Walter Reed offers 'breakthrough' vaccine for women
September 8, 2006
WASHINGTON (Army News Service, Sept. 7, 2006) - Women patients at Walter Reed Army Medical Center can now get vaccinated against certain subtypes of the virus that can lead to cervical cancer - a deadly cancer in women.
Walter Reed is one of the first military hospitals to begin using a Food and Drug Administration-approved "breakthrough" vaccine that can be administered to women ages 11-26 to protect them against human papilloma virus type 6, 11, 16 and 18.
Type 16 and 18 account for approximately 70 percent of all cancers of the cervix, and type 6 and 11 account for about 90 percent of all HPV related vulvar condyloma, also known as genital warts.
"It's a significant breakthrough in medicine with respect to vaccinating one against the human papilloma virus," said Lt. Col. G. Scott Rose, chief of gynecologic oncology at Walter Reed.
"While Walter Reed did not invent this vaccine, there's no doubt that we're on the forefront of technology and administration of medical care to our beneficiaries," Rose said. "Offering the vaccine is only an example of that commitment to our patients. This is an important vaccine. It will become a nationwide, if not worldwide, vaccination effort someday - it has the potential for that. And certainly, Walter Reed would like to be at the forefront of that effort."
Studies suggest that 3 out of 4 people will get an HPV infection during their lifetime, according to the American College of Obstetrics and Gynecologists. Women who have had three sexual partners in one year's time are likely to currently have or have had at one time during that year an HPV infection.
"HPV is a very common sexually transmitted disease, much more common than syphilis, gonorrhea and chlamydia," Rose said.
The HPV vaccine is only effective for patients who don't have an active ongoing HPV infection in one of the effected strains, Rose said. "However it's not likely that if you're infected with one, you're infected with all four, so it's still effective against three of the four even if you have one of the strains.
"Although there are over 100 subtypes of HPV that have been identified to date, the ones most commonly associated with cervical cancer and genital warts are covered by this vaccine. So, it's an important vaccine," he added.
"It's basically 100 percent effective vaccine against a disease naive patient - a patient who doesn't have type 6, 11, 16 or 18 - it's 100 percent effective against preventing that infection," Rose said.
"The real question is: 'Is it cost effective'' In other words, if you know it's not effective in a patient who has already been exposed or currently has an active infection, is it cost effective to give it to everybody' We are currently doing a cost analysis study in the Army to answer this question," he said.
"I think it will be, but what you have to take into consideration is the percentage of patients who are active duty, who have an active infection," Rose added.
Also, HPV infection is not necessarily an indication that an infected woman will get cervical cancer. "Once you get the virus, it's very common that it will regress on its own within 6 to 12 months." Rose explained. "If it does go away you can then get vaccinated against it. But even if you have HPV and you get vaccinated, you're still protected against the other three of the four strains. Unfortunately, there is no cost effective way to identify if a patient is infected with a specific strain. Current, HPV testing can only identify if a patient is infected with any one of a panel of the HPV."
It's the HPV infections that don't go away, those which are persistent, that cause doctors to be particularly concerned. "Persistence can lead to what is called cervical dysplasia, or abnormal cells on the cervix which can lead to pre-invasive cervical cancer and invasive cervical cancer," Rose said.
Regular gynecological exams are important for early detection and potential treatment of cervical cancer. Women who have regular Pap tests are least likely to get cervical cancer, according to the American Cancer Society.
Rose said it is very common for parents with teenage daughters to become defensive when the vaccination option is offered for teenage girls. They insist their daughters aren't having sex. But the denial is pointless, because the vaccine can protect them whether they are sexually active now or in the years to follow.
"The bottom line is, we really don't know if our children are having intercourse or not," Rose said. "Eighty-five percent of all college-aged students and high school seniors have been or are currently sexually active. That's an astounding number."
"Vaccination is an important method to help prevent cervical cancer and genital warts," Rose said. "The cost of not being vaccinated and late detection can be costly."
"Cervical cancer can result in loss of fertility, because it requires either the removal of the uterus or treatment with chemo radiation," he said. "And genital warts are a physically and socially debilitating disease in the sense that when somebody gets tagged with the moniker of having warts, not only are they visible, but it's psychologically impairing to the patient.
"If you have a vaccine that can prevent 90 percent of all vulvar warts - that's a significant vaccine," Rose said.
Vaccinating against HPV type 6, 11, 16 and 18 is a three step process given over a six-month period.
The actual human papilloma virus is not used for vaccination. It uses viral-like particles that mimic HPV, making it easier for the immune system to react and eliminate the virus if it enters the body.
Women and parents of girls should discuss HPV and vaccination options with their gynecologists. At Walter Reed, vaccinations are given to women ages 11-26 in the medical center's Allergy and Immunology Clinic. Pediatric patients get the vaccination in the Pediatric Clinic.