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miércoles, 5 de febrero de 2014

HPV vaccine doesn't promote risky sex

Young women who get the human papillomavirus (HPV) vaccine don't see it as a license to have more sexual partners or forgo condoms, a new study confirms.
The US Centers for Disease Control and Prevention calls for both girls and boys to be vaccinated against HPV, the sexually transmitted virus that causes cervical cancer.
Some parents and community groups have been concerned that the vaccine might promote risky sex.
But in the new study, even the small group of girls who misunderstood their risk of sexually transmitted infections (STIs) after getting vaccinated didn't change their behaviour as a result, researchers found.
"There are so many contributing factors to whether an adolescent decides to have sex or not, and whether they decide to limit their number of partners or use condoms," says Dr Jessica Kahn. "Getting a vaccine probably just plays a very, very small role in their decisions."
Kahn worked on the study at Cincinnati Children's Hospital Medical Center in Ohio.
Her team's findings are in line with another report that showed girls who had been vaccinated weren't more likely to get other STIs or become pregnant.
"To me, the issue is laid to rest," says Kahn. "As clinicians and researchers, we have no concerns that vaccination will lead to riskier sexual behaviours."

Maintaining their behaviour

She and her colleagues studied 339 young women between 13 and 21 years old who were getting their first of three HPV shots. Most of the women were black and came from low-income families.
The researchers surveyed participants about how important they considered safe sex to be, and how concerned they were about STIs. Then they asked the participants about changes in their sexual behaviour when the young women came back two and six months later for their next shots.
After getting the first vaccine, most young women agreed it was still necessary to use condoms and generally practice safe sex. On a scale from zero to 10, where lower scores indicate a better understanding of risks, participants scored a 1.6, on average.
Most study participants also understood that the HPV vaccine doesn't protect against other STIs, and they scored a 3.9 on their perceptions of STI risks, according to findings published in the journal Pediatrics.
"The vast majority of girls thought that safer sexual behaviours were still important after vaccination," says Kahn. But even those who didn't accurately perceive their risks weren't any more likely to start having sex or stop using condoms, her study shows.
Among women who say they had never had sex when they got their first vaccine, 20 per cent had become sexually active by the time the researchers checked in with them six months later.
Of those who were already having sex when the study started, close to two thirds said at their six-month visit that they used a condom the last time they had sex. About one third reported two or more sexual partners since their last visit.
"The findings strengthen a growing body of literature that indicates that getting HPV vaccination is very unlikely to change an adolescent's perception about risk and also their actual sexual behaviour," says Dr Amanda Dempsey.
Dempsey is a paediatrician and vaccine researcher at the University of Colorado, Denver and wasn't involved in the new research. She tells parents that young people's attitudes on sex are based on years of discussions about family values — so a shot shouldn't have a major effect.
Kahn says she is worried that parents' concerns about changes in sexual behaviour might still be keeping them from getting their children vaccinated.
HPV vaccination rates in the United States are relatively low. One in three girls between 13 and 17 years old had gotten all three shots in 2012, the researchers note.

Significant impact in Australia

In Australia, the HPV vaccine is given to girls and boys aged 12 and 13 years at school.
According to Dr Julia Brotherton of the Victorian Cytology Service in Melbourne, the rate of coverage in Australia is around 70 per cent.
"Vaccine uptake is fairly evenly spread across the socio-economic spectrum because of the school-based system," says Brotherton. "In the United States, it relies on parents to make an appointment, then a doctor has to administer it and it is then claimed from the insurer."
She says there has also been more of a focus on the benefits of the HPV vaccine in Australia.
Brotherton adds that since the vaccine was released on the market in 2007, the rate of HPV infections has declined.
"We've already seen rates of infection go down by 77 per cent, while genital warts have almost disappeared in young women and men," she says.
Two of the study's seven authors have received grants from the two companies that sell HPV vaccines, Merck and GlaxoSmithKline. The current study was funded by the US National Institutes of Health.
Tomado de: abc.net.au
Genevra Pittman and staff

lunes, 27 de febrero de 2012

HPV Vaccine Recommended for Boys in New AAP Guidelines

The American Academy of Pediatrics (AAP) has published new guidelines for the use of the human papillomavirus vaccine and, for the first time, has specifically recommended use of the vaccine in adolescent boys as well as girls.

The recommendations were published online February 27 and in the March print issue of Pediatrics.

The vaccine was recommended for girls in 2006, but even though at that time the AAP said the vaccine could be used in boys, it was not specifically recommended for that population.

The new recommendations were spurred in part by mounting evidence that the HPV vaccine is effective as prophylaxis against genital warts in both males and females. HPV infection has been associated with increased risk for cervical cancer, anal cancer, and oropharyngeal cancer.

The AAP recommends that the vaccine be administered at 11 to 12 years of age in both boys and girls. Their rationale is 2-fold: First, the vaccine is most effective if it is administered before the individual begins engaging in sexual activity, mainly because the vaccine is inactive against HPV strains acquired before vaccination. Second, children mount the most robust antibody responses to the vaccine when they are between the ages of 9 and 15 years, the AAP says.

Two HPV vaccines are currently available in the United States, but there are differences in their approved indications. Quadrivalent HPV vaccine (HPV4, Gardasil, Merck) is the only vaccine approved for use in boys. Bivalent HPV vaccine (HPV2, Cervarix, GlaxoSmithKline) is only approved for use in girls; HPV4 is also approved for girls.

Among the AAP's updated recommendations are that:

  • Girls aged 11 to 12 years should be routinely immunized using 3 doses of the HPV4 or HPV2 vaccine, administered intramuscularly at 0, 1 to 2, and 6 months.
  • Girls and women aged from 13 to 26 years who have not been previously immunized or who have not completed their vaccinations should finish the series.
  • Boys aged 11 to 12 years should be routinely immunized with HPV4, using the same schedule as for girls.
  • Boys and men aged from 13 to 21 years who have not already been immunized or who have not completed their vaccines should finish the series.
  • Men aged from 22 to 26 years who have not already been immunized or who have not finished the full series may be administered the recommended vaccine. (The AAP guidelines note that "cost-efficacy models do not justify a stronger recommendation in this age group.")
  • Special efforts should be made to target use of the vaccine in gay or bisexual men up to 26 years of age who have not previously received the vaccine.
  • People infected with HIV should be vaccinated or complete their series of vaccinations.
  • The vaccine is not recommended during pregnancy, nor should it be administered to individuals with a known immediate hypersensitivity to yeast. However, it may be administered during lactation, as well as to those who are immunocompromised from either illness or medication

The AAP recommends that because the HPV vaccine will not prevent infection from all types of HPV types, cervical screening should continue after HPV vaccination.

The organization also says that administration of the vaccine should not alter physicians' recommendations regarding use of barrier methods for preventing HPV and other sexually transmitted diseases.

The AAP urges that use of the vaccine be covered by all public and private health insurance.

More information on implementing the guidelines, including guidance on supply, payment, coding, and liability issues, is available on the AAP's

Pediatrics. 2012;129:602-605.

Tomado de Medscape Medical News © 2012 WebMD, LLC