Getting the adult HPV vaccine – Dorit Rubinstein Reiss’ story

adult-hpv-vaccine

On 5 October 2018, the FDA expanded the licensing Gardasil 9 – currently the only HPV vaccine marketed in the United States – to men and women up to the age of 45. If up till now getting the adult HPV vaccine was not a realistic option for me, now it was. But at this point, the vaccine is not yet recommended for my age group – the Advisory Committee on Immunization Practices has not made any additional recommendations after licensing. Which raised the question: should I get it?

On one hand, I am in a committed monogamous relationship. I am a married mother of two young children, I have no plans of changing partners, and I’ve already probably been exposed to anything my husband had. I have never had an abnormal pap smear. That means that I am likely pretty low risk for getting a new HPV infection and that I have cleared any I ever had (almost all sexually active people in the United States have had HPV). If you are in a relationship, including marriage, and if you had children, you likely had sex at some point.

So the benefits of the adult HPV vaccine for me are low – but not non-existent. You never know what will happen, and while I hope to stay with my partner forever, bad things can happen – like death or sexual assault. One hopes for the best, but it’s reasonable to also plan for the worst (for example, while we do not plan to die, we have a will written out with provisions for caring for our kids if we do) – and the vaccine is age-limited. There are nine cancer-causing HPV strains in the vaccine, and I am fairly certain that I have not been exposed to all of them. 

The risks of the adult HPV vaccine are extremely minor. I’m likely to get a sore arm, may get other mild reaction like fever, and have a theoretical reaction of an allergic reaction (or fainting, though not being a teen, I think that’s unlikely). Studies pretty much rule out other risks.

In spite of anti-vaccine claims, getting the vaccine after being exposed to HPV does not increase your risk of cancer (but the vaccine won’t protect you against strains you were already exposed to).

So the adult HPV vaccine has low benefits but minuscule risks, at least for me. Still, it seemed to me to make sense to go for it, if possible. Especially because I speak up about HPV vaccines and encourage others to go for them, I thought it’s fair to get them myself, too. Show I mean it when I say that they are safe. 

To be sure, I emailed Dr. Paul Offit, who I trust completely on vaccines. He recommended going for it. 

I did not know, however, if my provider will give me the vaccine or if my healthcare insurance will cover it at my age (most health insurance in the USA does cover all vaccines, including the HPV vaccine, for children). In spite of what anti-vaccine people believe, I do not have secret ties to pharma or special access to vaccines. 

So I emailed my doctor:

Dear Dr. X,

Since the FDA approved HPV vaccines for people up to 45, I would like to get the vaccine, if possible.

I emailed Dr. Paul Offit, a vaccine expert,  for his opinion, and he recommended getting it.

Can you help me do that?

Best,
Dorit.

My doctor said: “Sure, let me see what our protocol is here and get back to you.”

After I did not hear back for over a week, I emailed again. My doctor answered:

Sorry that I could not repond in a timely manner.
I had forwarded your request to Dr. Y [details omitted to preserve my providers’ – and my own – privacy] but did not hear from them. I have ordered the shots. You can call your … health plan to see if it will be covered just to be sure.

You can go to ### injection clinic Mon-Fri 9am-12pm, 1:30-4:30 pm for the shot (ordered already).

Okay. All that was left was to actually get the vaccine. I wanted a picture – so I asked my eight-year-old son if he will act as photographer and come with me. He agreed. We went together, waited, and went in. I told him to take a lot of pictures all through, and he did. 

Dorit adult HPV vaccine

The nurse asked if I was feeling okay, if I ever had a reaction to a vaccine, if I was allergic to latex or anything else I knew of (yes, no, no). She explained what the shot was, and gave me the Vaccine Information Statement. We also wrote out the schedule for the next two doses. Then she cleaned the area, told me to take a deep breath and let it out, and done. I barely felt the needle. 

She told me my arm will hurt for a day or two. It didn’t, actually. Not complaining. I’m okay with less pain. But I would have been okay (not happy, but okay) with a sore arm for a few days, too. 

My son did a great job taking a lot of pictures. I posted several of those pictures on Facebook and Twitter, because, again, I think it’s important to make it clear I stand behind what I say on HPV vaccines specifically, and vaccines generally. 

So that’s my adult HPV vaccine story. One dose down, two to go. Maybe my arm will hurt next time. 

Plus ça change – anti-vaccine activists revive the Hannah Poling case

Hannah Poling

Following a pattern we have seen repeatedly, anti-vaccine activists have tried to claim a conspiracy to hide a link between vaccines and autism. The latest effort, reviving the Hannah Poling case, follows the pattern we have seen in previous cases – anti-vaccine activists claim that the government knew of evidence that vaccines cause autism (in this case, through mitochondrial disorders), that the government committed fraud to hide that information, and that the combination of fraud and evidence should be a game changer.

As with those past events, the claims cannot withstand scrutiny. In this case, another claim was added – a denial of due process for claimants in the Omnibus Autism Proceedings generally and in one family’s case specifically. This claim, too, does not hold. 

In contrast to the claims in the latest set of anti-vaccine articles, there was no fraud by the government, the behavior they complain about did not decide the fate of the Omnibus Autism Proceedings, they provide no new evidence that vaccines cause autism, the mitochondrial claim is neither new nor strong, and there was no denial of due process to the claimants in the Omnibus Autism Proceeding or in the specific case in question. Continue reading “Plus ça change – anti-vaccine activists revive the Hannah Poling case”

Nick Catone son dies tragically – blaming vaccines with no evidence

Nick Catone

On May 12, 2017, the son of retired UFC fighter Nick Catone, Nicholas Catone, by all accounts a healthy, sweet, happy, child, died in his sleep. It’s horrible to lose a child, and I want to start by extending my condolences to the family.

Sadly, I can’t stop there. His parents blame vaccines. The story is being spread in mom groups and understandably scares moms from vaccinating. But Nicholas’ tragic death is not a good reason to refuse vaccines. First, the alleged link to vaccines is extraordinarily weak. There is no good reason to blame vaccines for the boy’s tragic death. Second, even if this was linked to vaccines – and there’s no evidence of that – it’s still safer to vaccinate.  Continue reading “Nick Catone son dies tragically – blaming vaccines with no evidence”

Italian vaccine mandate – implementation delayed – another UPDATE

Italian vaccine mandate

On Monday, the Italian Senate passed a large bill that, among other things, delayed the implementation of the Italian vaccine mandate passed in 2017 until the 2019-2020 school year. This short post explains what this means – and does not mean.

In response to a large measles outbreak in Italy that killed about 1:1000 (around 8 in the past year) and hospitalized thousands, the Italian government then in power passed a law that mandates that children 0-6 be vaccinated with ten vaccines (before that, four were required) before attending daycare or school. It also imposed fines on parents of children 0-16 who were not vaccinated with these vaccines.

In the 2018 election, two anti-establishment parties joined the coalition government. One, the 5 Star Movement, includes people who are openly anti-vaccine. It’s not clear to what extent their anti-vaccine views affected their election results, but among other things, the party promised to roll back the Italian vaccine mandate.

As a first step, the new health minister allowed parents to self-certify vaccines for the 2018-2019 school year – to declare whether or not their children were vaccinated (in a sense, rewarding dishonest anti-vaccine parents over honest ones). 

The new Italian Senate law included many things, but the most important issue is that they delayed the implementation of the mandate for the school year 2019-2020. Importantly, the law will not become effective until it passes Italy’s lower house, which is on recess until September 11, 2018, so it will not apply in the school year 2018-2019.

During the current year, the mandate still applies, as does the self-certification decree, probably. But if it becomes law, it will mean that the law is not applicable the following year, giving the new government a chance to try and overturn the mandate completely. 

Naturally, medical societies – as well as politicians from other parties – are concerned about the repeal of the Italian vaccine mandate.

The measles outbreak, which was the impetus for the original law, is still going strong. In fact, the CDC has issued a level 1 travel warning for Italy because of this ongoing outbreak.

Several people in Italy have died recently from the measles, and many were hospitalized. Almost all the cases are in the unvaccinated, including those too young to be vaccinated. This is not a great time to roll back the Italian vaccine mandate intended to protect children and contain the outbreak. 

Update – 6 September 2018

Italy today reaffirmed that the vaccine mandate applies in 2018-2019 and children 0-6 need to be vaccinated. It also removed the option of self-certification, requiring that parents provide a doctor certificate showing children are vaccinated.

However, the government still announced its intent to revisit the mandate in future.

Update – 9 September 2018

The Italian Parliament relaxed its change of direction – self-certification will be allowed during the current school year. The mandate, however, is still in force, at least until March 2019.

Israel vaccine law proposal – seeking balance to improve vaccination rates

With the support of a local pro-vaccine non-profit made of parents and professional volunteers, two parliament members are proposing an Israel vaccine law to improve immunization rates. This and other proposals are a response to a measles outbreak made up mostly of unvaccinated individuals. The proposal explicitly seeks to improve disease prevention while minimizing the effect on autonomy. It does so with a mix of measures that mirror laws existing in other countries and new ideas. 

While the proposal is likely to face criticism from both immunization opponents and those seeking stronger measures, the proposed Israel vaccine law has potential to improve immunization rates in Israel and may be a better fit for Israel’s situation than alternatives. It is clear that a lot of thought went into it. Continue reading “Israel vaccine law proposal – seeking balance to improve vaccination rates”

Debunking myths about vaccine testing and safety

vaccine testing

The goal of this article is to respond to a number of recurring myths raised by anti-vaccine activists regarding vaccine testing and safety – a common trope used against vaccines.

The bottom line is that vaccines are extensively and carefully tested for safety, and that vaccine safety is shown by many, many studies from a variety of sources, reinforcing each other and all pointing to the same result – serious problems from vaccines are possible, but extremely rare. And those small, rare risks are far outweighed by the benefits vaccines provide by protecting us against much larger risks.

Continue reading “Debunking myths about vaccine testing and safety”

Samoa vaccine story – tragedy abused by anti-vaccine websites

Samoa vaccine story

On Friday, July 6, a tragedy occurred in Samoa, a small country located in the Pacific Islands. Two children brought in for routine MMR vaccination died within minutes of receiving the vaccine (one report said hours and the first expert quoted below was responding to that, but the rest consistently said minutes – another question for investigation). The government reacted to the Samoa vaccine story immediately, opening an inquest into what may have killed the children. 

These are the known facts about the Samoa vaccine story. First, my deepest condolences to the families – it is beyond tragic. This tragedy should be investigated, and when the facts are known, they should be shared, steps should be taken to prevent recurrence, and consequences imposed where appropriate (the fact that a second vaccine was administered after the first death is especially troubling).

Unsurprisingly, this has been picked up by anti-vaccine pages and activists as evidence that vaccines kill and that there is a conspiracy of silence to hide that. Both of those storylines are wrong. I want to take a look the facts behind this Samoa vaccine story. Continue reading “Samoa vaccine story – tragedy abused by anti-vaccine websites”

Flu vaccine mandate for day care reinstated by New York court

flu vaccine mandate

On Thursday, June 28, 2018, New York State’s highest court, the Court of Appeals, unanimously reinstated New York City’s flu vaccine mandate for certain daycares, which was previously struck down by two lower courts on different grounds. The decision, Garcia v. New York City Department of Health and Mental Hygiene, is mostly about a specific legal issue – the line between when agencies act independently, and when they need legislative direction and direct authority to act.

At its core, it is a question about the limits of bureaucratic power. However, the decision also makes it clear that the New York City Board of Health has extensive power to establish a flu vaccine mandate (and for other vaccines) and to act to prevent infectious diseases. In that sense, it’s good news, upholding the ability of the Board to protect public health.  Continue reading “Flu vaccine mandate for day care reinstated by New York court”

Dr Bob Sears medical license on probation resulting from his anti-vaccine views

Dr Bob Sears

On 27 June 2018, Dr Robert (Bob) Sears, an anti-vaccine pediatrician, agreed to a stipulation with the California Medical Board that put his license to practice on probation and subjected him to a set of non-trivial conditions. The revocation of the medical license of Dr Bob Sears was stayed by the Medical Board – it will not become operative unless he violates the conditions – but given the specific allegations in the complaint and the fact that this was his first disciplinary action, an immediate full revocation was not likely. The sanction is non-trivial, and a clear warning against future misconduct.  Continue reading “Dr Bob Sears medical license on probation resulting from his anti-vaccine views”