Vaccines: Adolescent Vaccines
Transcript:
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.
If you have any questions about the services
or programs offered at the Medical University of South
Carolina or if you would like to schedule an
appointment with one of our physicians, please call MUSC Health
Connection: (843) 792-1414.