Introducing our new monthly feature, Ask the Doctor. Our healthcare partners will be answering your questions. To submit a question, please email [email protected].

What is the purpose, benefits and risks for the HPV vaccine? Why is it controversial?

Meredith Brazell: Recommended by the AAP and the ACIP of the CDC, the HPV vaccination is an opportunity to prevent HPV-related cancer deaths along with genital herpes. According to a publication in the AAP Pediatrics magazine titled “The Need to Optimize Adolescent Immunization,” the HPV vaccine protects against the high-risk HPV types which are responsible for virtually all cases of cervical cancer and a large percentage of cervical, vulvar, vaginal, anal and throat cancers. It also protects against two other HPV strains that are responsible for 90% of genital warts. Part of the controversy is that the lifetime risk of acquiring HPV is 80% and several HPV strains will go away on their own. However the vaccine is covering the cancer strains that can cause death and will not go away. Also some cultures believe if their child gets the HPV vaccine, it is giving their child permission to be sexually active therefore they want to wait. This is not the case and the reason to get it at such a young age is that the vaccine is more effective and therefore requiring less doses if given before age 15. Previously, it was not approved for anyone over age 26 although recently changed to 45. However, most children will become sexually active in their lifetime and therefore recommended as early as age nine. The most common side effects are a sore arm, fever, headache and sometime fainting (it is recommended to sit 15 minutes after the vaccine to prevent this). Please see the Vaccine Information Statement on Hepatitis A from the CDC for more information (https://pediatrics.aappublications.org/content/139/3/e20164186).

Mobeen Rathore: The HPV vaccine is designed primarily to protect women against cervical and vaginal cancers. In addition, it affords protection against penile cancers and laryngeal papillomas (a medical condition in which benign tumors grow along the aerodigestive tract).  Therefore, the vaccine is most beneficial if given prior to the time a woman becomes sexually active. For the same reason, males also need to be protected from HPV with the use of the HPV vaccine.

HPV is not the first vaccine that males are given to protect females from an infection. The rubella vaccine (Measles, Mumps and Rubella [MMR] vaccine) has been used for decades in males. In addition, MMR is also given to females prior to the time they can become pregnant. The ultimate goal is to protect the fetus from getting rubella and the dreaded and devastating congenital rubella syndrome (which can result in miscarriages, stillbirths and a host of severe birth defects). Unfortunately some have associated HPV as a vaccine to protect against a sexually transmitted disease (it does that, too) but it is really a cancer-protecting vaccine very much like the hepatitis B vaccine. That is why HPV vaccine has become unnecessarily controversial.

What is the purpose, benefits and risk of the Hepatitis A vaccine? Why has this become highly suggested?

Meredith Brazell: Hepatitis A is a disease that can cause liver failure and death but can also cause fever, nausea, vomiting, stomach pains and diarrhea for up to six months. It occurs when a person drinks water or eats food that was contaminated by the fecal matter of another person infected with hepatitis A. People can also contract this virus through unprotected oral or anal intercourse. Just last month, Florida declared a “Public Health Emergency” to alert the public about this serious illness and prevent the spread of Hepatitis A. The best way to prevent the spread of Hepatitis A is through vaccination. The vaccine is a two dose series with the second dose to be given at least six months after the first dose in order to provide long-term immunity from HAV infection. Children are routinely vaccinated between their first and second birthdays and those who have not been vaccinated can also receive two doses. The most common side effects are soreness or redness near vaccine site, fever, headache and sometimes fainting (it is recommended to sit 15 minutes after the vaccine to prevent this). Please see the Vaccine Information Statement on Hepatitis A from the CDC for more information.

Mobeen Rathore: The hepatitis A vaccine protects against hepatitis A infection (a viral liver disease that can cause mild to severe illness). It is often much more severe in adults than in children. Hepatitis A vaccine is recommended for all children at one year of age so that they don’t get the infection later in life and become more seriously ill with conditions such as serious liver disease. This vaccine also protects against outbreaks. Since there is a current ongoing outbreak of hepatitis A in Florida and some other states, this vaccine is being highly suggested.

What vaccines are recommended at each stage of a child’s growth – early childhood, upon entering school, transitioning to middle school and entering college?

Meredith Brazell: Most vaccines for children are given in infancy up to entering school. These include Hepatitis B starting within the first 24 hours after birth. Subsequently, at ages two, four, and six months old, a child normally receives the remaining doses of Hepatitis B along with Diptheria, Tetanus, Pertussis (whooping cough), Polio, Pneumonia vaccine, Haemophilus influenzae, and Rotavirus (responsible for diarrhea – an oral medication). From a year old to four years old, they will be vaccinated against Measles, Mumps, Rubella, Varicella (chicken pox), and Hepatitis A along with finishing up the series of vaccines given as an infant. The next big round of vaccines occurs when the child is around middle school age of 11 years old when they get a booster of Tetanus, Diptheria, and Pertusis along with the Meningitis vaccine covering strains ACWY and their HPV (Gardasil) Vaccine. At 16, before entering college, children are then due for a second Meningitis vaccine covering ACWY along with another that covers strain B (MenB).

Mobeen Rathore: Childhood vaccines are recommended at particular ages so that the children can be protected before they are at risk for those infections and also because the vaccines have been proven safe and effective at those ages. The Centers for Disease Control (CDC)/American Academy of Pediatrics (AAP) schedule is researched and based in best science. There is not “alternate” schedule other than what CDC/AAP schedule. All other immunization schedules are “dangerous” schedules for children.

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