2015-02-20

HPV Immunization Update- 2015

HPV Immunization Update- 2015

HPV is an abbreviation for a particular species of virus called Human Papilloma Virus.   A papilloma is a small lump, the most common papillomas we have are warts.  So the HPV is the virus that causes all warts in people.

Warts
Warts are a usually harmless lump that is the product of a relatively quiet viral infection.  So a wart has a virus and on top of the viral infection, a lump.  For common warts on hands and feet, the wart infection is so quiet that no redness, or warmth occurs.  All the virus does is make that spot make more skin.  The extra skin piles up and the lump is the wart.  The virus does not go into the body, and the body tends to leave it alone, that's why warts sit there so long.

HPV Subtypes
There are many, many dozen subtypes of HPV, and the subtypes determine if the wart will be on your hands or feet, or genital area.  And of the ones that infect the genital area, the subtype will determine if the wart infection will cause cancer or not.

The vast majority of HPV subtypes do not cause genital warts and do not cause cancer.  But some do both.

The only subtypes the HPV immunization protect against, are the subtypes that cause genital infection and cancer.  Originally the HPV immunization protected against 2 subtypes, then 4.  The 4-subtype version was the standard until this year when a 9-subtype version came out.   

How Common is HPV genital infection?
Very.
Studies have found about 70-75% of all adult Americans, male and female, are infected with at least one HPV subtype.
It is the most common STD, by a very, very wide margin.

Preventing Cancer
The 4-subtype version, which is what everyone who has gotten an HPV immunization series prior to 2015 has had, protected against 70% of all cervical cancers.  It also protected boys and girls from genital warts, and protected males against throat cancer (which has gone up 30% in the US in the last 5 years).

Now comes the 9-subtype version, and it protects against over 95% of all cervical cancers.

When is Best to get HPV immunization?
The HPV immunization only works before one can get an HPV infection.   So it works best if you are immunized before you begin sexual activity.

It can be given in later elementary school, but we think it best to get it in later middle school or early high school, a bit closer to the onset of sexual activity, to increase the protective levels of antibodies closer to the time in your life when you need them.

What is the Timing of an HPV immunization series?
Currently the HPV is a 3 shot series.   You get your first shot, and the second then has to be at least 2 months later, but can be much later than that, just not sooner than 2 months.  The third dose has to be at least 4 months after the second.   Many families have their child get dose 1 at a check-up, come back 2 or months later for the second dose, and then get the third at the next annual check-up.

There is a new look being taken at a 2 dose HPV immunization schedule, where the two doses are at least 6 months apart, but studies that will measure if that works are still pending.

Cost of the HPV immunization
When HPV immunization was first started, many insurers did not cover it, and then when they did, they only covered girls.

For the 4-subtype HPV immunization that has all changed.  Most insurers cover this as they would any other immunization.

The 9-subtype HPV immunization costs about 15% more than the current 4-subtype one.  It is included as an immunization that any ObamaCare compliant plan has to cover, and is covered by Medicaid.  Any new insurance plan has to be ObamaCare compliant, but if you have a plan that you have used for many years, it might be grandfathered, exempt from being ObamaCare compliant, and not cover the new 9-valent HPV immunization.

What to Do
We see the 9-valent HPV immunization as an improvement on the old 4-valent HPV, boosting protection against cervical cancer to very high levels.

But it may be more costly if not covered.

We will have both the 4-subtype and the newer 9-subtype available.  If you want the newer 9-subtype version, we recommend you talk to your health insurance company first to see what your cost will be.

What if You have been Immunized with the 4-subtype version already?
This question is currently under review, clear recommendations are not yet available.
I suspect that if you are already sexually active and have been exposed to HPV (remember about 75% of Americans have HPV genital infection and almost all have no symptoms at all), that getting the new HPV immunization won't help.
If you have not yet begun sexual activity, it might help, but we await further information to see.

BOTTOM LINES
1.  HPV is the virus that causes all warts.  There are lots and lots of subtypes.
2.  Some subtypes only cause warts in the genital area and about 9 of these cause over 90% of all cervical cancers in women, and a rising number of throat cancers in men.  All 9 cause genital warts in males and females.
3.  HPV is a very, very common genital infection, about 70-75% of all adult Americans have HPV genital infection.
4.  The HPV immunization can prevent over 90% of all cervical cancers in women, a vast number of genital warts in all adults, and throat cancers in men.
5.  A new 9-subtype HPV immunization is now available, and increases protection against cancer.  It may or may not be covered by your insurer.  
6.  We will continue to carry the older 4-subtype HPV until insurance coverage of the 9-subtype version is widespread.
7.   We recommend immunizing your children against HPV genital infection before onset of sexual activity, and getting it in later middle school or early high school is good timing for this goal for most children.


To your health,
Dr. Arthur Lavin






*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

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