Dumb and Dumber
Vaccination against human papillomaviruses (HPV) is a hot topic on Microbiologybytes – and rightly so. Cervical cancer is estimated to kill 275,000 women worldwide every year, including more than 1000 in the UK. Earlier this year the UK Joint Committee on Vaccination and Immunisation recommended routine vaccination for 11 to 12-year old girls. The Department of Health has just accepted the recommendation, but announced that all girls aged 12-13 will be eligible, and there will also be a catch-up campaign for girls up to age 18. It is thought that vaccinating against human papillomavirus (HPV) could save hundreds of deaths from cervical cancer in the UK each year. The vaccine is given in three injections over six months at a cost of around £300 a course – more than the cost of all other childhood vaccinations put together.
Sounds great, right? Well it’s not. The original recommendation was dumb, and the DoH’s announcement is dumber. Why? Well, girls have cervices (plural of cervix), so vaccinating them protects than against cervical cancer. But how does the DoH think girls get infected with this sexually-transmitted virus? From toilet seats? Unwashed cutlery? The truth is that girls get HPV infections … from boys. And since the boys are not going to be vaccinated against the virus – well, you figure it out.
It’s not the first time a UK government has pulled this dumb cost-cutting stunt. When vaccination against rubella virus (which causes birth defects when it infects pregnant women) was introduced, it was decided to vaccinate only girls … because boys don’t get pregnant. It took a few years for the government bean-counters to figure out that wasn’t working, and if they were serious about rubella, they had to vaccinate both sexes. So they backed down. But now they are pulling the same dumb stunt with HPV vaccines. Boys don’t have a cervix. But they do have heads and necks:
Trends in head and neck cancer incidence in relation to smoking prevalence: an emerging epidemic of human papillomavirus-associated cancers? Cancer 2007 110: 1429-1435
This paper reviews trends in head and neck cancer incidence and smoking prevalence, and discusses where such trends are parallel but also how and why they may not. In the USA, public health efforts at tobacco control and education have successfully reduced the prevalence of cigarette smoking, resulting in a lower incidence of head and neck cancer. Vigilance at preventing tobacco use and encouraging cessation should continue, and expanded efforts should target particular ethnic and socioeconomic groups. However, an unfortunate stagnation has been observed in oropharyngeal cancer incidence and likely reflects a rising attribution of this disease to oncogenic human papillomavirus, in particular type 16 (HPV-16). For the foreseeable future, this trend in oropharyngeal cancer incidence may continue, but with time the effects of vaccination of the adolescent and young adult female population should result in a lower viral prevalence and hopefully a reduced incidence of oropharyngeal cancer. To hasten the reduction of HPV-16 prevalence in the population, widespread vaccination of adolescent and young adult males should also be considered.
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Tags: Biology, Health, Medicine, Microbiology, Science, Vaccines, Virology
If we vaccinate girls, then how come they will be infected, even if the reservoir/portal of infection remained? Obviously vaccinating boys will be much more efficacious. In fact, both partners are traditionally (and with obvious reason) treated for STDs.
I enjoyed the dual meanings of ‘Boys don’t have a cervix. But they do have heads and necks’
The double meaning was not intentional – thanks for pointing it out ;-)
There is prophylactic value in vaccinating anyone. The value probably increases if males are included. The tests for use in boys are being done now, as I recall.
The real controversy over this vaccine in the U.S. is whether young girls will burn in hell if they are protected against HPV. HPV is a skin contact virus, of course, so sexual contact is not necessary, and especially not intercourse (“petting” will do). Religious nuts oppose the use of the vaccine, here. It sounds as that that particular form of stupidity hasn’t hit your shores.
Of course, there are those in the UK who oppose any form of vaccination, but this is usually on safety rather than religious grounds (hence the MMR debacle).
To some extent safety is an issue. For example, the Semple vaccine for rabies (caused paralysis including that of the respiratory muscles) and OPV or Salk vaccine for polio which caused paralysis too.
So, its better not to inoculate anyone than to inoculate half the population?
No. It’s better to build up herd immunity (http://tinyurl.com/yuk5kt) by vaccinating the whole population.
While the vaccines for papillomaviruses are aimed MAINLY at preventing cervical cancer, which of course only affects women (although men can develop genitourinary tract cancers, they do so at much lower frequency), note that the Merck vaccine – Gardasil – includes components of two types (HPV-6 and -11) which cause genital warts. And both men and women suffer equally from genital warts, which are much more obvious than cervical lesions or the invisible penile lesions caused by HPVs 16 and 18.
REALLY good reason to vaccinate boys too….