally, anally, or sometimes, orally. However, a person is much more likely to get cervical cancer than the other three cancers combined. They reduce your chances of getting infected with HPV but they don’t eliminate your risk, because skin-to-skin contact still occurs when a condom is used. It has very limited effectiveness, however, against other types of HPV that cause approximately 30% of cervical cancers.
Because cancers take so long to develop, we will not know the true impact of Gardasil on cervical cancer for several decades.
In clinical trials, Cervarix was shown to be 93% effective in preventing cervical pre-cancers associated with HPV 16 or HPV 18 in women-this means that it protects against abnormal cervical changes that could lead to cervical cancer.
Of these reports, 92% were considered non-serious, which includes fainting, pain and swelling at the injection site, headache, nausea, and fever. They also maintain that being a new vaccine, adverse reactions to Gardasil were over-reported.
Most parents don’t know how to report problems or don’t find the time to do so, and many doctors under-report as well. The recommendation was based on less than two years of efficacy, safety and immunogenicity data provided to the FDA from clinical trials with 16-23 year-olds, combined with safety and immunity studies in 9-15 year old girls.[9] In October of 2009, the CDC’s ACIP also recommended Cervarix for 11-12 year old girls, but this too was based on short-term data.
The chances of HPV and cervical cancer increase with the number of sexual partners, and the number of sexual partners of their sexual partners. Approximately 41% of all childhood vaccines in the United States are purchased by and administered through the VFC Program.[16] However, the CDC recommendation does not include a booster shot, and even if it did, once girls are older than 18 years, the VFC Program would not cover the cost of the HPV vaccine or a booster. From a broad perspective, the vaccine may not be cost effective because long-term effectiveness is unknown and we don’t yet know if booster shots are necessary to sustain protection against the virus. However, for women who are less likely to undergo regular Pap smears, and especially for women at highest risk for getting HPV and cervical cancer (such as Hispanics and blacks), the HPV vaccine reduces risk. That is why it is so important to determine how effective the vaccine is against preventing HPV and cervical cancer, and for how long. In fact, approximately 20 million Americans are currently infected with HPV, and another 6 million become newly infected every year.
There are approximately 130 strains of HPV, some of which may cause warts and others which may cause cancer.
In fact, having a regular screening every 2 to 3 years greatly reduces a woman’s risk of getting cervical cancer. For that reason, girls and women who are vaccinated with Gardasil will still need regular Pap smears to detect cervical cancer in its early stages when treatment is most effective. It is important to know if Gardasil will require a booster shot in order for it to offer long-term protection, but those studies have not yet been conducted. Cervarix was approved for use in girls ages 10 to 25, and like Gardasil, is given as a three dose series over six months.
It may also provide protection against other strains of HPV, including types 45 and 31, which also cause cervical cancers. For Gardasil, over 29,000 males and females participated in the trials, while Cervarix studied over 30,000 females from around the world. If there was extensive under-reporting of problems associated with Gardasil, then that may have partly offset Sourayah’s overestimation of the number of people getting all 3 doses.
However, Cervarix’s approval was based on several studies where subjects were followed for an average of 3 to 7.5 years-a longer period than the Gardasil studies, but still not long enough to know the longer-term effects of the vaccine.


A few years from now, the vaccine manufacturers may announce that booster shots are needed. While the vaccine may be safe for girls as young as 12, we do not yet have enough data on how effective it is or how long it lasts to justify this policy, particularly given the high cost of the vaccine to working class and middle class parents and to government health programs for the poor. Research is now underway to evaluate the effectiveness of Gardasil among women 27 to 45, and also in boys and men. Given that the vaccination was relatively new at the time of data collection, it’s safe to assume that these rates have increased over the past two years.[17] Also, as of 2008, 42% of adolescents living at or above poverty received at least one dose of the vaccine, with 36% receiving all three doses. Because Hispanics have higher rates of cervical cancer in comparison to whites and blacks, the VCF Program could narrow this gap.  The VFC Program can reach out to the medically underserved, who are less likely to receive regular cancer-prevention screenings. If the vaccine is offering less protection than it promises or is wearing off by the time most girls are becoming sexually active, then some people may decide that the cost and risks of the vaccine simply aren’t worth it.
Of these strains, two types cause 70% of cervical cancer cases (strains 16 and 18) and two types cause 90% of genital warts cases (strains 6 and 11).1 Most HPV infections in adolescents are short term-70% of infections disappear within a year and 90% disappear within two years. Cervarix costs about the same as Gardasil: on average, $385 for the three doses of the vaccine. In clinical trials, Cervarix was 75% effective at protecting against three cancer-causing types of HPV that are not part of the vaccine, while Gardasil is only 50% effective at protecting against other cancer-causing HPV types. Clearly, more research will need to be done to determine if Gardasil slightly increases the very low risk of GBS. However, data show that having a previous HPV infection that has cleared by the time you get the vaccine will not interfere with the vaccine’s effectiveness. If that’s the case, will young adults who were vaccinated as children actually get them?  What if the booster is expensive and they don’t have coverage for it? The vaccine’s safety and antibody response was tested on girls as young as 9 and 10, but the impact on lesions or disease was not studied in girls under 16. In comparison, for those living below poverty, 41% have received at least one dose of the vaccine, while 46% have received all three doses of the vaccine. Assuming that the vaccine is effective in the long-run (which is still unknown), the VFC program could potentially prevent 70% of HPV cases in those who are vaccinated. It’s important to remember that whatever you decide, you still need to get regular Pap smears.
However, while most HPV infections go away on their own, it is possible for abnormal cells to develop on the cervix, vulva, vagina or anus when high-risk types of HPV persist over time. Unlike Gardasil, Cervarix only protects against two HPV strains-types 16 and 18, which are the leading causes of cervical cancer.
All of these serious reports have been carefully reviewed by medical experts and no common medical problems caused by the vaccine were found. But, if you have an ACTIVE infection that has not cleared, the vaccine will not be as effective against that type of HPV in the future.
Since data show that the antibodies protecting vaccinated girls and women against HPV 18, a major cause of cervical cancer, appear to decrease over time, many girls vaccinated at age 12 could possibly lose much of their immunity against HPV 18 just as they are becoming more sexually active at ages 16 or 17. Girls and women living below poverty were fully vaccinated at a higher rate than those living at or above poverty.
But for women who can’t or don’t get annual Pap smears and who can get the HPV vaccine at low or no cost through their insurance or through the VFC Program, the HPV vaccines (Gardasil or Cervarix) provide needed protection. Like Gardasil, the long-term effectiveness is still unknown and the need for a booster shot to maintain protection is uncertain.
However, there have been some reports of individuals getting blood clots after receiving the vaccine, although these individuals had other blood clot risk factors such as using birth control pills, smoking, and obesity. However, even with the vaccine, it is still very important to get regular pap smears to stay healthy and prevent cervical cancer.



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