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A Different Sex Story

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$4300 is today's magic number, but perhaps we should be talking about 25% instead. Today, a CDC study reports that 1 in 4 teenage girls has a sexually transmitted disease. From the AP article:

A virus that causes cervical cancer is by far the most common sexually transmitted infection in teen girls aged 14 to 19, while the highest overall prevalence is among black girls — nearly half the blacks studied had at least one STD. That rate compared with 20 percent among both whites and Mexican-American teens, the study from the federal Centers for Disease Control and Prevention found....Among girls who admitted ever having sex, the rate was 40 percent.

18% of girls in the study had HPV. Is there a role for school entry policies and school-based vaccination programs in increasing the HPV vaccination rate? The Guttmacher Institute has written:

A large body of evidence suggests that the most effective means to ensure rapid and widespread use of childhood or adolescent vaccines is through state laws or policies that require children to be vaccinated prior to enrollment in day care or school. These school-based immunization requirements, which exist in some form in all 50 states, are widely credited for the success of immunization programs in the United States. They have also played a key role in helping to close racial, ethnic and socioeconomic gaps in immunization rates, and have proven to be far more effective than guidelines recommending the vaccine for certain age-groups or high-risk populations.

School entry requirements might therefore provide an important opportunity to deliver public health interventions that, like the HPV vaccine, offer protections to individuals who have the potential to become disconnected from health care services later in life. Similar to the HPV vaccine's promise of cervical cancer prevention, these benefits may not be felt for many years, but nonetheless may be compelling from a societal standpoint. And bearing in mind that school dropout rates begin to climb as early as age 13, middle school might be appropriately viewed as the last public health gate that an entire age-group of individuals pass through together—regardless of race, ethnicity or socio-economic status.


Here is a CDC Q&A on the HPV vaccine. In my view, states should add the HPV vaccine to the menu of shots students should receive before entering school. And schools are promising sites to vaccinate older students (especially since students must receive 3 shots over the course of six months). What do you think?
4 Comments

The ends justifies the means here, but not in so many other areas you have written about? Why?

On the surface this issue is pretty clear cut. Gardasil (the HPV vaccine from Merk) protects girls from 4 of the main types of HPV, including HPV Types 16 and 18 which cause 70% of cervical cancer cases. However, as one delves into the specifics of HPV and Gardasil things become a little more complicated.

There are over a 60 different types of high and low risk HPV. With Gardasil targeting high risk HPV Types 16 and 18, will some low risk types of HPV become high risk if the vaccine is mandated?

And what about follow up care? Gardasil is marketed as the "only cervical cancer vaccine," but it is not a cervical cancer vaccine it is an HPV vaccine. If the vaccine does not protect against 30% of cervical cancer cases, will vaccinated girls continue to get the necessary follow up care (Pap test)?

How about boys? Eduwonkette astutely calls for "students" to be vaccinated, but some proposals are only calling for girls to be vaccinated. Yes, cervical cancer in girls is worse than genital warts in boys, but if we want to truly slow HPV we need to vaccinate boys and girls.

Lastly, based on cross sectional data (which has limitations) the pattern of prevalence for HPV is different among different countries. For countries like the US the prevalence appears to spike in the late teens/early 20's and then decline linearly with age. For Thailand, Vietnam, India, and Nigeria the line is flat, and in Chile, Columbia, and Mexico the prevalence takes on a "j" shape. We don't know why this is or what this means, but it hints that we are missing something.

None of these are reason enough not to pursue mandating HPV vaccinations, but we need to think carefully about all the aspects of this issue. For some interesting information on HPV check out the 2007 Bicknell Lecture at BU.

I'm happy to see you writing about health issues Eduwonkette! Sorry about the long winded post.

Arnie, I'm a little confused about your question - can you say more? I'm not sure the means here have potential unintended consequences in the same way that, for example, paying kids for scores might. Should we expect kids to engage in riskier behavior because they are vaccinated against one of many STDs? I doubt it.

Sanzio - thanks for the lecture link and for pointing out some of the questions that still need to be answered.

All the ways that you usually suggest that student be encouraged to learn autonomy in conjunction with strong parental inclusion are in this abandoned for a "higher good". That arises out of false assumptions: that in this singular case parents are uninformed, vaccines themselves have no unintended consequences, this is such a clear case that we MUST intervene.

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