HPV vaccine

Human papillomavirus (HPV) vaccine is a vaccine that prevents infection with certain species of human papillomavirus associated with the development of cervical cancer, genital warts[1], and some less common cancers (e.g., anal[2], vulvar[3], vaginal[3], penile[2]). Two HPV vaccines are currently on the market: Gardasil and Cervarix.[4] Both vaccines protect against two of the HPV types that cause cervical cancer, and some other genital cancers; Gardasil also protects against two of the HPV types that cause genital warts.[1]

Public health officials in the Australia, Canada, Europe and United States recommend vaccination of young women against HPV because of high infection rates worldwide, a desire to reduce the number of painful and costly treatments for cervical dysplasia, which is caused by HPV, and the desire to prevent genital warts and cervical cancer.[5] Worldwide, HPV is the most common sexually transmitted infection in adults.[6] For example, more than 80% of American women will have contracted at least one strain of HPV by age fifty.[7][8][9][10][11]

Although most women infected with genital HPV will not have complications from the virus,[12] worldwide there are an estimated 470,000 new cases of cervical cancer that result in 233,000 deaths per year.[13] About eighty percent of deaths from cervical cancer occur in poor countries.[14] In the United States, most of the approximately 11,000 cervical cancers found annually[15] occur in women who have never had a Pap smear, or not had one in the previous five years.

Since the vaccine only covers some high-risk types of HPV, experts still recommend regular Pap smear screening even after vaccination.[16]

Gardasil has been shown to also be effective in males.[2]

Contents

History

In work that was initiated in the mid 1980s, the vaccine was developed, in parallel, by researchers at Georgetown University Medical Center, the University of Rochester, the University of Queensland in Australia, and the U.S. National Cancer Institute [17]. In 2006, the U.S. Food and Drug Administration approved the first preventive HPV vaccine, marketed by Merck & Co. under the trade name Gardasil. According to Merck press release [18], in the second quarter 2007, it had been approved in 80 countries, many under fast-track or expedited review. Early in 2007, GlaxoSmithKline filed for approval in the United States for a similar preventive HPV vaccine, known as Cervarix. In June 2007 this vaccine was licenced in Australia, and it was approved in the European Union in September 2007.[19]

Therapeutic HPV vaccines

In addition to preventive vaccines, such as Gardasil and Cervarix, laboratory research and several human clinical trials are focused on the development of therapeutic HPV vaccines. In general these vaccines focus on the main HPV oncogenes, E6 and E7. Since expression of E6 and E7 is required for promoting the growth of cervical cancer cells (and cells within warts), it is hoped that immune responses against the two oncogenes might eradicate established tumors.[20]

Prevalence of genital HPV

United States

See also: HPV: Prevalence of Genital HPV

According to the Centers for Disease Control, by the age of 50 more than 80% of American women will have contracted at least one strain of genital HPV.[21] Both men and women can be carriers of HPV.[22] HPV is the most common sexually transmitted infection in the US.[21] A large percentage of the American population is infected with genital HPV[23] because HPV is highly communicable. As a result, American public health experts recommend wide-spread HPV vaccination.[24]

Only a small percentage of women with HPV develop cervical cancer.[25] Each year, between 250,000 and 1 million American women are diagnosed with cervical dysplasia, which is caused by HPV and is a potential precursor to cervical cancer.[26] About 11,000 American women are diagnosed with cervical cancer every year, and about 3,700 die per year of the disease.[15] Most cancers occur in those who have not had Pap smears within the previous five years.

HPV-induced cancers

There are 19 "high-risk" HPV types that can lead to the development of cervical cancer or other genital/anal cancers; some forms of HPV, particularly type 16, have been found to be associated with a form of throat cancer.[27] Studies have found that human papillomavirus (HPV) infection is responsible for virtually all cases of cervical cancer.[28][25]

Condoms protect against HPV, but do not completely prevent transmission.[29][30][31] College freshmen women who used condoms consistently had a 37.8% per patient-year incidence of genital HPV, compared to an incidence of 89.3% among those who did not.[29][30][31]

No data is kept by the U.S. government on genital wart infection rates[32], however it is estimated that 20 million people are presently infected with genital warts, and there are six million new cases of genital warts every year in the United States.[33]

Worldwide

Worldwide, cervical cancer is the fifth most deadly cancer in women.[34] There are an estimated 470,000 new cases of cervical cancer, and 233,000 deaths per year.[13]

Vaccination and public health

According to the American National Cancer Institute, "Widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds, if all women were to take the vaccine and if protection turns out to be long-term. In addition, the vaccines can reduce the need for medical care, biopsies, and invasive procedures associated with the follow-up from abnormal Pap tests, thus helping to reduce health care costs and anxieties related to abnormal Pap tests and follow-up procedures (2)."[16]

Current preventive vaccines protect against the two HPV types (16 & 18) that cause about 70% of cervical cancers worldwide.[35] Because of the distribution of HPV types associated with cervical cancer, the vaccines are likely to be most effective in Asia and Europe/North America.[35] Vaccines covering more of the types common in cancers would prevent more cancers, and be less subject to regional variation.[35]

Only 41% of women with cervical cancer in the developing world are able to access medical treatment for their illness.[36] Therefore, prevention of HPV by vaccination may be a more effective way of lowering the disease burden in developing countries than cervical screening.

Vaccine target populations

Gardasil and Cervarix are preventative (rather than therapeutic) vaccines, recommended for women who are 9 to 25 years old and have not contracted HPV. However, since it is unlikely that a woman will have already contracted all four viruses, and because HPV is primarily sexually transmitted, the U.S. Centers for Disease Control and Prevention has recommended vaccination for women up to 26 years of age.

When Gardasil was first introduced, it was recommended as a prevention for cervical cancer for women that were 25 years old or younger. New evidence suggests that all Human Papillomavirus (HPV) vaccines are effective in preventing cervical cancer for women up to 45 years of age.[37]

In November 2007, Merck presented new data on Gardasil. This data indicated that in an investigational study, their HPV vaccine reduced incidence of HPV 6, 11, 16 and 18-related persistent infection and disease in women through age 45. The study evaluated women who were free of infection from at least one vaccine HPV type at the beginning of the study, and who remained free of infection with the relevant HPV type(s) until they completed the three-dose vaccination series. Merck planned to submit this data before the end of 2007 to the U.S. Food and Drug Administration (FDA), and to seek an indication for Gardasil for women through age 45.[38]

Vaccination during pregnancy

In the Gardasil clinical trials, 1,115 pregnant women received the HPV vaccine. Overall, the proportions of pregnancies with an adverse outcome were comparable in subjects who received Gardasil and subjects who received placebo [39]. However, the clinical trials had a relatively small sample size. Currently the vaccine is not recommended for pregnant women.[1] The long term effects of this vaccine on fertility are not known, but no effects are anticipated.

Vaccination of males

Gardasil can also be used in males to reduce their risk of genital warts and precancerous lesions caused by HPV.[2] The reduction in precancerous lesions is expected to reduce the rates of penile and anal cancers in men.[2] Since penile and anal cancers are much less common than cervical cancer, HPV vaccination of young men is likely to be much less cost-effective than for young women.[40] From a public health point of view, vaccinating men as well as women might be useful if it decreased the virus pool within the population. Gardasil is in particular demand among gay men, who are at significantly increased risk for genital warts, penile cancer, and anal cancer.[41]

Just as with females, the vaccine must be administered before infection with the HPV types covered by the vaccine occurs. Vaccination before adolescence makes it more likely that the recipient has not been exposed to HPV.

In the UK, HPV vaccines are licensed for boys aged 9 to 15.[42] Merck, the maker of Gardasil, is expected to ask the FDA for permission to market the vaccine in the United States for boys and men between ages 9 to 26.[2] The vaccine is already available in the United States and can be used off label for the vaccination of males.[2]

Safety

Further information: Gardasil#Safety and efficacy

According to the FDA and CDC, the vaccine has only minor side effects, such as soreness around the injection area. The FDA and CDC consider the vaccine to be safe. It does not contain mercury, thimerosal or live or dead virus, only virus-like particles, which cannot reproduce in the human body.[1] Merck, the manufacturer of Gardasil, will continue to test women who have received the vaccine to determine the vaccine's efficacy over the period of a lifetime.

Mechanism of action

The latest generation of preventive HPV vaccines are based on hollow virus-like particles (VLPs) assembled from recombinant HPV coat proteins. The vaccines target the two most common high-risk HPVs, types 16 and 18. Together, these two HPV types currently cause about 70 percent of all cervical cancer.[35] Gardasil also targets HPV types 6 and 11, which together currently cause about 90 percent of all cases of genital warts.[25]

Gardasil and Cervarix are designed to elicit virus-neutralizing antibody responses that prevent initial infection with the HPV types represented in the vaccine. The vaccines have been shown to offer 100 percent protection against the development of cervical pre-cancers and genital warts caused by the HPV types in the vaccine, with few or no side effects. The protective effects of the vaccine are expected to last a minimum of 4.5 years after the initial vaccination.[43]

While the study period was not long enough for cervical cancer to develop, the prevention of these cervical precancerous lesions (or dysplasias) is believed highly likely to result in the prevention of those cancers.[44]

Although a 2006 study suggests that the vaccines may offer limited protection against a few HPV types that are closely related to HPVs 16 and 18, there are other high-risk HPV types are not affected by the vaccines.[43] Ongoing research is focused on the development of HPV vaccines that will offer protection against a broader range of HPV types.[45] There is also substantial research interest in the development of therapeutic vaccines, which seek to elicit immune responses against established HPV infections and HPV-induced cancers.

Vaccine implementation

Main article: vaccination policy

In developed countries, the widespread use of cervical "Pap smear" screening programs has reduced the incidence of invasive cervical cancer by 50% or more. Current preventive vaccines reduce, but do not eliminate the chance of getting cervical cancer. Therefore, experts recommend that women combine the benefits of both programs by seeking regular Pap smear screening, even after vaccination.[46]

Australia

Commencing in 2007 The Australian federal government began funding a voluntary program to make the Gardasil vaccine available free of charge to women aged between 12 and 26 for a period of two years, with an ongoing vaccination program for 12-13 year olds as part of the pre-existing high school vaccination program.[47][48]

In Australia, the Australian government and the PBS (Pharmaceutical Benefits Scheme) have approved the vaccine for use and in 2007 began a nationwide vaccination program free of charge to schoolgirls in years 7 to 12. These programs are run by local councils with funding and vaccine supplies coming from the government. The subsidization approval process, however, appears to have been heavily influenced by political interference from politicians of all political parties, and by the Prime Minister who publicly advised that it would be approved (before approval). In addition, women between 18 and 26 years of age at the time of the first dose may receive the vaccine for free upon request from their general practitioner. After June 2009, the program will be scaled down to 12–13 year old girls only. Australia also approved Gardasil for boys 9–15 years old, but Australia is not providing government funding for vaccinating boys.[49][50]

Canada

Canada has approved use of Gardasil[51]. Initiating and funding free vaccination programs has been left to individual Province/Territory Governments. In the provinces of Ontario, Prince Edward Island, Newfoundland and Nova Scotia[52], free vaccinations to protect women against HPV are slated to begin in September 2007 and will be offered to girls 11-14 in age. Similar vaccination programs are also being planned in British Columbia and Quebec.[53][54][55]

France

On July 17, 2007, France issued a directive[56] authorizing state-aided voluntary vaccination for girls aged 14–23 years who have not yet become sexually active, or have been sexually active for less than a year. The state refunds 65% of the cost, based on a program of 3 vaccinations at €135 (slightly less than $200) per shot, meaning that the patient covers €141.75 (slightly more than $200).

Germany and Italy

On March 26, 2007, early approval for Gardasil vaccinations was granted in both Germany and Italy.[57]

Greece

On February 12, 2007, Greece made HPV vaccination mandatory for girls entering gymnasion (7th grade). All vaccines including hepatitis B are mandatory and are supplied free to everyone in Greece with parents being allowed to opt out of vaccinating their kids. Cervarix and Gardasil are supplied free to all girls and women between the ages of 12 and 26.[58][59].

Romania

In Novermber 2008, Romanian authorities launched a campaign to vaccinate 110,000 girls aged 10 and 11. The Ministry of Health acquired 330,000 vaccine doses for $23 million euros. By an order of the Ministry, the girls' parents must approve or reject the vaccination in writing, and must "fully assume the consequences for their children" if they reject the vaccination.[60]

New Zealand

From September 2008, Gardasil will be available for New Zealand girls and young women born in 1990 and 1991 through primary care and from 2009, the HPV immunization program will be part of the regular immunization schedule for 12 year old girls.

South Korea

On July 27, 2007, South Korean government approved Gardasil for use in girls and women aged 9 to 26 and boys aged 9 to 15.[61] Approval for use in boys was based on safety and immunogenicity but not efficacy.

United Kingdom

In the UK the vaccine is licensed for girls and boys aged 9 to 15 and for women aged 16 to 26.[42]

HPV vaccination will be introduced into the national immunisation programme in September 2008, for girls aged 12-13 across the UK. Then, starting in autumn 2009, a two year catch up campaign will vaccinate all girls up to 18 years of age. This catch up campaign will offer to vaccinate:

By the end of the catch up campaign, all girls under 18 will have been offered the HPV vaccine.

When the HPV vaccination programme begins in 2008, women over the age of 18 will not be vaccinated as it would not be cost effective in preventing cervical cancer. This is because as soon as a woman becomes sexually active, she is at risk of infection with the virus.

It will be many years before the vaccination programme has an effect upon cervical cancer incidence so women are advised to continue accepting their invitations for cervical screening.[62]

United States

As of late 2007, about one quarter of US females age 13-17 years had received at least one of the three HPV shots.[63]

Legislation

Opt-out policies

Almost all pieces of legislation currently pending in the states that would make the vaccine mandatory for school entrance have an "opt-out" policy.[64]

State-by-State

Other states are also preparing bills to handle issuing the HPV Vaccine.[64]

State Proposal Status Opt Out Policy
Alaska Voluntary vaccination program Passed N/A
California Bill would have required girls entering the sixth grade to be vaccinated. Withdrawn for further consideration. Yes
Colorado Bill would require 12-year-old girls to be vaccinated to attend school. Pending Yes
Connecticut Bill would require girls receive a first dose of the vaccine before entering the sixth grade. Allows parents to opt their daughters out on medical or religious grounds. Pending Yes
District of Columbia Bill would require girls to be vaccinated before they turn 13 to attend school. Pending Yes
Florida Bill would have required 11- and 12-year-old girls to be vaccinated to attend school. Died in committee Yes
Georgia Bill would require girls entering the sixth grade to be vaccinated unless parents can't afford the vaccine or object to it on medical or religious grounds. Died in Committee Yes
Illinois Bill would require girls entering the sixth grade to be vaccinated. Pending Yes
Kansas Bill would require girls entering the sixth grade to be vaccinated. Allows parents to opt their daughters out on medical or religious grounds. Pending Yes
Kentucky Bill would require girls entering middle school to be vaccinated. Passed House, to Senate Yes
Maryland Bill would have required girls entering the sixth grade to be vaccinated. Withdrawn Yes
Massachusetts Bill would require girls entering the sixth grade to be vaccinated. Allows parents to opt their daughters out on religious grounds. Pending Yes
Michigan Bill would require girls entering the sixth grade to be vaccinated. Pending. Yes
Missouri Bill would require girls entering the sixth grade to be vaccinated. Allows parents to opt their daughters out on medical or religious grounds. Pending Yes
Minnesota Bill would require 12-year-old girls to be vaccinated to attend school. Pending Yes
Mississippi Bill would have required girls entering the sixth grade to be vaccinated. Died. Sponsor planning to re-introduce it with an opt-out clause. No
Nevada Bill would require health insurance companies to cover the cost of the vaccine Passed into law N/A
New Hampshire Voluntary program provides vaccine free of charge to girls between the ages of eleven and eighteen. Passed and presently in effect. Yes
New Jersey Bill would require girls in grades seven through 12 to be vaccinated. Allows parents to opt their daughters out on medical or religious grounds. Pending Yes
New Mexico Bill would require nine- to 14-year-old girls to be vaccinated to attend school. Passed legislature. Vetoed by governor. Yes
Ohio Bill would require girls entering the sixth grade to be vaccinated. Pending Yes
Oklahoma Bill would require girls entering the sixth grade to be vaccinated. Pending Yes
South Carolina Bill would require girls entering the seventh grade or 11 years of age to be vaccinated. Allows parents to opt their daughters out on medical or religious grounds. Pending Yes
Texas Governor issued executive order requiring that girls entering the sixth grade be vaccinated. Texas legislature overrode executive order and barred mandatory vaccination until at least 2011. Yes
Vermont Bill would require girls entering the sixth grade to be vaccinated. Allows parents to opt their daughters out on medical, moral or religious grounds. Pending Yes
Virginia Bill requires girls entering the sixth grade to be vaccinated. Passed the legislature. Goes into effect Oct. 1, 2008; to be implemented in fall of 2009. Yes
West Virginia Bill would require girls entering the sixth grade to be vaccinated. Allows parents to opt their daughters out on medical grounds. Died n/a

Source: National Conference of State Legislatures, state legislatures

Opposition in the United States

Main article: Vaccine controversy
Health insurance companies

There has been significant opposition from health insurance companies to covering the cost of the vaccine ($360).[65][66][67]

Religious right and conservative groups

Several conservative groups in the U.S. have publicly opposed the concept of making HPV vaccination mandatory for pre-adolescent girls, asserting that making the vaccine mandatory is a violation of parental rights. Both the Family Research Council and the group Focus on the Family support widespread (universal) availability of HPV vaccines but oppose mandatory HPV vaccinations for entry to public school.[68][69][70][71]

Response

Many organizations disagree with the assessment that the vaccine would increase sexual activity among teens. Dr. Christine Peterson, director of the University of Virginia's Gynecology Clinic, said "The presence of seat belts in cars doesn't cause people to drive less safely. The presence of a vaccine in a person's body doesn't cause them to engage in risk-taking behavior they would not otherwise engage in." [72] All states offer an "opt-out" policy which allows parents not to vaccinate their girls for religious reasons.

References

  1. ↑ 1.0 1.1 1.2 1.3 CDC (2006). "STD Facts - HPV Vaccine". Retrieved on 2007-08-22.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Cortez, Michelle Fay and Pettypiece, Shannon. "Merck Cancer Shot Cuts Genital Warts, Lesions in Men". Bloomberg News. (Bloomberg.com) 13 Nov 2008.
  3. ↑ 3.0 3.1 "FDA Approves Expanded Uses for Gardasil to Include Preventing Certain Vulvar and Vaginal Cancers" (2008-09-12). Retrieved on 2008-10-12.
  4. ↑ Glaxo cervical cancer shot approved in Australia Reuters (2007-05-21) Retrieved on 2007-05-25
  5. ↑ Jacobs Institute for Women's Health New Report Examines Laws that Would Mandate HPV Vaccine for Young Women
  6. ↑ Human Papilloma Virus – Common but with dire potential consequences
  7. ↑ Planned Parenthood "In fact, the lifetime risk for contracting HPV is at least 50 percent for all sexually active women and men, and, it is estimated that, by the age of 50, at least 80 percent of women will have acquired sexually transmitted HPV (CDC, 2004; CDC, 2006)."
  8. ↑ Medical News Today
  9. ↑ Dunne EF, Unger ER, Sternberg M, et al (February 2007). "Prevalence of HPV infection among females in the United States". JAMA : the journal of the American Medical Association 297 (8): 813–9. doi:10.1001/jama.297.8.813. PMID 17327523. 
  10. ↑ American Social Health Association "Genital HPV is the most common STD in America; an estimated 80% of sexually active individuals will contract it at some point in their lives."
  11. ↑ "Study Reveals High Infection Rate In Teens For Virus Linked To Cervical Cancer" Sience Daily "The research, reported by Darron R. Brown, M.D., and colleagues at the Indiana University School of Medicine, found four out of five sexually active adolescent females infected with the human papillomavirus."
  12. ↑ Snijders PJ, Steenbergen RD, Heideman DA, Meijer CJ (2006). "HPV-mediated cervical carcinogenesis: concepts and clinical implications.". J. Pathol. 208 (2): 152–64. doi:10.1002/path.1866. PMID 16362994. "cervical cancer is a rare complication of an hrHPV infection since most such infections are transient, not even giving rise to cervical lesions.". 
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  18. ↑ Merck News Item
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  24. ↑ New Report Examines Laws that Would Mandate HPV Vaccine for Young Women George Washington University, December 27, 2007
  25. ↑ 25.0 25.1 25.2 Lowy DR, Schiller JT (May 2006). "Prophylactic human papillomavirus vaccines". The Journal of clinical investigation 116 (5): 1167–73. doi:10.1172/JCI28607. PMID 16670757. 
  26. ↑ Women's Health Channel "Cervical Dysplasia: Overview, Risk Factors"]
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  28. ↑ [1]
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  30. ↑ 30.0 30.1 Winer RL, Hughes JP, Feng Q, et al (June 2006). "Condom use and the risk of genital human papillomavirus infection in young women". The New England journal of medicine 354 (25): 2645–54. doi:10.1056/NEJMoa053284. PMID 16790697. 
  31. ↑ 31.0 31.1 Baldwin SB, Wallace DR, Papenfuss MR, Abrahamsen M, Vaught LC, Giuliano AR (October 2004). "Condom use and other factors affecting penile human papillomavirus detection in men attending a sexually transmitted disease clinic". Sexually transmitted diseases 31 (10): 601–7. PMID 15388997. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0148-5717&volume=31&issue=10&spage=601. 
  32. ↑ Avert.org
  33. ↑ Genital HPV Infection - CDC Fact Sheet
  34. ↑ World Health Organization (February 2006). "Fact sheet No. 297: Cancer". Retrieved on 2007-12-01.
  35. ↑ 35.0 35.1 35.2 35.3 Muñoz N, Bosch FX, Castellsagué X, Díaz M, de Sanjose S, Hammouda D, Shah KV, Meijer CJ (2004-08-20). "Against which human papillomavirus types shall we vaccinate and screen? The international perspective.". Int J Cancer 111 (2): 278–85. doi:10.1002/ijc.20244. PMID 15197783. 
  36. ↑ Wittet S. & Tsu V. (2008) Cervical cancer prevention and the Millenium Development Goals. Bulletin of the World Health Organization, 86, 488-490.
  37. ↑ "HPV Vaccine Update". Your Cancer Today (2007-12-11).
  38. ↑ 05 Nov 2007, New Data Presented on GARDASIL®, Merck's Cervical Cancer Vaccine, in Women Through Age 45, http://www.merck.com/newsroom/press_releases/product/2007_1105.html
  39. ↑ Merck Pregnancy Registries - GARDASIL
  40. ↑ Rosenthal, Elisabeth (2008-08-19). "Drug Makers’ Push Leads to Cancer Vaccines’ Fast Rise", The New York Times. Retrieved on 2008-08-20. "Said Dr. Raffle, the British cervical cancer specialist: “Oh, dear. If we give it to boys, then all pretense of scientific worth and cost analysis goes out the window.”" 
  41. ↑ Cancer Research UK. "Gay men seeking HPV vaccine". (http://info.cancerresearch.org). 23 Feb 2007.
  42. ↑ 42.0 42.1 "Gay men seek 'female cancer' jab". BBC (2007-02-23).
  43. ↑ 43.0 43.1 Harper DM, Franco EL, Wheeler CM, et al (April 2006). "Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial". Lancet 367 (9518): 1247–55. doi:10.1016/S0140-6736(06)68439-0. PMID 16631880. 
  44. ↑ "FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus". FDA (2006-06-08). Retrieved on 2007-02-04.
  45. ↑ "New HPV Vaccine Under Study.". Medical College of Georgia, ScienceDaily (2007-11-20). Retrieved on 2008-03-01.
  46. ↑ Cutts FT, Franceschi S, Goldie S et al. (2007). "Human papillomavirus and HPV vaccines: a review". Bull World Health Organ 85 (9): 719–26. doi:10.2471/BLT.06.038414. PMID 18026629. http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862007000900018&lng=en&nrm=iso. 
  47. ↑ Australian Government To Fund Cervical Cancer Vaccine Gardasil
  48. ↑ "Australian Government Funding Of Gardasil®", Australian Government Department of Health and Ageing (2006-11-28). Retrieved on 2008-08-29. 
  49. ↑ Poljak, Vesna; Daley, Gemma (2006-11-29). "Australia to Subsidize Merck Cervical Cancer Vaccine (Update3)", Bloomberg. Retrieved on 2007-01-26. 
  50. ↑ The Department of Health and Ageing (2007-08-13). "The National HPV Vaccination Program - Frequently Asked Questions for Young Women". Retrieved on 2007-09-28.
  51. ↑ Human Papillomavirus (HPV) Prevention and HPV Vaccine: Questions and Answers
  52. ↑ HPV Immunization Launched
  53. ↑ "McGuinty Government Launches Life-Saving HPV Immunization Program:", Premier of Ontario (2007-08-02). Retrieved on 2007-12-02. 
  54. ↑ "HPV Immunization Launched", Province of Nova Scotia (2007-06-20). Retrieved on 2007-12-02. 
  55. ↑ "British Columbia To Launch Program To Provide HPV Vaccine to Sixth-Grade Girls Next Fall if Approved, Official Says", Kaiser Daily Women's Health Policy, Kaiser Family Foundation (2007-08-09). Retrieved on 2007-12-02. 
  56. ↑ "Gardasil authorised for subsidised vaccination", French govt news release (in French) (2007-12-31). Retrieved on 2007-12-31. 
  57. ↑ Fagbire, OJ (2007-03-26). "Gardasil, Merck HPV Vaccine, Gets German And Italian Approval For Girls", Vaccine Rx. Retrieved on 2007-03-27. 
  58. ↑ fskilkis.gr - Tο εμβόλιο κατά του καρκίνου τραχήλου της μήτρας και Cervarix vs Gardasil , Φαρμακευτικός Σύλλογος Κιλκίς (Pharmacy Association of Kilkis).
  59. ↑ iatronet.gr - Υγεία / Γυναικολογία - Μαιευτική / Καρκίνος του τραχήλου της μήτρας / Ο εμβολιασμός κατά του HPV στην Ελλάδα
  60. ↑ (Romanian) Claudia, Marcu (21 November, 2008) "100.000 de fetiţe, injectate cu un vaccin controversat" (100,000 girls injected with a controversial vaccine) Gândul
  61. ↑ "가다실® 제품 허가 공지" (2007-06-27). Retrieved on 2007-08-06. 
  62. ↑ "NHS Cervical Screening Program". Retrieved on 2008-06-26.
  63. ↑ "1 in 4 US teen girls got cervical cancer shot". Retrieved on 2008-10-12.
  64. ↑ 64.0 64.1 HPV Vaccine
  65. ↑ HPV Vaccine - Why Your Doctor Doesn't Offer the HPV Vaccine - Gardasil
  66. ↑ Public Health & Education | Detroit News Examines Cost of HPV Vaccine Gardasil - Kaisernetwork.org
  67. ↑ A question of protection
  68. ↑ Sprigg, Peter (2006-07-15). "Pro-Family, Pro-Vaccine — But Keep It Voluntary". The Washington Post. Retrieved on 2007-02-04.
  69. ↑ Coyne, Brendan (2005-11-02). "Cervical Cancer Vaccine Raises 'Promiscuity' Controversy", The New Standard. Retrieved on 2006-08-28. 
  70. ↑ Family Research Council: Thursday, February 7, 2008 "IF07B01"
  71. ↑ Focus on the Family Position Statement: Human Papillomavirus Vaccines
  72. ↑ "Lifesaving Politics." Ms. Magazine. pp 12-13. Spring 2007.

External links

Information about the HPV and vaccination

Major media coverage

Organizations in favor of vaccination

Organizations opposed to vaccination

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Anthrax • BCG (tuberculosis) • Flu • MMR • MMRV • Polio(OPV) • Rotavirus • Smallpox • Varicella • Yellow fever
Inactivated/toxoid
inactivated virus: Flu • HAV • Polio(IPV) •• inactivated bacteria/toxoid: DTwP •• conjugate: Hib • PCV • Meningococcus
Other
subunit: Anthrax • DTaP • HPV •• recombinant DNA: HBV •• other: Anthrax • PPV • Meningococcus
Controversy
General • Autism Action Coalition • MMR • NCVIA • Pox party • SafeMinds • Simpsonwood • Thiomersal
See also
List of vaccine topics • Epidemiology • Eradication of infectious diseases