October 2012, VOLUME 130 / ISSUE 4
[No relevant content]
Pediatrics eFirst Pages
Sexual Activity–Related Outcomes After Human Papillomavirus Vaccination of 11- to 12-Year-Olds
Robert A. Bednarczyk, Robert Davis, Kevin Ault, Walter Orenstein, and Saad B. Omer
Pediatrics peds.2012-1516; Published online October 15, 2012 (10.1542/peds.2012-1516)
OBJECTIVE: Previous surveys on hypothesized sexual activity changes after human papillomavirus (HPV) vaccination may be subject to self-response biases. To date, no studies measured clinical markers of sexual activity after HPV vaccination. This study evaluated sexual activity–related clinical outcomes after adolescent vaccination.
METHODS: We conducted a retrospective cohort study utilizing longitudinal electronic data from a large managed care organization. Girls enrolled in the managed care organization, aged 11 through 12 years between July 2006 and December 2007, were classified by adolescent vaccine (HPV; tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed; quadrivalent meningococcal conjugate) receipt. Outcomes (pregnancy/sexually transmitted infection testing or diagnosis; contraceptive counseling) were assessed through December 31, 2010, providing up to 3 years of follow-up. Incidence rate ratios comparing vaccination categories were estimated with multivariate Poisson regression, adjusting for health care–seeking behavior and demographic characteristics.
RESULTS: The cohort included 1398 girls (493 HPV vaccine–exposed; 905 HPV vaccine–unexposed). Risk of the composite outcome (any pregnancy/sexually transmitted infection testing or diagnosis or contraceptive counseling) was not significantly elevated in HPV vaccine–exposed girls relative to HPV vaccine–unexposed girls (adjusted incidence rate ratio: 1.29, 95% confidence interval [CI]: 0.92 to1.80; incidence rate difference: 1.6/100 person-years; 95% CI: −0.03 to 3.24). Incidence rate difference for Chlamydia infection (0.06/100 person-years [95% CI: −0.30 to 0.18]) and pregnancy diagnoses (0.07/100 person-years [95% CI: −0.20 to 0.35]), indicating little clinically meaningful absolute risk differences.
CONCLUSIONS: HPV vaccination in the recommended ages was not associated with increased sexual activity–related outcome rates.
Media Release: HPV Vaccination Not Associated with Increased Sexual Activity Among Girls
Kaiser Permanente Study First to Examine Clinical Markers of Sexual Activity After HPV Vaccine
Media Release Excerpt:
ATLANTA, Oct. 15, 2012 /PRNewswire/ — The human papillomavirus (HPV) vaccine known as Gardasil is not associated with an increase in pregnancy, sexually transmitted infections, or contraceptive counseling, according to a Kaiser Permanente study published online today in the journal Pediatrics.
Since 2006, the Centers for Disease Control and Prevention has recommended that girls ages 11–12 receive three doses of the vaccine to protect them from HPV, which is transmitted through sexual activity and can cause genital warts and cervical, penile, vaginal, and head and neck cancers. The vaccine is also recommended for females ages 13–26 who did not receive the vaccine when they were younger, and for males ages 11–21.
But the vaccine has been slow to catch on. By 2010, fewer than half of girls eligible for Gardasil had received even one dose. Since the introduction of Gardasil, there have been concerns—raised both in peer-reviewed literature and the popular media—that use of the vaccine might lead to increased sexual activity, due in part to the mistaken belief that Gardasil protects against pregnancy and sexually transmitted diseases other than HPV. This new study, which was an independent research project funded by Kaiser Permanente and Emory University, shows there is no evidence to support these concerns.
“Our study found a very similar rate of testing, diagnosis and counseling among girls who received the vaccine and girls who did not,” said Robert Bednarczyk, PhD, an epidemiologist and the study’s lead author. “We saw no increase in pregnancies, sexually transmitted infections or birth control counseling – all of which suggest the HPV vaccine does not have an impact on increased sexual activity…”
See also article abstract in Pediatrics [Journal Watch below] and New York Times editorial [Media Watch below]
New York Times
Accessed 20 October 2012
An HPV Vaccine Myth Debunked
Published: October 18, 2012
One of the most preposterous arguments raised by religious and social conservatives against administering a vaccine to girls to protect them from human papillomavirus, or HPV, has been that it might encourage them to become promiscuous. That notion has now been thoroughly repudiated by a study published on Monday in Pediatrics, a journal of the American Academy of Pediatrics.
Although most women infected with HPV, the most common sexually transmitted virus, experience no symptoms, persistent infections with some strains of the virus can cause cervical and other types of cancer, as well as genital warts. In 2006, the government’s top committee of experts on immunization practices recommended that all girls ages 11 or 12, and even some as young as 9, receive the vaccine so that they could develop immunity before they became sexually active. The Centers for Disease Control and Prevention, the American Academy of Pediatrics, the American Cancer Society and the American Academy of Family Physicians have all endorsed the recommendations and attest to the vaccine’s safety.
In previous surveys, teenage girls have said they would not modify their sexual behavior after getting the HPV vaccine, but those were based on self-reporting which is not considered highly reliable. The new study, conducted by researchers from Kaiser Permanente and Emory University, analyzed medical data collected by the Kaiser Permanente managed care plan in metropolitan Atlanta. It looked at 1,400 girls who were 11 or 12 in 2006, roughly a third of whom had received the HPV vaccine, and followed them for up to three years.
Over all, there was no difference between girls who had received the vaccine and those who had not in such indicators of sexual activity as pregnancies, sexually transmitted diseases, testing for sexually transmitted diseases and counseling on how to use contraceptives. As one expert said, parents should think of the vaccine as they would a bicycle helmet; it is protection, not an invitation to risky behavior.
A version of this editorial appeared in print on October 19, 2012, on page A30 of the New York edition with the headline: An HPV Vaccine Myth Debunked.