Panel backs vaccine as cervical cancer alternative
A second kind of vaccine against cervical
cancer may be added to the recommended list for girls and young women after a federal advisory
panel voted Wednesday to support it.
The panel gave a limited endorsement to GlaxoSmithKline's
vaccine, Cervarix, which the government licensed last week. Merck & Co. has
had the vaccine Gardasil on the market since 2006.
The Advisory Committee
on Immunization Practices did not state a preference for one
vaccine over the other. But officials noted that while both protect against
cervical cancer, the older Merck vaccine also protects against genital warts.
The committee advises a federal
public health agency, the Centers for Disease Control and Prevention. The
CDC
still has to adopt the new recommendation for it to become official advice for
U.S. physicians.
Both shots are a three-dose series that target two types of human papillomavirus,
believed to be responsible for about 70 percent of cervical
cancer cases. HPV is spread through sex.
The vaccine is considered most effective when given to girls at around
age 11 or 12, before they become sexually active.
The Merck series costs about $390 and Glaxo's costs about $385.
Committee members discussed whether it was appropriate or not to give a
subtle nod to one vaccine over the other. To some, the fact that Gardasil also
targets two other types of HPV that cause genital warts was an important
consideration. Genital warts are not a serious condition, but there are a half
million such infections a year, many of them in teens and young adults.
"It has an enormous impact on relationships and self esteem,"
said Dr. James Turner, executive director of student health at the University
of Virginia. Turner is not a voting member of the committee; he is a liaison to
the committee on behalf of the American College Health Association.
Some cost-effectiveness studies have suggested the Glaxo vaccine series
should be priced about $100 less than it is, since it doesn't protect against
genital warts, said Harrell Chesson, a CDC economist.
But because it's slightly less expensive than the Merck vaccine, some
patients and doctors may still choose it instead, some experts said.
More women getting the Glaxo vaccine reported pain, redness and swelling
at the injection site. Committee members said that could be due to the fact
that the vaccine uses a new kind of adjuvant — a chemical compound used to
boost the immune system and stretch the vaccine's active ingredient, board
members said.
CDC officials advised avoiding a statement on preference of one over the
other. "We wanted to facilitate a market for both vaccines," said Dr.
Lauri Markowitz, a CDC HPV expert.
No studies have addresses whether the vaccines are interchangeable —
that is, if a girl can get, say, the Merck product for the first dose but the Glaxo
product for one or both of the subsequent doses.
Neither vaccine is recommended for pregnant women — a precaution,
because the effect of the vaccine on pregnant women and developing fetuses has
not been thoroughly studied.
Last week, the Food
and Drug Administration approved a new use for Gardasil, to
prevent genital warts in boys.
The committee considered whether to recommend routine vaccination of
boys against HPV,
partly as a strategy to prevent the spread of HPV to girls. Fewer that 40
percent of the girls and young
women recommended to get Gardasil have gotten a first shot, and
fewer than 20 percent have had the whole three-dose series.
Some physicians who work with adolescents passionately endorsed such a
step. But the committee decided not to do that, after hearing experts say such
a strategy was not very cost effective, and female HPV vaccination rates are
expected to rise without such a step.
But while doctors are not expected to prod families to get their boys
vaccinated against HPV, the committee voted that for families who want it for
their boys ages 9 to 18, it will be covered by a federal program that pays for vaccinations for children
who are uninsured or on Medicaid or meet other criteria.
Source: news.yahoo.com