You and your daughter may hear a new question at her next sports or camp physical exam at the doctor's office. For Woodinville pediatrician Neil Kaneshiro, M.D., the question is just part of the routine. For months, parents in his practice have been deciding whether to get their daughters vaccinated against a common sexually transmitted disease.
The new vaccine
The U.S. Centers for Disease Control (CDC) now recommends a new vaccine, Gardasil, for girls ages 11 and 12 years old, as part of a set of vaccinations for that age group that includes a tetanus-pertussis booster. The CDC also recommended Gardasil as a catch-up vaccination for older girls and women up to age 26.
Gardasil protects against four different strains of the human papilloma virus, or HPV. This family of viruses is very common in adults, is transmitted sexually and is responsible for genital warts and, in some cases, cervical cancer. The vaccine is given in three separate doses, over a period of about six months.
Most health-care insurers cover it as a recommended routine vaccine for children, but some don't cover it once a girl is 18 or older. Without insurance, the vaccine can cost between $360 and $500 for all three doses. But the state of Washington is expected to offer it at a big discount for all females younger than 19 by summer.
A new decision
For some parents, the question of getting their child protection against a sexually transmitted disease may not be routine at all. Kaneshiro and his practice of 11 other doctors began dispensing the vaccine this year and said the majority of their families wanted it, and only a few hesitated.
"Some people say, 'My daughter won't be sexually active until she is 20,'" Kaneshiro says. "I can't really recommend that attitude." Parents cannot be sure when their child's sexual exposure will begin, he adds.
Kaneshiro is chair of the vaccine committee for the Washington chapter of the American Academy of Pediatrics. From his perspective, the vaccine should be given far in advance of any sexual activity. It is not effective if given to a person already exposed to these four viruses.
A cautious approach
Seattle mother Cheryl Murfin Bond does not see the newest vaccine as routine. She has an 11-year-old daughter, and she feels comfortable waiting and weighing the benefits for a few more years.
"The medical culture promotes [the vaccine] in a simplistic way," she says. Bond believes the vaccine is useful, but thinks every family should consider vaccinations carefully, weighing risks and benefits for their particular children.
By contrast, South Seattle mother "Chris" (who asked that her real name not be used) calls getting the vaccine for her 13-year-old a "no-brainer." She remembers becoming sexually active at 15 and believes anything she can do to protect her own daughter from the viruses and potential cancer is a great deal.
Tacoma pediatrician John Hautala, M.D., sees many teens in his practice and gives every one of them a packet with information about the new vaccine. Some parents may be more cautious or feel uncomfortable talking to their daughter about sexually transmitted diseases. But he believes the conversation itself is healthy, even if the parents decide not to have their daughter vaccinated.
There are no serious side effects reported for the Gardasil vaccine. A competitor, Cervarix, may be approved for use by later this year.
A controversial vaccine
The release of Gardasil has caused controversy, some of which may come from the high-profile advertising campaign by its manufacturer, Merck. Athletic girls in television spots invite the viewer to be "one less" girl infected with the viruses. Across the United States, some state legislatures moved to make the vaccination mandatory for school admission, but that wasn't proposed in Washington state.
State legislators did sponsor a bill to require schools to give out information about both the HPV vaccine and the meningococcal vaccine to all sixth-graders. At press time, that bill appeared headed for approval.
Rep. Jeanne Darneille, D-Tacoma, is the main sponsor of the bill, which is supported by nearly all of the women in the state House of Representatives.
"Washington is not ready for a blanket mandate," said Darneille. "But women in the Legislature are ready to demand that we educate as many parents as possible about the importance and availability of the vaccine. If I had a daughter, I'd make sure she was vaccinated."
Sally James is a Seattle writer specializing in medicine and science, and the mother of three.