The True Risks and Benefits of HPV Vaccine

We know some of you might have been concerned by recent news reports questioning the safety of the HPV vaccine. Unfortunately, much of the information in these reports is misleading or ill-informed. We’d like to take this opportunity to dispel some of the misinformation by sharing what science and research have shown and discussing what the true risks and benefits of the vaccine are.

How do we know the HPV vaccine is 100 percent safe?

The answer is: It’s not. Vaccines today are safer than they’ve ever been, but no medical intervention is 100 percent risk-free. That’s because not all human bodies are the same. Just like some individuals can be allergic to strawberries or penicillin, there will always the possibility (however small) that someone is allergic to a vaccine component. As much as we would like it to be, medicine is not one-fits-all. There will always be risks for some individuals, and we can’t always anticipate who those individuals will be.

What is really important to know is: Do the benefits of getting the HPV vaccine outweigh the risks?

To answer that, let’s first look at what the true risks of the HPV vaccine are.

Prior to being licensed, all vaccines have to go through rigorous testing to assess its safety and effectiveness. This process is more intense and thorough than systems for other pharmaceutical products because they are meant to keep healthy people healthy. Researchers have to prove time and time again in hundreds or (more likely) thousands of people that the vaccine produces minimal side effects (if any) and that it is effective at protecting people from disease.

The HPV vaccine was tested with roughly 30,000 individuals over several years to identify any potential side effects. What the researchers found was that the vaccine might lead to a slight increased risk of fainting (which is common among adolescents after any injection), and, like many vaccines, a little soreness and redness where the vaccine was administered.

After vaccines are approved, we continue to monitor them to ensure they are safe and effective. One of the ways we do this is through the Vaccine Adverse Event Reporting System (VAERS).

Anyone can report any side effect or adverse event after a dose of vaccine — even if they aren’t certain the vaccine was the cause. The reporting process is purposefully open and inclusive, so that health officials can spot extremely rare side effects that might not have shown up during clinical trials. It’s also a way to identify certain risk factors that might increase a person ‘s chances of having a bad reaction. If we can identify those risk factors, we can let doctors know that patients with these risk factors should not receive the vaccine.

Since its release in 2006, over 56 million doses of HPV vaccine have been administered in the United States, and since then, approximately 22,000 adverse events have been reported to VAERS — most of them mild issues like headache, soreness or nausea. Even still, this doesn’t mean that the vaccine caused those 22,000 bad reactions. All these reports can tell us is that those events happened after a dose of HPV vaccine was given.

As an example, say you eat a bowl of Cheerios and then get into a car accident. It doesn’t mean that Cheerios cause car accidents. It could very likely be that you just happened to eat Cheerios and then got into a car accident simply by chance. The two aren’t necessarily linked. 

People develop or suffer from a wide range of medical issues every day. Some of those reports could have been caused by the vaccine, yes, but some were probably caused by something else entirely.

What’s important to know is whether those who received the vaccine were more likely to develop those issues than those who didn’t get the vaccine.  

And so the Centers for Disease Control and Prevention (CDC) have been investigating the most serious of these reports using another tool called the Vaccine Safety Datalink (VSD) to see whether those who receive the HPV vaccine do, in fact, have an increased risk. What they found was that those who received the HPV vaccine weren’t any more likely to experience things like seizures, ovarian failure, Guillain-Barre syndrome or stroke than those who didn’t get the HPV vaccine. The biggest risks associated with HPV vaccination appear to be a little soreness or swelling at the injection site. 

It’s also important to note that while the vaccine has not changed since its release in 2006 and more people have been vaccinated, the number of adverse events reported have actually gone down — suggesting that many of these reports were likely fueled more by fear and media hype than anything to do with the vaccine itself.

Source: Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007-2012, and Postlicensure Vaccine Safety Monitoring, 2006-2013 – United States 


Those are the risks. Now let’s talk about the benefits of the HPV vaccine. 

HPV is extremely common. Nearly everybody will be infected with HPV at some point in their lifetime. Even if they remain virgins until they’re married. Even if they only have one partner. Even if they use condoms. HPV is spread through contact, so condoms don’t fully protect against it. And it’s not necessary to have sex in the traditional sense to become infected.

Thankfully, most people who are infected with HPV are able to clear the infection fairly quickly on their own within 1-2 years without ever realizing they even had it. But there are many different types of HPV, so even if you’ve already been infected once, you can still be infected by other types. And some of those types can lead to cancer.

HPV is responsible for an estimated 5 percent of all cancers worldwide in both men and women. In the U.S. alone, HPV is associated with more than 30,000 new cases of cancers every year. While cervical cancer is the most well-known of these cancers, HPV can also lead to throat cancers, anal cancers and penile cancers.

The HPV vaccine can prevent cancer-causing HPV. It’s too soon to have direct proof that the HPV vaccine prevents cancer directly — that will take years. But we already have evidence that it has been extremely successful at reducing the rate of the types of HPV most often associated with cancer, as well as the incidence of cancer precursors.

TL;DR: This vaccine helps reduce our children’s risk of cancer. And large-scale, quality studies have shown that most side effects of the vaccine are extremely mild and temporary. 

For more information, please refer to these trusted resources: 

Immunization Heroes: Dorit Reiss

The Immunization Partnership asked some of the leading voices championing immunizations — the heroes in the fight against vaccine-preventable disease  – what set you down the path of immunization advocacy? What made you passionate? In short, what is your origin story? Throughout the next few months, we hope to showcase the responses. 


by Dorit Reiss

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Dorit with her son Daniel

Getting drawn in:

My son was born in 2010. My mom said he was a big baby, at 8 pounds 10 ounces, but it certainly didn’t seem that way to me: he looked so small. I really, really, really wanted to do right by him, to take care of him in every way. There were scary stories in the news about a whooping cough epidemic. When I asked my doctor what I could do to protect my son, not yet two weeks old, her best advice was to get vaccinated myself, so I did. We were lucky. He didn’t get whooping cough.

Fascinated by everything baby, I got addicted to reading parenting blogs in my spare time. One day, one of my favorite blogs, written by a scientist using the pseudonym Squintmom, published an article discussing measles in 2011 – a bad year – and myths about MMR. And someone made a comment repeating anti-vaccine claims.

I’m a history buff, and reading about early modern history means many, many heart rending stories of how what are now preventable diseases killed the young, old, and everything in between. So I was shocked to my core that someone could oppose vaccines that protect against them. I read the comment twice, and it still did not make sense. So I started reading more, via online sources and books. And the claims against vaccines did not make any more sense. I’m not a scientist, but the answers provided by scientists to those claims were, well, solid. Powerful.

I started commenting. First on Facebook, then on other articles. I changed my professional focus, from regulation and agency accountability to vaccine policy. The topic took over my life.

Why stick?

There are multiple reasons continuing to speak up for vaccines is very, very important to me. The rest of this post is a list – in no particular order – of those reasons.

The most straightforward one is that I have hostages to fortune. I have a young child. I have young and incredibly adorable nephews. I don’t want to see diseases that we can keep at bay come anywhere near them, thank you. Or their friends. Or other little people I don’t know. We owe them better. If we can prevent a danger from coming near a child, we should. Yes, my son, and my nephews, like most children, are fully vaccinated. But no vaccine is 100% effective, and I’d rather, if they are in the small percentage who suffer vaccine failure, that they not be exposed to something that can be prevented. And other children and adults also deserve better. Letting people suffer when we have a safe, effective preventive at hand simply seems unconscionable.

I started the Before Vaccines blog following a discussion on the Anti-Vax Wall of Shame, a Facebook group created to publicly expose (and mercilessly mock, which I have more mixed feelings about) the excesses of anti-vaccine claims. In that discussion, our older members told about their own and their family experiences with Vaccine Preventable Diseases. I thought we should document those stories, since most people haven’t seen the diseases. Through the blog, I spoke to people who have lost family members, friends or students, or seen them suffer, or suffered themselves, because of diseases we can vaccinate against. It’s nowhere near the experience doctors who have to see these things up close have. But it brought home to me how important this is, and thinking about those stories keeps me going.

Vaccines protect children, and safeguard the public health. Being a part of those that work to promote immunization rates gives me a purpose. Something to do that means something. I’ve met amazing people in this journey – people with large hearts, brilliant minds, dedication and selflessness. I’m very proud to know them, and am amazed to be a part of some of these groups.

When I was 18, I became a soldier-teacher in the Israeli military, teaching Hebrew to new immigrants from Ethiopia. After my military service I worked in a day care. During graduate school, I TAed, and since 2007 I teach law. Teaching is a large part of my life. I like explaining things. Explaining vaccine issues in comment threads, writing informative blog posts is another form of teaching. It’s a professional joy.

Finally, as some people may have noticed, the discussion about vaccines is often conducted with less than perfect decorum. I have come across occasions where anti-vaccine activists tried insults and intimidation tactics. And yes, I realize pro-vaccine advocates also use harsh terms against the other side.

I admit that is, at times, another motivation: I don’t like it when people try to shut me up. Out of sheer contrariness, it makes me want to do more.

Dorit Reiss is an Associate Professor of Law at the University of California Hastings College of the Law. She recently wrote a piece for the San Francisco Daily Journal on speech, intimidation and the anti-vaccine movement, which we highlighted last week. 

Speech, Intimidation and the Anti-vaccine Movement

Remember the group of students who flew out to Houston for our premiere of the documentary Invisible Threat? As we’ve written before, the documentary was well-researched and scientifically accurate, but those students are now under attack from the anti-vaccine movement. A national call for action was issued against the film, and the students and their adult mentors have received an onslaught of online insults and harassing messages. The bullying has been vicious, even going so far as comparing the students to nazis.

Harpocrates Speaks wrote a great post going into depth regarding the claims made against the filmmakers (and why they’re inaccurate), as well as some thoughts and feelings held by the students.

Needless to say, this bullying against a group of high school students is troubling.

Dorit Reiss, a professor at the University of California, Hastings College of the Law, wrote an op ed for the San Francisco Daily Journal about the attacks not just on the students, but also on other individuals such as Paul Offit, MD, and Emily Willingham, who have been vocal about the science supporting vaccination.

In it, Dorit writes, “The scientific consensus is clear: Vaccines save lives, and their small risks are far outweighed by their tremendous benefits. The anti-vaccine movement cannot win on the facts or on the science. So they attack: It’s all they have.

“It won’t work… All the attacks do is expose the weakness of the anti-vaccine case. And reflect badly on those that use them.”

We couldn’t agree more. Truth is on the side of these students, and we hope you’ll join us in showing your support for them.

You can read Dorit’s full op ed here: “Speech, intimidation and the anti-vaccine movement”

Parents – we matter too!

planeMore often than not, parents put their children before themselves. When you become a parent, your own wants and needs take a back seat almost immediately. However, think about the last time you took a flight – as the captain prepared for takeoff and the flight attendant gave the mandatory “safety information” speech, you probably heard these instructions: “If you are traveling with a child, apply your own oxygen mask before assisting the child.” I’m no aviation expert, but I believe this is recommended because if the adults do not apply their oxygen first, they physically will not be able to help the child next to them. There are times that we (as parents) have to focus on ourselves in order to protect our children and others around us. Getting vaccinated as an adult is a prime example.

A couple of years ago (before I had a baby and received a Tdap vaccine in the hospital), I visited a new family practice physician for a checkup. She asked me if I’d had a tetanus vaccine recently…and I had no idea. Vaccinations weren’t really on my radar at that time, but the question got me thinking: as adults – have we focused so much on children’s vaccinations that we forget about vaccinating ourselves?

When you dig a little deeper, the statistics are somewhat alarming. For adults over 19 years of age, Tdap (tetanus, diphtheria and pertussis) vaccinations rates for adults were only 14.2% in 2012. And only 25.9% of adults living with an infant under a year old (those most at risk for being hospitalized or worse due to pertussis) were immunized. With pertussis on the rise, these rates are very scary.

When it comes to the flu vaccine, only about 1 out of every 3 adults under 50 get it every year. I know several friends who haven’t gotten the flu vaccine in years past – either because they think it doesn’t work (it does), or they simply don’t take the time. I’ve learned – especially as a parent of a young child –that getting immunized against the flu every year is SO important. Why? Because thousands of adults and children lose their lives every year to the flu and pneumonia. Roughly 500,000 Americans cannot be vaccinated because they’re immune systems are compromised – perhaps they’re undergoing chemotherapy treatment or receiving immunosuppressants. When you choose not to be vaccinated as a healthy adult, you run the risk of infecting those around you who cannot be immunized. These individuals rely on the rest of us to protect them.

So the next time you contemplate the flu shot, or you’re not sure if you’ve been immunized against tetanus and pertussis, remember the airplane/oxygen mask analogy. Take a responsible stance and ensure you are vaccinated so others around you may remain healthy.

To read a compelling OpEd about the power of immunizations, click here. And if you’re interested in learning what influenza vaccination rates are in your area, check out FluVaxView for more information.

Why Wakefield’s “Wrong About Vaccine Safety”

In February of 1998, Andrew Wakefield published a paper claiming that the MMR was linked to autism. The paper, it turned out, was fraudulent. The Lancet retracted the article, Wakefield was stripped of his medical license, and a large body of scientific research has thoroughly dismissed any connection between vaccines and the developmental condition — including a study published just this month that looked at more than 1 million people.

But the overwhelming evidence against his claims hasn’t stopped Wakefield from trying to perpetuate the myth. In 2010 he published Callous Disregard: Autism and Vaccines — The Truth Behind a Tragedy, where he claimed that the loss of his medical license was, in fact, political. A means, he claims, of silencing criticism regarding vaccine safety.

Well, one retired epidemiologist has had enough. Joel A. Harrison, PhD, MPH, has written a comprehensive paper systematically examining (and refuting) claims made by Wakefield in his book. His article, titled “Wrong About Vaccine Safety: A Review of Andrew Wakefield’s ‘Callous Disregard’,” includes a total of 142 references that serve to contrast Wakefield’s claims with what science has really shown regarding vaccine safety. Harrison writes in the abstract that he hopes “this review will be used by doctors and public health personnel to encourage parents hesitating to have their children vaccinated to question anti-vaccination claims in general, given that many proponents often refer to Wakefield as an authority and display in their own writings and pronouncements similar erroneous claims.”

A physician referenced by Wakefield in his book has also written a letter to the editor, stating that she was misrepresented in Callous Disregard and that she is “grateful to Dr Harrison for setting the record straight.”

You can read Harrison’s full paper by going here.

A Mother’s Love

IMG_0764Yesterday was very special for me – my very first Mother’s Day! Last year at this time, I was pregnant, and dreaming about what the next several months would hold for me. The past year has been filled with so many emotions – starting with uncertainty, anxiety and fear (following my daughter’s premature birth)…and ending with happiness, gratitude and sheer joy. I have gotten to experience a bond stronger than I ever knew was possible, and I have realized just how great a mother’s love is for her child. I am incredibly lucky to have a wonderful mother of my own, but this year – I am lucky to celebrate motherhood myself.

My Mother’s Day was spent relaxing with my little family, and loving on my little girl (who just got her first tooth!). As I listened to her sweet giggle, and watched her hair blow in the breeze, I felt like my heart could just explode with love. I am so very thankful.

Among other things, I am thankful for Stella’s health, and thankful for the circumstances surrounding her entrance into the world. You see, if she had been born in another country (or even another decade), things could have been different. When my daughter was tiny and too young to be vaccinated, the flu and pertussis (“whooping cough”) vaccines protected her from serious illness at a very vulnerable time; and as a mother, I was grateful that my family could be immunized, ultimately protecting Stella from harm. Millions of moms around the world do not have that same opportunity.

So as we celebrate mothers everywhere and love on our kiddos, let’s not forget to celebrate our health, and the medical miracles we sometimes take for granted — like vaccinations available to us and to our children.

Here’s to all the wonderful mothers out there. Thanks for everything you do, and happy (belated) Mother’s Day!

“When you are a mother, you are never really alone in your thoughts. A mother always has to think twice, once for herself and once for her child.”
~Sophia Loren, Women and Beauty


For more information about vaccines, vaccine-preventable diseases and immunization schedules, check out The Immunization Partnership’s website: www.immunizeUSA.org/resources/

Eradicating a Disease, One Dime at a Time

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Last weekend, my family and friends participated in “March for Babies”– a fundraiser and walk benefitting the March of Dimes Foundation, whose mission is to improve the health of babies by preventing birth defects, premature birth and infant mortality.  During my daughter’s hospital stay, I learned firsthand that the March of Dimes is also a tremendous support for families with babies in the NICU (like mine.)  What a fantastic organization and a great cause.

You probably have all heard of the March of Dimes.  But…did you know that is was established as a foundation benefiting polio research when the disease was on the rise in the U.S.?  Created by President Franklin Roosevelt in 1938 (after his personal struggle with polio) and led by mostly volunteers, the organization was initially called the National Foundation for Infantile Paralysis.  Its large grassroots fundraising campaigns eventually collected enough money to fund research for polio vaccines.

Few diseases have brought about fear and panic in our nation like polio, or poliomyelitis.  Polio is an infectious viral disease that affects a person’s nervous system.  It was one of the most feared diseases of the 20th century because no one understood how it spread, and children were most frequently affected.  Polio was easily transmitted, regardless of geographic region, economic status, or population density, and there was no vaccine available.  I can imagine parents had many a sleepless night worrying about their children, and wondering who would be affected next in their community.

Polio peaked in the US in 1952, when there were over 21,000 cases of paralytic cases that year alone.

During the years in which the National Foundation for Infantile Paralysis (NFIP) operated, millions of people gave small amounts of money to support both the care of people who contracted polio, and to fund research for prevention and treatment.  Radio entertainer Eddie Canter urged listeners to send their spare change to the White House to be used by the NFIP in the fight against polio.  The NFIP eventually changed its name to…you guessed it…the March of Dimes.

Finally on April 12, 1955, it was announced that a vaccine had been developed to prevent polio.  Following widespread vaccination across the country, reported cases quickly diminished, and today, complete eradication is within reach – endemic polio now only exists in just three countries (Afghanistan, Pakistan and Nigeria).  The vaccine, largely funded by donations from the general public, essentially wiped out the disease.  Talk about everyone chipping in for a good cause!  However, the story doesn’t end there.  We are still at risk of losing progress in the fight against polio unless we get serious about immunizations for everyoneClick here to read about the alert issued just this week by the World Health Organization, calling current numbers of polio a “Public Health Emergency of International Concern.”

So, as I “marched for babies” last weekend with my 10-month old, I felt honored to be supporting an organization with such an incredible legacy and drive to help others.  Today, the March of Dimes’ slogan is “saving babies, together.”  I thought about the number of babies and children the polio vaccine alone has saved, and it took my breath away.  I think President Roosevelt would be proud!

The CDC recommends children get four doses of IPV, ideally at ages 2 months, 4 months, and 6 through 18 months; then a booster dose at age 4 through 6 years.  Ensure your child has been properly vaccinated.

For childhood, adolescent and adult immunization schedules, as well as resources regarding vaccine-preventable diseases, check out the resources page on The Immunization Partnership’s website: www.immunizeusa.org/resources/.

 

Immunization Heroes: Dr. Peter Hotez

The Immunization Partnership asked some of the leading voices championing immunizations — the heroes in the fight against vaccine-preventable disease  — what set you down the path of immunization advocacy? What made you passionate? In short, what is your origin story? Throughout the next few months, we hope to showcase the responses.  


by Peter Hotez, MD, PhD

My entry into the world of vaccines began as a student in the 1980s enDr. Peter Hotezrolled in a unique MD PhD program at Weil Cornell Medical College and Rockefeller University (originally known as the Rockefeller Institute for Medical Research) in New York.  I began testing whether the molecules I was analyzing from parasitic hookworms might one day be developed into a human hookworm vaccine.  Some thirty years later a human hookworm vaccine developed by our Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development is undergoing clinical testing, with vaccines for several other neglected tropical diseases — such as schistosomiasis, ascariasis, trichuriasis, Chagas disease, leishmaniasis, SARS, and West Nile virus infection — hopefully entering the clinic soon!

An unexpected second and parallel career path was my becoming a global health and vaccine advocate.  With respect to vaccines, this interest first began as a medical student when I saw my first case of congenital rubella infection during a rotation on the pediatric wards of the New York Hospital.  I was horrified not only by the devastating nature of this syndrome but also the fact that it was totally avoidable had the child’s mother been vaccinated.

The need to advocate for vaccines was reinforced when I later became a pediatric house officer in Boston.  Something I will never forget was admitting young patients to the Children’s Service of Massachusetts General Hospital with Haemophilus influenzae B (Hib) meningitis and explaining to the parents about the likelihood that their child might die or become neurologically devastated.  At that time during the late 1980s several new conjugate Hib vaccines were being introduced and starting to be made available.  Within just a few years through widespread immunization of children in the United States, Hib meningitis disappeared.  By 1993 as a new attending pediatrician at Yale, I was teaching the pediatric house staff there about Hib meningitis, but mostly for its historical interest!  Through expanded use of a vaccine, for all practical purposes Hib meningitis had been eradicated from the US.  Indeed, I taught about Hib much in the same way that my medical school professors previously taught me about diphtheria and measles.   Such was the power of immunizations!

Starting in the 1990s I began to make visits to Central America and elsewhere in Latin America in order to further my tropical disease interests.  I will always remember reaching Guatemala City after a short flight, getting off the plane, and making clinical rounds at Hospital Roosevelt – their big public general hospital.  It was though I had gone back in time 100 years seeing children with measles, pertussis, and neonatal tetanus, i.e., diseases that had disappeared long ago from the US.  The major difference between American children and Guatemalan children was that we vaccinated our children whereas the Guatemalans did not have access to vaccines.

Dr. Hotez in GuatemalaWitnessing first-hand the effects of not vaccinating children was a strong motivator for me to advocate for childhood immunization, especially as a very shrill and increasingly powerful anti-vaccine movement began to take shape in US during the 1990s and into the 21st century.

It seemed to me that the “anti-vaxers” (as they are now sometimes labeled) had no scientifically sound arguments when it came to linking vaccines with autism.  Yet they had a strong voice.  I still remember flying back from Brazil where local public officials campaigned on their track record of vaccinating children living in poverty, and then landing in the US where ignorant politicians campaigned on making vaccines optional!

The disassociation between vaccines and autism became especially clear to me when my youngest daughter Rachel was diagnosed with pervasive developmental disorder – autism – at the Yale Child Study Center.  I could not envision a single plausible mechanism by which a vaccine could cause the complex neurodevelopmental changes that go with Autistic Spectrum Disorder.  Numerous published scientific findings have confirmed the genetic and epigenetic basis of autism and the fact that vaccines do not and cannot cause autism.  And yet the anti-vaccine movement remains strong.

Moreover new reports of nascent anti-vaccine sentiments emerging in several large middle income countries such as Brazil and India – where the great childhood killers have not yet been eradicated – has convinced me that our vaccine advocacy work is only now just beginning!

In the coming years we must remain vigilant on the importance of ensuring that all of the world’s children receive their childhood vaccines.  A new Global Vaccine Action Plan (GVAP) has now been launched as part of the Decade of Vaccine (DoV) Collaboration through the efforts of a group of international partners that includes WHO, GAVI Alliance, UNICEF, the Bill & Melinda Gates Foundation, and NIAID, NIH.  It is more important than ever that the global health and vaccine community rally around GVAP to ensure that my sad and tragic scenes I first saw during visits to Central America will not be repeated!

Peter Hotez, MD, PhD, is on the Board of Directors of TIP.  He is also Founding Dean at the National School of Tropical Medicine at Baylor College of Medicine; President of the Sabin Vaccine Institute and Director of the Texas Children’s Hospital Center for Vaccine Development; Texas Children’s Hospital Endowed Chair in Tropical Pediatrics;  and a Baker Institute Fellow in Disease and Poverty.