Medical Edge Newspaper Column

Age 9 an Appropriate Age for Girls to Receive HPV Vaccine

December 2, 2011
Dear Mayo Clinic:
Our pediatrician recommended the HPV vaccine for our 9-year-old daughter. This seems early for a vaccine that protects women from a sexually transmitted disease. Wouldn't it be better to wait? What are the side effects? How do I know it's safe?

Answer:
Age 9 is a good time for girls to receive the vaccine against human papillomavirus (HPV) infection. This important vaccine protects against cervical cancer, a common cancer that can destroy a woman's fertility and may be life-threatening. Side effects of the vaccine are uncommon and generally mild. The HPV vaccine has proven to be a safe, effective anti-cancer vaccine.

Most cases of cervical cancer are caused by HPV, a sexually transmitted infection. The Food and Drug Administration (FDA) has approved two cervical cancer vaccines — Gardasil and Cervarix. To be effective, the vaccine must be given in three doses over six months. The vaccine can prevent most cases of cervical cancer if all three doses are given before a girl or woman is exposed to the virus. It can also prevent most cancers of the vagina and vulva.

The Centers for Disease Control and Prevention (CDC) recommends the HPV vaccine for girls 11 to 12 years old and gives permission to begin the vaccination as early as age 9. Mayo Clinic starts at 9 years for several reasons. First, if they are healthy, preteens and teenagers don't often come to the doctor. That makes it challenging to ensure they receive the HPV vaccine in a timely manner. More parents bring their 9- and 10-year-olds in for care, making those ages a good opportunity to start the HPV vaccine series.

Second, when children are 9 to 11, their bodies respond to vaccines better than at any other time in their lives. Giving the HPV vaccine at age 9 takes advantage of this ideal window of time for a child to receive vaccines.

Third, many older teenagers are sexually active. We can't wait until children are in their late teens to receive this vaccine without risk. In order to be protected, persons need to receive all three doses before they are exposed to the virus. If they have sex before receiving all three, they are at risk for HPV infection.

Some adults have expressed concern that getting the HPV vaccine will encourage girls to participate in sexual activity earlier than they would otherwise. A considerable amount of research has not produced any evidence that receiving the HPV vaccine causes changes in sexual behavior.

This vaccine has been proven safe. The process it went through before being approved by the FDA was extensive. Since then, more than 60 million doses have been given and closely monitored. We have a wealth of data that supports the safety and effectiveness of the HPV vaccine.

In the past, there was concern the vaccine could lead to Guillain-Barré syndrome, a neurological disorder. That possibility was thoroughly investigated, and no association was found. In addition, no evidence supports claims that the HPV vaccine causes mental retardation.

Side effects of the HPV vaccine are typically mild and commonly include pain, swelling or redness at the vaccination site. In teenagers, HPV vaccination may result in fainting, because teens tend to be prone to fainting with vaccinations and having their blood drawn. This is another reason why beginning early with the vaccines — before the teenage years — is a good idea. Patients should remain seated for about 15 minutes after receiving the vaccine to lower the risk of harm from fainting and tell their health care provider if they feel faint.

The HPV vaccine is a safe, effective anti-cancer vaccine and can protect your daughter against a deadly form of cancer. Givingher this vaccine is a critical step in ensuring her long-term health.

— Robert Jacobson, M.D., Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minn.