A vital vaccine for young girls?

When Lorraine Wilson took her two teenage daughters to the doctor recently, they got their annual physicals and the required shots. But the pediatrician didn't stop there.

"She starts talking about this HPV vaccine," Wilson recalls.

Wilson was vaguely aware of the vaccine. It made headlines at the end of June when the Advisory Committee on Immunization Practices, a division of the federal Centers for Disease Control and Prevention, voted to recommend it to prevent cervical cancer and other diseases in females caused by certain types of genital human papillomavirus (HPV).

According to the ACIP, the vaccine is most effective if given before a woman is sexually active. The committee recommended it for girls ages 11 and 12, and suggested it be given to girls and women between the ages of 9 and 26.

Unlike other vaccines for children, this one is designed to prevent a sexually transmitted disease, and that has ignited some controversy.

On the one hand are those who believe a vaccine that can prevent any disease, especially the first one developed to prevent cancer, is a wonderful thing. On the other hand are those who, while supporters of the vaccine, definitely do not see it as necessary for girls 11 and 12, let alone as young as 9, and don't want to see it join other vaccinations now mandatory for school.

It's a long way to that point, says Curtis Allen, who spoke by phone from CDC headquarters in Atlanta.

"Although the recommendations are fairly simple, the document itself is a fairly lengthy scientific document that needs to be peer-reviewed," he explains.

The CDC has to sign off on the recommendations, and then it goes to the federal Health and Human Services Agency and, if given the nod there, the HPV immunization joins other recommended vaccines.

Dr. Shakha Gillin, of La Jolla Pediatrics in San Diego, is way ahead of that.

"The first thing she did was ask them if they are sexually active," Lorraine Wilson remembers of the visit to Dr. Gillin's office a couple of weeks ago. Wilson's daughters - Drew Pitcairn, 15 this month, and her sister Lauren, 18 - told the doctor no.

"She said to them, 'Good, you shouldn't be. Stay that way.' Then she explained about the vaccine, the virus, the occurrences of HPV and cervical cancer, how long the study has been going on, and she told them that getting the vaccine is something they need to do," Wilson recalls, "and do it now."

So, with their mother's blessing, they did.

Linda Haack-Rogers, mother of a 12-year-old girl, is more hesitant.

"I'm a little more conservative, in general, when it comes to immunizations," she says. "My feeling is, if you're putting stuff in your body, please be careful."

She understands the importance of the vaccine but isn't sure it's right for her daughter.

"Why give her something she doesn't need for four years or so?" she says. "I agree it's an issue, I agree with the medical findings, and I agree that all parents of young women should be educated and aware, and educate their teenagers."

But Haack-Rogers says her daughter, going into seventh grade, is not ready for a detailed explanation about sexually transmitted diseases.

"I could explain it on a much simpler level, but to have a real-life detailed explanation of why you need the vaccine, in terms of sexual relations, I would have it later, when it's appropriate, given her developmental age."

She will, however, bring it up with her daughter's doctor.

"We're going in a week or two to get her 12-year-old shots, and I'll discuss it with the pediatrician and get her recommendation on whether to get (the vaccine) now or later."

She acknowledges that the whole thing is more difficult because the issue is sexually transmitted diseases. That's certainly what bothers other parents, some of whom have said in the media that they won't get their daughters vaccinated because it would send a message that it's OK to be sexually active. Others simply want to have a choice about whether to get the vaccine, and at what age.

Focus on the Family, the Colorado Springs-based Christian group, puts it this way in its policy statement on HPV: " ... Focus on the Family supports widespread (universal) availability of HPV vaccines but opposes mandatory HPV vaccinations for entry to public school. The decision of whether to vaccinate a minor against this or other sexually transmitted infections should remain with the child's parent or guardian."

Haack-Rogers agrees with that, but as her daughter gets older, she expects to see things differently.

"If she starts liking boys, that's it," she says. Then it will be time to get the vaccine. "Yes. Boom. Done."

Her husband, Jack Rogers, isn't quite as adamant. He grew up without vaccinations against any diseases.

"I was raised in a household where this was the belief system, and we didn't know any other way," he says. He and his wife looked for common ground and agreed their kids would receive mandatory shots but none that were considered "optional."

Rogers believes the same approach is appropriate for the HPV vaccine. Right now, for their 12-year-old, the HPV vaccine seems optional.

And if she decides she wants the vaccine when she's older, when they know sexual activity is a possibility?

"That's her choice," Rogers says. "We would go through all the information we could gather, talk to people on both sides, and let her decide. She's the one who has to live with the decision, not I."

Rogers is among those who don't want the vaccine to be mandatory.

"My reticence about this immunization has nothing to do with the sexual subject matter," he emphasizes. "That is not something difficult for us to talk about.

"I don't want government telling me what to do. I want to make my own choices in how to be protected. I don't believe in a silver bullet. If women get Pap smears and pick their partners carefully, they can minimize their chances of getting cervical cancer. I'm not going with sky is falling. I sit on two health boards in the county, so I'll stay informed."

For now, the vaccine is something that families will decide individually. Some, like the Rogers family, have the time to take a wait-and-see approach for their young daughter.

For Lorraine Wilson and her teenage daughters, the issue is more urgent. Wilson lost her husband, David Pitcairn, to cancer seven years ago. There's no way, she says, she would turn down a cancer vaccine.

"I wouldn't want to die that way," says Drew, who was 8 when her father died.

But as her mother and her doctor have told her, and as Jack Rogers believes, HPV vaccine isn't a guarantee.

The CDC's Curtis Allen says the vaccine has been found to protect against strains of HPV that cause 70 percent of cervical cancers and 90 percent of genital warts. However, "about 50 percent of cervical cancers are found in women who have not had a recent Pap smear."

"I don't think it protects you completely," Drew says. "You still can get pregnant; it's not installing a condom."

She agrees with her sister Lauren, who says, "I could ask a guy a million questions about his sexual history and still never get the truth."

Abstinence is the best policy, these girls believe, and taking care of their bodies. Lauren, now 18, will get her first Pap test before she goes back to college for the fall. And she's glad to have the vaccine, too.

"I want anything that's going to protect me."

TO LEARN MORE

For more information about the HPV vaccine, HPV or cervical cancer, talk to your health-care practitioner.

Also, check out the following Web sites and search for "HPV vaccine":

American Cancer Society, www.cancer.org

Centers for Disease Control and Prevention, www.cdc.gov

FDA Office of Women's Health's fact sheet on HPV: www.fda.gov

National Cancer Institute's fact sheet on HPV and cancer: www.cancer.gov