Vaccines: Adolescent Vaccines

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Vaccines: Adolescent Vaccines




Guest:  Dr. Paul Darden – Pediatrics

Host:  Dr. Linda Austin – Psychiatry


Dr. Linda Austin:  I’m Dr. Linda Austin.  I’m interviewing Dr. Paul Darden who is Professor of Pediatrics and an epidemiologist, as well as a specialist doing research in vaccines.  Dr. Darden, there’s been a lot of talk recently about adolescent vaccines with the new HPV vaccine.  What is HPV?


Dr. Paul Darden:  HPV is human papillomavirus, and the vaccine against it has just recently been introduced.  There will be two providers of it very soon.  Human papillomavirus, we think, is the major, or perhaps even the sole, cause of cervical cancer in women.  So, it’s actually an infection that you get, probably sexually, and that later in life can result in cervical cancer.


Dr. Linda Austin:  You know, it’s a funny thing because one would think that getting vaccines would be the most obvious thing in the world to do.  Who doesn’t want to prevent an illness and yet even HPV has become a bit controversial.  What is the controversy around that vaccination?


Dr. Paul Darden:  We worry a lot and we think a lot and perhaps even obsess a lot about sex.  And, of course, adolescence, which is when we’re going to give this, is a time that, probably, the obsession is even the greatest.  And their parents worry about that.  And HPV, of course, is largely a sexually transmitted disease and we’re giving a vaccine against this sexually transmitted disease.  So, the controversy seems to come up around, are we, in fact, in some sense, by giving the vaccine, giving the child a license to go out and have sex?


My adolescence may have been unusual.  But I must admit, for my friends, the girls that I hung out with, cervical cancer didn’t often come up.  I don’t think that a vaccine against cervical cancer is going to enter into anybody’s consideration about whether to have sex or not.


Dr. Linda Austin:  So you don’t think the kids are going to say, oh, phew, now it’s safe to have sex?  That’s pretty funny.


Dr. Paul Darden:  Well, I must admit, I wish adolescents thought into the future.  They seem to have trouble thinking even a week ahead.  Twenty or thirty years ahead?  I don’t even think they understand they might even be alive, much less cervical cancer.  I don’t think it enters into it.  In some ways I wish it did.  Thinking about the future would really benefit them a lot.


Dr. Linda Austin:  That’s very understandable.  Now, earlier, you and I were just chatting informally about a very interesting issue of who should get the HPV vaccine.  What are your thoughts about that?


Dr. Paul Darden:  The HPV vaccine is a wonderful vaccine.  It’s our first vaccine that’s against cancer.  It’s a wonderful thought.  We have a vaccine that prevents cancer.  When you think about that and when you think about how infectious diseases are transmitted, we have an example of a vaccine, the rubella vaccine from way back in the 60s and 70s.  Rubella vaccine is a vaccine that is really given to prevent congenital rubella syndrome.  This is a disease that affects newborn babies, and happens while their mothers are pregnant.  It causes deafness, mental retardation, a variety of problems.  England decided to give the rubella vaccine to adolescent women, and it made sense, you know, adolescence, when you start having babies, prevent the disease at that time.


The Unites States made a different decision.  They decided not to do just girls.  They did everyone and they did it earlier in life.  They did it in one to two year olds, and that’s when we give the MMR even today.  And there was a real dramatic difference in the results in the two countries.  England saw about one half the cases of rubella syndrome that they saw before, which is actually not a great result in some ways.  But, the United States saw almost an eradication.  They saw none of it.  It all went away.


Dr. Linda Austin:  How do you explain that?


Dr. Paul Darden:  Well, what you do when you only immunize a segment of the population, only girls, but you still leave the boys out there with the disease and circulating the disease among themselves, and then leaving the potential for infection for the girls who hadn’t received the vaccine, or the vaccine hadn’t worked, whatever, you still left a substantial risk there.  What works better, which happened in the United States, is, by immunizing everybody, the disease was just gone.  Nobody had rubella.  We protected not only the people who received the vaccine but all those who the vaccine may not have worked well or who could not get the vaccine for some reason.  So, you protect everybody, and that’s a real nice thing.


Dr. Linda Austin:  Would you suggest, then, that parents should have their sons vaccinated for HPV?


Dr. Paul Darden:  The first thing to realize is it’s not licensed for use in boys.


Dr. Linda Austin:  So, that’s not possible?


Dr. Paul Darden:  Well, you can do it, but I’m not sure I’d recommend it at this point.  But I think that that’s where we need to be heading with this vaccine.  We would love to eradicate cervical cancer.  And if we want to do that, the way to do it is to reduce or eliminate the HPV strains that cause cervical cancer.


Dr. Linda Austin:  What is the youngest that one could get HPV vaccine?


Dr. Paul Darden:  The youngest that it’s been studied in is nine-year-olds and, actually, it’s licensed down to nine years of age.  The people that recommend when to give vaccines, the American Academy of Pediatrics and the Centers for Disease Control and Prevention, are recommending that it be given at 11 years of age, at their well check then, and that’s when we’re routinely giving it.  It’s licensed for use in women from 9 years to 26 years of age.  It actually protects against four different types of human papillomavirus.  There are many types, maybe hundreds of types of HPV.  We’re protecting against the strains that cause about 70 percent of cervical cancer.


Dr. Linda Austin:  What are some other vaccines that are given in adolescence?

Dr. Paul Darden:  The one we’ve given forever, of course, is tetanus.  Tetanus has been given forever.  A long time ago, we added diphtheria to it, so most kids got diphtheria and tetanus, and very recently, we’ve added pertussis to it.  So, it’s TDAP, tetanus, diphtheria and acellular pertussis vaccine.  Pertussis vaccine protects against whooping cough.  And the reason we’re giving it now is severalfold.  One is that we’re seeing an increase in whooping cough in the United States.  The amount of diagnosed whooping cough has quadrupled over the last 10 years.  And we know that most of the cases of pertussis are occurring in adolescents and young adults.


Dr. Linda Austin:  I have a friend who had whooping cough.  How long does that vaccination last?


Dr. Paul Darden:  I’ve had whooping cough myself.  I treated a child that had it and managed to catch it.  And, by the way, I don’t recommend it as a holiday treat.  Boy, it’s not fun.  The vaccine probably lasts somewhere around four or five years.  It doesn’t last a lifetime.  At one point, we thought that it did, but it was a time that whooping cough was circulating freely in the population and, probably, people were just being boosted.


Dr. Linda Austin:  So then, what would you suggest as a schedule for getting DPT?  It sounds like, maybe, it needs to be repeated every so often.


Dr. Paul Darden:  Well, we don’t know.  It’s a very new vaccine.  It’s actually licensed for use in adolescents up through 64 years of age.  I have gotten it.  Even though we’re now giving it routinely to adolescents, most physicians, especially those who deal with children, should receive it now.  We’re, in fact, immunizing the whole Children’s Hospital, everybody who works there, against pertussis.  In some respects, I took it to protect myself, but we immunize medical professionals, really, to protect our patients.  We don’t want to transmit the diseases to them and, often, they’re the ones that would be most at risk for doing very badly with those diseases.


Dr. Linda Austin:  One final question:  Hepatitis vaccination, is that not an adolescent vaccination?


Dr. Paul Darden:  It is not anymore.  There are two types of hepatitis vaccine that we give routinely now.  We give hepatitis B vaccine, which is probably the one you were talking about, which is bloodborne, needle sticks, men who have sex with men.  We started with giving that in adolescence.  We now routinely give it more to newborns and, really, give it very infrequently to adolescents, only if they’ve never received the vaccine previously. 


Dr. Linda Austin:  I see.


Dr. Paul Darden:  About a year ago, we started giving hepatitis A.  That’s fecal-oral transmitted, so it’s when you have stool contaminating food.  We’ve started giving it routinely at one year of age.  It’s sort of an interesting phenomenon in that it’s a very common disease around the world, not as common in the United States.  But we see episodic outbreaks, often related to contaminated food, sometimes from Mexico, sometimes from other places.  And one happened in Chi Chi’s, in the northeast, and it was based on, we think, the salad bar ingredients that came from Mexico.


Dr. Linda Austin:  Dr. Darden, thank you so much for talking with us today.

Dr. Paul Darden:  Thank you, Linda.


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