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Introduction to the public
The health care system in the United States introduced HPV to the public in 2006 following its approval by the Food and Drug Administration.
Indication for medication
All children aged 11 or 12 years, who are presumed to have not done sexual intercourse, should get routine HPV vaccination. Males aged13 through 21 years and females aged 13 through 26 years should receive catch-up vaccination if they did not get routine HPV vaccination. The young men who are bisexual and gays should also receive HPV vaccination. People with compromised immunity such as those living with HIV/AIDS should receive vaccination. (Markowitz et al., 2013).
Pharmacokinetics
Following administration, the absorption of HPV vaccines such as Gardasil and Cervarix occur slowly due to intramuscular administration and the use of aluminium-based adjuvant. HPV vaccine enters the blood and distributes across the body through the circulatory system and the lymphatic system. In metabolism, phagocytes engulf virus-like proteins in the HPV vaccine and degrade using lytic enzymes. Phagocytes excrete the metabolized proteins into extra-cellular space and the bloodstream transports them to the liver where deamination occurs before their excretion through the kidneys as urea.
Pharmacodynamics
HPV vaccine comprises HPV proteins, which the immune system perceives as virus particles. The virus-like particles trigger an immune system to elicit an immune response that is specific to HPV. Given that HPV vaccination entails the introduction of virus-like particles into the body, the antigen presenting cells process them through the endocytic pathway. The antigen presenting cells process and present the viral proteins as the major histocompatibility complex (MHC) class II proteins because HPV vaccination introduces viral proteins from outside the cells (Ma et al., 2012). T-cells recognize processed antigens in antigen presenting cells through their T-cell receptors and trigger cascades of immune responses, which lead to the activation of B-cells. The immune responses prime B-cells and enhance immunity of an individual to HPV infection.
Dose
The healthcare provider should administer three doses within six months. For example, the dosage of Gardasil is 0.5 ml. The dosage of 0.5 ml contains HPV 11 L1 protein, HPV 6 L1 protein, HPV 18 L1 protein, and HPV 16 L1 protein. (Harper, Vierthaler, & Santee, 2013).
Monitoring
Since HPV is a recent vaccine, close monitoring is essential to establish its safety and efficacy. Long-term immunogenicity is necessary to determine the efficacy of HPV vaccine in the prevention of HPV infections and the occurrence of cervical cancer.
Side effects
Approximately 80% of the people experience pain around the injection site in the arm. About 25% of people experience redness and swelling of the injection site.
Approximately 10% of people experience fever when injected with HPV vaccine such as Gardasil. A headache is also a common side effect among people vaccinated with Gardasil. Among adolescents, fainting and dizziness are other common side effects. (Tomljenovic & Shaw, 2011).
Average cost of medication
The average cost of Gardasil is $150 per dose. Since each person requires three doses for complete vaccination, it means that the cost is $450.
Guidelines
Professional groups that recommend the use of HPV vaccine are the American Academy of Pediatrics, the American Cancer Society, the Centers for Disease Control and Prevention, the American Congress of Obstetricians and Gynecologists, the American Family Physician, the Food and Drug Administration, and the Advisory Committee on Immunization Practices amongst other professional groups. These professional groups support the guideline of administering three doses of HPV vaccine to children aged 11 through to 12 years and teens and adults aged 13 through 26 years. The guideline emanated from randomized controlled trials, which show that HPV vaccination is effective when administered before the onset of sexual activity among the adolescents. Moreover, other randomized controlled trials indicate that immune responses are very high when individuals are at the ages of 9 to 15 years and reduce by a half at the ages of 15 to 26 years (American Academy of Pediatrics, 2012). The guideline also excludes pregnant women and children below the age of 10 years for healthcare providers would be liable for any damages if they administer HPV vaccine to these groups.
Controversy
The controversy that surrounds the use of HPV vaccine in the prevention of cervical cancer revolves around economics, morality, ethics, and side effects. From the economic perspective, HPV vaccine such as Gardasil is expensive because three doses cost approximately $450, which the poor cannot afford. The controversy of morality and ethics centers on the mandatory vaccination, which violates the autonomy of parents to raise their children with appropriate sexual values (Navarro-Illana, Aznar, & Diez-Domingo, 2014). Parents feel that mandatory vaccination assumes that all children are sexually active, and thus, it predisposes to be sexually active at their tender ages. As HPV vaccine mainly targets women, it elicits ethical issues regarding the equal protection of men and women in the society. The use of aluminium-based adjuvant and the route of administration cause side effects such as swollen injection sites, fever, pain, and dizziness among other side effects. Analysis of the HPV controversy indicates that it has affected parents because they incur the cost of vaccination and cede parental control due to the loss of autonomy. Moreover, HPV vaccine affects children because they must get the mandatory vaccination and endure side effects.
The literature concludes that mandatory HPV vaccination complies with the ethical principles of beneficence, non-maleficence, autonomy, and justice. Given that the youths are sexually active, HPV vaccination would alleviate the impact of HPV on their lives by preventing the occurrence of cervical cancer and genital warts. Additionally, mandatory vaccination enhances the autonomy of children by enabling them to access healthcare services for their benefits. According to the ethical principle of justice, mandatory vaccination improves justice because it ensures that all people irrespective of their age, gender, race, religion, or ethnicity have access to healthcare services.
Alternatives
An alternative to HPV vaccine is Podofilox, which is a medication used in the treatment of HPV infection. The dosage is the topical application of 0.5g of the gel twice per day for three consecutive days and four days without any dosage. The treatment cycle should take four consecutive weeks. The common side effects are inflammation, moderate burning, pain, and bleeding. Podofilox costs about $100 for the complete course of treatment. Following the topical application, Podofilox requires close monitoring of hypersensitivity and side effects.
Trichloroacetic acid is a medication used in the treatment of HPV, which is another alternative to HPV vaccine. The dosage is a weekly application of 80-90% Trichloroacetic acid on warts for several months. The common side effects are burning sensation during treatment, dermal injury, destruction of tissues, and ulceration. It is the cheapest alternative to HPV vaccine because it costs less than $30. The treatment with Trichloroacetic acid requires continuous monitoring to ensure that warts and HPV infections do not recur due to under dose.
Rational decision
Given that HPV vaccine effectively prevents HPV infection, I will use it in clinical practice and prescribe to young people so that they can benefit from it. Owing to the side effects, I will prescribe it with caveats for patients to understand the nature of the medication that they use. I will use the alternatives in treating HPV and preventing their spread among individuals.
References
American Academy of Pediatrics. (2012). HPV Vaccine Recommendations. Pediatrics, 129(3), 602-605.
Harper, D., Vierthaler, S., & Santee, J. (2013). Review of Gardasil. Journal of Vaccines &Vaccination, 1(107), 1-16.
Ma, B., Maraj, B., Tran, N., Knoff, J., Chen, A., Alvarez, R., Hung, C., & Wu, T. (2012). Emerging human papillomavirus vaccines. Expert Opinion on Emerging Drugs, 174(4), 469-492.
Markowitz, L., Hariri, S., Lin, C., Dunne, E., Steinau, M., McQuillan, G., & Unger, E. (2013). Reduction in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health, and Nutrition Examination Surveys, 2003–2010.Journal of infectious Diseases, 208(1), 385-393.
Navarro-Illana, P., Aznar, J., & Diez-Domingo, J. (2014). Ethical considerations of universal vaccination against human papillomavirus. BMC Medical Ethics, 15(29), 1-7.
Tomljenovic, L., & Shaw, C. (2011). Human papillomavirus (HPV) vaccine policy and evidence-based medicine: Are they at odd? Annals of Medicine, 45(2), 182-93.
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