Newbie - FAQ

Re: Here's why:
Todd82 8 Reviews 1513 reads
posted
1 / 11

I'm over 30. HPV vaccine can be found in Costco. But I'm not sure if I should get it. All websites I checked said "recommended for people age through 26"  Like this one

http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.html

any thought on this?

JeffEng16 22 Reviews 494 reads
posted
2 / 11

You raised a good question that I've heard asked by a lot of people for years.

If you read further down in the article or the the other medical literature on the bivalent and quadrivalent vaccines

The reason is because in many trials conducted during the N.D.A.s (New Drug Application process progressing from a small number of hospital beds in an experimental setting to large numbered trials towards the end conducted by physicians in their offices who agree to follow certain requirements and standards for testing and to do the paper work to report a number of results of administering the new drug "candidate") to get approval for the bivalent and quadrivalent vaccines in men and women, the vaccine ******was not effective in preventing HPV over age 26*****. It was safe, but not an effective vaccine over that age.

Why efficacy falls off at that age is not known.

But there is another very important important point that pushes the recommendation for administering down to the ages of pre-teens besides that maximal efficacy happens at an earlier age in scores of trials.  The target age for giving the vaccine is around 9-12 years of age because after the onset of sexual activity (and whatever it is for most individuals it's getting younger all the time), the individual may have already been infected with HPV.

From the  American College of Obstetrics and Gynecology's statement or "ACOG"

"In Sweden, data that linked multiple population registers showed that vaccine effectiveness in preventing genital warts was 93% among girls vaccinated between ages 10 years and 13 years compared with 48% and 21% if vaccinated at ages 20–22 years and 23–26 years, respectively (15). Data from the United States show that 1 month after the completion of HPV vaccination, girls aged 10–14 years generally have higher antibody levels than young women aged 15–26 years and retain these higher levels for several years (16, 17). All of these findings underscore the importance of vaccination during the target age or before the onset of sexual activity."

The CDC does a lousy job by inserting one sentence alluding to that in their whole article. Maybe that's why the're advertising for writers for their website who can explain their concepts right now

JeffEng16 22 Reviews 338 reads
posted
3 / 11
JeffEng16 22 Reviews 342 reads
posted
4 / 11

The reason for preventing HPV goes way above and beyond the HPV lesions themselves Robin as I hope you know--we are trying to prevent cervical cancer.  So any physician who told you that if you don't get the vaccine before you're sexually active, it's a waste of time needs to go back to school.

I know you can understand this Robbin--I read your blogs.  And since there are 120 sub-types of HPV your "simple" approach would miss preventing some of the cervical cancers that could be prevented.

I hope I'm making this clear to you.  We want to prevent as much certical cancer in as many women as we can.  So while for sure we would rather vaccinate them at ages 9-12 there is still a very compelling reason to try to get everyone vaccinated even after they become sexually active.

In medicine, keeping it simple (as you phrase it) could still cause women to get cervical cancer who should not have.  

The reason HPV vaccine is still given after people is sexually active, Robbin is that some of the subtypes of HPV that cause cervical cancer (first developing in the endocervix which is why Pap Smears are done with some type of brush scraping cells from the endocervix where cervical cancer first develops) is that some of the subtypes of HPV don't appear in earlier age patients so ACOG and CDC and every infectious disease article in the medical literature on the vaccine and on HPV shows that there is still value in giving the vaccine after somoene becomes sexually active because there are still HPV types that cause cervical cancer

1) Both in the female who gets these types ***after she is sexually active***
2) And in the male who can give these types to the female during sex ***after or when he or she*** becomes sexually active

From the ACOG statement on HPV that you can read or not read for yourself:

"Obstetrician–gynecologists should advise patients and parents that HPV vaccines are most effective in preventing genital cancers when administered before the onset of sexual activity. ***However, sexually active individuals can receive some benefit from the vaccination because exposure to all HPV types prevented by the vaccines is unlikely in persons aged 13 years through 26 years***"

Human papillomavirus (HPV) is a group of more than 120 different viruses. Infection with HPV is associated with the development of anogenital cancers (including cervical, vaginal, vulvar, and anal), oropharyngeal cancer, and genital warts. Approximately 40 HPV genotypes are primarily sexually transmitted from person to person (eg, genital–genital contact, oral–genital contact, and sexual intercourse) and infect the oral, anal, or genital areas of men and women. However, only 13 genotypes have been shown to cause cervical cancer (1). Approximately 70% of all cases of cervical cancer are caused by HPV genotypes 16 and 18, and 90% of cases of genital warts are caused by HPV genotypes 6 and 11 (2).

Each year in the United States, cervical cancer is diagnosed in more than 12,000 women, and nearly 4,000 die from the disease (3). In addition, there are more than 1 million cases of abnormal cytology screening results that require evaluation (4, 5). Although the implementation of cervical cytology screening programs and treatment of precancerous lesions has led to a decrease in deaths from cervical cancer in the United States, such deaths still occur. Approximately one half of all cases of cervical cancer are found in women who have never had a Pap test, and another 10% occur in patients who have not had one within the past 5 years (6). Both ongoing cervical cytology screening and HPV vaccination are needed to help reduce these deaths."

https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Adolescent_Health_Care/Human_Papillomavirus_Vaccination

Cervical cancer can come from several sub-types of HPV virus, all of which are not acquired until after the male or female (covered both sexes there didn't I?) are sexually active.  To further prevent these cervical cancers as the ACOG statement makes clear and simple above, we do vaccinate people after they become sexually active--at least those of us who know what we're doing.


-- Modified on 3/16/2014 9:58:44 AM

JeffEng16 22 Reviews 327 reads
posted
5 / 11

Solvadi is a pill to treat; not a vaccine and it can be given for 12 to 20 weeks depending on the difficulty of treating Hepatitis C case by case.

Chronic HCV infection often follows a progressive course over many years and can ultimately result in cirrhosis, hepatocellular carcinoma, and the need for liver transplantation.

Pts. with HCV are often very fatigued, and peginterferon and ribavirin hasn't been near as effective as uber-expensive Solvadi which was approved for Tx of HCV in 2013. Solvadi has excellent efficacy in a significant percentage of Hep C pts. with an 80-90% efficacy in pts. with early liver fibrosis.

 Ondansetron, a med often used for nausea treatment in pts. receiving chemo or nausea tx in pts. with GI disorders where nausea is prominent, can be significantly effective in treating the fatigue in some patients.

There's a big controversy over the cost of  this treatment in infectious disease and other medical circles.  It's a very valuable new weapon against many stages of Hepatitis C. Insurance companies are paying for it, but Medicare (which is extended to HIV patients and a substantive number of them have Hepatitis C) as do other disable pts on Medicare under 65.
Gilead wants Medicare to pay full price and many physicians are furious.

It's the subject of an editorial in today's NY Times and you can read about it here:

FDA Approves New Pill to Treat Hepatitis C (December 2013)
http://www.nytimes.com/2013/12/07/business/fda-approves-pill-to-treat-hepatitis-c.html?_r=0

How much should Treatment for Hepatitis Cost March 16, 2014
http://www.nytimes.com/2014/03/16/opinion/sunday/how-much-should-hepatitis-c-treatment-cost.html

JeffEng16 22 Reviews 314 reads
posted
6 / 11

There are more than two billion individuals with serological evidence of hepatitis B infection worldwide. Of these, 400 million are chronic carriers and 500,000 to 1.2 million will die annually from cirrhosis and hepatocellular carcinoma.

Despite advances in antiviral therapy, only a minority of patients with chronic hepatitis B will have a sustained response. Thus, primary prevention by vaccination to increase herd immunity remains the main thrust in the control of hepatitis B virus (HBV) infection.  

Currently available hepatitis B vaccines are extremely safe and have an efficacy of >90 percent and are effective against all HBV serotypes and genotypes. ***Thus, HBV infection can potentially be eradicated through global vaccination.***

 Humans are the only known reservoir for hepatitis A virus (HAV). Thus, the virus could theoretically be eradicated if widespread immunization strategies were successfully employed.  

HAV vaccination was incorporated into the routine childhood vaccination schedule in the United States 2006.

The ACIP recommended the immunization of all patients with chronic liver disease against HAV.

AngieNoir See my TER Reviews 368 reads
posted
7 / 11

I agree ;)  BTW I think that company should be ashamed of itself asking for charging $1000 per Pill. Would not surprise me that 3rd world countries "steal" it like they did with HIV meds.

Posted By: RobbinYoung
Thank God, I don't have Hepatitis or any STD's & STI's, but it's great you post the information for the TER community to read.

hbyist+truth=;( 379 reads
posted
8 / 11

I would look into this drug from Europe and Canada. I get drugs prescribed here but will get them at a big chunk of change lower from Canada and Europe. Fax over the script and you're good to go. I hope this drug is available as the price is shameful.

Todd82 8 Reviews 396 reads
posted
9 / 11

Thank you! I already got vaccinated for Hepatitis. I'm just concerned by the transmitting diseases that people will link to sex immediately.  

Posted By: RobbinYoung
I hope your question was answered, in the various posts by TER members, so you may make a choice that's best for yourself.  
   
 Also, as I stated previously, please consider getting the Hepatitis A & B vaccine.  
   
Posted By: Todd82
I'm over 30. HPV vaccine can be found in Costco. But I'm not sure if I should get it. All websites I checked said "recommended for people age through 26"  Like this one  
     
  http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-gardasil.html  
     
  any thought on this?

Todd82 8 Reviews 282 reads
posted
10 / 11

Hi Jeff, Thanks for your reply!  If I go to Costco to get HPV vaccine, I bet the people there will immediately know I going to develop a hobby.  

Posted By: JeffEng16
You raised a good question that I've heard asked by a lot of people for years.  
   
 If you read further down in the article or the the other medical literature on the bivalent and quadrivalent vaccines  
   
 The reason is because in many trials conducted during the N.D.A.s (New Drug Application process progressing from a small number of hospital beds in an experimental setting to large numbered trials towards the end conducted by physicians in their offices who agree to follow certain requirements and standards for testing and to do the paper work to report a number of results of administering the new drug "candidate") to get approval for the bivalent and quadrivalent vaccines in men and women, the vaccine ******was not effective in preventing HPV over age 26*****. It was safe, but not an effective vaccine over that age.  
   
 Why efficacy falls off at that age is not known.  
   
 But there is another very important important point that pushes the recommendation for administering down to the ages of pre-teens besides that maximal efficacy happens at an earlier age in scores of trials.  The target age for giving the vaccine is around 9-12 years of age because after the onset of sexual activity (and whatever it is for most individuals it's getting younger all the time), the individual may have already been infected with HPV.  
   
 From the  American College of Obstetrics and Gynecology's statement or "ACOG"  
   
 "In Sweden, data that linked multiple population registers showed that vaccine effectiveness in preventing genital warts was 93% among girls vaccinated between ages 10 years and 13 years compared with 48% and 21% if vaccinated at ages 20–22 years and 23–26 years, respectively (15). Data from the United States show that 1 month after the completion of HPV vaccination, girls aged 10–14 years generally have higher antibody levels than young women aged 15–26 years and retain these higher levels for several years (16, 17). All of these findings underscore the importance of vaccination during the target age or before the onset of sexual activity."  
   
 The CDC does a lousy job by inserting one sentence alluding to that in their whole article. Maybe that's why the're advertising for writers for their website who can explain their concepts right now.  
   
 

Roxie_Jabulani 392 reads
posted
11 / 11

It's because chances are you've already been exposed to the types of HPV that it protects against when you're sexually active.

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