Caution on Mass HPV Vaccination
One reason for the relatively low uptake of the HPV vaccine, as Dr. Krishna Upadhya suggests, may be that parents and pediatricians want to avoid the subject of sex (Second Opinion, Fall 2016). There are, however, cogent reasons why HPV vaccination is not in the best interests of children.
Fourteen million people may be infected with HPV in the United States annually, as Dr. Upadhya says, but vaccination is being promoted not to prevent HPV infection itself but to prevent cervical cancer, with which some strains of HPV are associated. From 2008 to 2012, the average annual number of cervical cancers diagnosed in the United States was 11,771 (or 7.4 of every 100,000 females). That may seem high—actually, it’s about the same as the number of infants with phenylketonuria detected by newborn screening in the U.S. annually—but in 1975, 30 years before HPV vaccination began, the incidence was twice as high, at 14.8 of every 100,000 females.
This drop is attributable primarily to Pap screening of women, beginning in their 20s. Unfortunately, HPV vaccination cannot replace Pap screening because the vaccines do not protect against all cervical cancer-related strains of HPV. Since vaccinated women should continue to have Pap smears, those cases prevented by vaccination would have been detected anyway. There is, unfortunately, evidence that HPV vaccination has lowered the rate of Pap screening.
Nor is HPV vaccination without harm. Associations with primary ovarian failure and other autoimmune disorders have been reported. Until more data are collected, caution is needed in promoting mass vaccination.
Neil A. Holtzman, M.D., M.P.H.
House Staff, Pediatrics, 1959–62 | Emeritus Professor of Pediatrics