· A vaccine against certain strains of Human Papillomavirus (HPV) that can lead to cervical cancer is currently being offered to all school-girls in the 12-13 age group

· An information leaflet on the vaccination programme is available to parents

· The information leaflet does not properly stress that HPV is sexually transmitted nor does it tells them the more sexual partners a person has the more likely they are to contract a strain of HPV.

· Parents should contact the HSE and ask it to amend the leaflet to include this potentially life-saving information

· An editorial in the prestigious New England Journal of Medicine in 2008 expressed doubt about the ultimate effectiveness of such vaccination programmes in combating cervical cancer and warned of unintended consequences

The Health Service Executive (HSE) has begun its roll out of a vaccination programme for school-girls in the 12-13 age group against HPV 16 and 18 viruses which can give rise to 70 per cent of all cervical cancers. HPV, or Human Papillomavirus Virus, is sexually transmitted.

While there can be no objection in principle to people receiving the vaccine, the information campaign accompanying the vaccination programme should inform parents and/or their children that the chances of contracting a HPV rise according to the number of life-time sexual partners a person has.

Quoting a recent study, the Immunisation Guidelines for Ireland produced by the National Immunisation Advisory Council (NIAC) (p3, chapter 6a) says the prevalence of HPV among Irish urban women is 19.8 per cent. This varies from 31 per cent in women under 25, to 23 per cent in women aged 25-35 and 11 per cent in women over 35 years of age.

In the vast majority of cases HPV does not lead to cancer, and it usually clears up without treatment.

However, the Council says that, on average, 180 women develop cervical cancer each year with 73 deaths. The average age at diagnosis is 46 years and of death is 56 years.

In contrast to the information leaflet for parents, NIAC’s chapter on HPV does highlight the link between the incidence of HPV and the number of sexual partners a person has.

It says: “Individuals can reduce their risk of getting genital HPV infection by changes in sexual behaviour including abstinence from any sexual activity or lifelong monogamy. Reducing the number of sexual partners and the frequency of new partners will also reduce the risk. Condom use reduces but does not eliminate the risk of sexual transmission of HPV.”

This confirms evidence conducted elsewhere. A study of Dutch women aged 18-29 published in 2008 found that women who had more than 10 lifetime sexual partners had a 50 per cent chance of contracting a HPV. This compared to women who had a single lifetime sexual partner, who had a 4.2 chance of having contracting the virus. Similarly women who had more than two sexual partners in the previous six months had a greater than 50 per cent chance of having the virus.

However, in the advisory information for parents on the HPV vaccination campaign, this is not pointed out either in the leaflet or on the HSE website.

The failure of the HSE to properly alert parents to the means of transmission of HPV is mystifying. It simply tells them that “Most people will get a HPV infection during their lifetime, from sexual activity”.

Why does it not give parents the same information that is provided by NIAC? At an absolute minimum this should be expected because it is potentially life-saving. Parents should insist that the leaflet be amended to contain this information.

On a broader note, the HSE have claimed that the scheme is the most cost-effective way of ensuring that young women are protected from the virus and therefore from the cancer it causes.

However, such vaccination programmes do have their critics. For example, in an article in 2008 in the prestigious New England Journal of Medicine (NEJM), Drs Jane Kim and Sue Goldie suggest that the vaccination of girls aged 12 and over might only reduce the risk of cervical cancer by two per cent compared to screening alone.

Drs Kim and Goldie have further concerns. They suggest that:

· there is a possibility that the HPV types targeted by the vaccine could be replaced with other high-risk types for which the vaccine offers no protection;

· the vaccination programme may have the effect of altering the sexual behaviour of young people (they will take more risks) or lead to the misconception that screening is no longer necessary.

They are not the only experts to express some scepticism about such vaccination programmes. An editorial in the same issue of NEJM by Dr Charlotte Haug expresses similar concerns, and also questions how such a vaccination programme will affect the natural immunity of those vaccinated.

The editorial also points out that only limited trials of the vaccine have been conducted on pre-adolescent girls and the impact of the vaccine on this population is unknown. It is also unclear, she suggests, what impact the suppression of HPV types 16 and 18 may have on other HPV types which lead to cancer. It is possible, she argues, that there might be an increase in such HPV types.

The editorial makes clear that we do not know how long the vaccine will be effective for – it could be as little as ten years – and we won’t know its ultimate effect for decades.

As Dr Haug says: “How can policymakers make rational choices about the introduction of medical interventions that might do good in the future, but for which evidence is insufficient, especially since we will not know for many years whether the intervention will work or – in the worst case – do harm?”

It is fair to say that the introduction of this vaccine has not been properly debated.

ENDS