Pre Study Arrangements : A Research Protocol

The human papillomavirus (HPV) is a sexually transmitted disease (STD) that is very common throughout the United States and worldwide (World Health Organization (WHO), 2016). There are over 100 different forms of the virus with 13 of these types being capable of causing cancer (WHO, 2016). HPV can lead to the development of serious health problems. Theses health problems are especially an issue for adolescent women due to the highly increasing STD rates among this age group (Kostas-Polston, Johnson-Mallard & Berman, 2012). There is a vaccine for many of the common types of HPV, however, many parents are refusing to vaccinate their daughters for various reasons. With the rising cases of STDs, less birth

In addition, the immune system of most women will usually suppress or eliminate HPVs. This is very important because only an ongoing persistent infection has the potential to lead to cervical cancer (HPV). Eleven thousand cases of this kind of cancer were confirmed in 2007 in the United States; the amount undiagnosed is still unclear but believed to be in the tens of thousands. But to give some perspective of the problem you need to understand its effects on a global level. On the world wide scale cervical cancer strikes nearly half a million women each year, claiming more than a quarter of a million lives. “High risk” HPV types 16 and 18 are implicated in Seventy percent of cervical cancers and are hence selected for vaccine targets (The HPV).

HPV vaccinations bring up many public health and ethical issues. Some states want to require vaccines for school attendance. In the academic journal article “HPV Vaccination’s Second Act: Promotion, Competition, and Compulsion”, author Jason Schwartz states that, “Although some argue that HPV vaccines should never be mandated for school attendance, the temptation for policymakers to revisit this ethical and policy debate must be resisted until HPV vaccination has successfully become a routine, trusted component of adolescent medical care” (Schwartz). This train of thought exemplifies the opposition to HPV vaccination in this country, which restricts us in immunizing possible victims as effectively as possible. If the ignorance towards the vaccine continues, there will not be a powerful impact in decreasing rates of HPV infections.

Human papillomavirus is currently affecting the entire US population without discrimination. To mitigate this, the Advisory Committee on Immunization Practices (ACIP) recommended that adolescent girls be required to vaccinate at age 11 – 12 while boys were optional (Kepka et al., 2016). Today, adolescent boys are required to vaccinate too. The focus of this research is about adolescent boys age 12 – 15 in the United States (US). However, the study is not focused on assessing the population at risk. Instead, the focus will be on the state and territory immunization programs that are responsible for meeting the Healthy People 2020 goals for HPV vaccination in males. The sample size will be extracted from the population.

HPV is by far the most common sexually transmitted infection in the United States. Per the Centers for Disease Control and Prevention (CDC), 50 percent of all sexually active men and women will get it at some point in their lives, and 20 million already have it. A vaccine is available that prevents 70% of cervical cancers that arise from sexual intercourse. The human papillomavirus is unknowingly common and is diagnosed in 10,000 women a year, causing 4,000 deaths per year (“HPV Question and Answers”). If we take the responsibility to vaccinate young girls and boys, to be safe, we can eliminate many unnecessary deaths. This vaccine is a great discovery that should be put to good use, the HPV vaccine should be mandated in young teens everywhere.

There are many ethical and legal issues that count against a mandatory HPV vaccination for all girls aged 11-12 years old. First, the long-term safety and effectiveness of the vaccination is unknown (Javitt et al., 2008). Clinical trials conducted on the HPV vaccine concluded no short-term adverse effects, but as more girls and young women begin to get the vaccine some adverse effects may appear (Javitt et al., 2008). The extent immunity of the HPV vaccine is also unclear. Studies have shown the vaccine to be present in 3-4 year follow-ups, but the long-term effectiveness has not been studied (Javitt et al., 2008). Furthermore, HPV has a long incubation period, which would only affect a small amount of individuals many years after they finish school (Stewart, 2008).

Prophylactic vaccination against high risk human papilloma virus 16 and 18 represents an exciting means of protection against HPV related malignancy. However, this strategy alone, even if there is a level of cross protection against other oncogenic viruses, cannot completely prevent cervical cancer. In some countries cervical screening programs have reduced the incidence of invasive cervical cancer by up to 80 percent although this decline has now reached a plateau with current cancers occurring in patients who have failed to attend for screening or where the sensitivity of the tests have proved inadequate. Cervical screening is inevitably associated with significant anxiety for the many women who require investigation and treatment following abnormal cervical cytology. However, it is vitally important to stress the need for continued cervical screening to complement vaccination in order to optimize prevention in vaccines and prevent cervical cancer in older women where the value of vaccination is currently unclear. It is likely that vaccination will ultimately change the natural history of HPV disease by reducing the influence of the highly oncogenic types HPV 16 and 18. In the long term this is likely to lead to an increase in recommended screening intervals. HPV vaccination may also reduce

There are many reasons that this vaccine could be beneficial, not only to our society, but to many of the underdeveloped nations of the world in which HPV and cervical cancer are still considered to be an epidemic (MacDonald). It could save the young women who get the vaccine from the future trouble of dealing with a highly invasive cancer, as well as protect them from the embarrassment that comes with contracting a venereal disease. However, the controversy of this topic is not in whether the vaccine is a benefit to women’s health, which many, including the FDA and the Centers for Disease Control, believe that it is; but in the debate over whether it is the parents’ right, not the states’, to choose what is best for their child. The question of mandatory vaccination raises medical, moral and legal issues that are not easily reconcilable (Lovinger). Many parents are opposed to the mandating of this vaccine for three reasons. First, HPV is not spread by casual contact, as are the other diseases that children are vaccinated against for the safety of the classrooms. Second, the vaccine has only been approved for a short while, thus not all of the side effects and long term effects are known. Last, parents are afraid that by getting their child vaccinated against a sexually transmitted disease they will be encouraging promiscuity. Gardasil would become the first vaccine mandated for school-aged children that targets a

In an online survey, the survey administrator and his team asked over fifteen hundred parents of 11-17 year old children whether they agreed that laws requiring HPV vaccination for sixth grade school entry were “a good idea” about half of the parent believed the HPV vaccine, was at least as important as the Tdap and Meningococcal vaccines, the other two recommended for adolescent, only forty percent believed the vaccine prevented cervical cancer. Nearly a quarter of the parents inaccurately believed the vaccine might cause long term health problems and one

HPV vaccinations have been involved in some heated debates involving the general public and the government for some time now; whether the vaccine is worth being administered to young girls is the underlying question and if so at what cost. In the articles “HPV Vaccine Texas Tyranny” and “The HPV Debate” both authors Mike Adams and Arthur Allen provide enlightening information on why the HPV vaccinations should not be mandated through legislation, Adams conveys his bias and explains how the government is over stepping its boundaries when it comes to the publics’ health while Allen on the other hand, is more opt to present analytical data on previous cases similar to the one he is currently facing.

Economic evaluations of preventive interventions are necessary. Public health professionals designing and implementing preventive interventions typically work in the context of limited resources. Economic considerations are important because intervention costs must be justified in light of the benefits achieved (Rossi et al., 2004). As a profession, public health must be concerned about limited resources and about caring for entire populations. For these reasons, public health professionals must make often hard decisions to maximize health benefits while minimizing costs (CDC, n.d., page 1). In circumstances where resources are unlimited, economic evaluations would not be necessary as there would not be a need to reduce costs. In reality,

In young women aged sixteen to thirty years old, does vaccinating for Human Papillomavirus (HPV) compared to not vaccinating lead to a decrease in the expense of treating the complications from HPV?

Among the many arguments for mandatory HPV vaccination, the foremost is that it is an important medical achievement and a major public health milestone. This vaccine has proven to be one-hundred percent effective in preventing the 4 HPV strains that are responsible for seventy percent of cervical cancers and ninety percent of genital warts. In addition, no serious side effects have been identified. Because this vaccine is a preventive measure, administration before onset of sexual activity is ideal; however, even females who have been sexually active can still benefit from this vaccination (Perkins et al., 2010). Nationally and internationally, the HPV vaccine will significantly reduce disease burden by reducing monetary and psychological costs of invasive procedures that remove precancerous and cancerous lesions. By combining vaccination with routine Pap smear screening, these public health efforts have the remarkable opportunity to eradicate cervical cancer (Ramet et al., 2011).

According to the Sexuality Information and Education Council of the United States (SIECUS) the human papillomavirus (HPV) is the most common sexually transmitted infection (STI). I wasn’t aware that it impacts so many people; SIECUS reports that each year there are approximately 6.2 million new cases of HPV and that 75% of people between ages 15 and 49 have had a genital HPV infection. This isn’t something that I hear about as an adult male in this country. Before conducting research, I was only aware that HPV was tied to cervical cancer and there was a vaccine for young women. In the last decade, the understanding of HPV has increased considerably. Although schools don’t require the vaccination it’s recommended that children age 11-12. People have till their mid-20’s to receive a “catch up” immunization. HPV is responsible for causing more than 90% of anal and cervical cancers, about 70% of vaginal and vulvar cancers, and more than 60% of penile cancers and HPV is linked to 70% of oropharynx cancers (CDC, 2015). Not all people infected have complications, in fact, most people are asymptomatic and

A sexually transmitted agent, human papillomavirus (HPV) is the causative agent for genital warts and most invasive forms of cervical cancer and other cancers of the anogenital tract (Trottier & Franco, 2006). In the United States (US), about 80 million people are infected with at least one strain of HPV, resulting to a prevalence rate of 50-80% among sexually active adolescents. This ranks HPV infections among the most commonly diagnosed sexually transmitted diseases (STDs) in the US (Faridi, Zahra, Khan, & Idrees, 2011; Gerend & Shepherd, 2012). According to (Gerend & Shepherd, 2012)), an estimated 12,000 cases of invasive cervical cancer, and 4,000 resulting deaths occur in the US annually due to low HPV vaccine uptake, thus predisposing sexually active adolescents to HPV infection (Baseman & Koutsky, 2005; Trottier & Franco, 2006). HPV vaccines have been shown to be safe and effective in preventing genital warts, and cancers of the anogenital tract, yet parental consent to vaccinate is still very low. The low vaccination rate can be attributed to vaccine safety concerns, “license” for adolescents to engage in sexual intercourse, lack of knowledge among the US population about HPV as a cause of genital warts and cancer, its mode of transmission, cost, and missed opportunities by HCPs to either recommend or administer the vaccine to adolescents (Dempsey & Zimet, 2008; Faridi et al., 2011). A child’s HCP is consistently cited as the determining factor in parental vaccine