STD vaccines in works, but for children

Chicago Tribune

(KRT)

CHICAGO - A wave of experimental vaccines against sexually transmitted diseases could revolutionize the prevention of such infections during the next few years, but there's a catch: The shots likely will work best when given to children as young as 11.

The first such vaccine to prevent human papillomavirus - the leading cause of cervical cancer - could be submitted for approval to the U.S. Food and Drug Administration by year's end. Another vaccine against genital herpes is in advanced clinical trials, and shots for gonorrhea and chlamydia are in the works.

Already the injections have drawn moral opposition from some conservative groups, who fear such immunizations could give young teens a green light to have sex.

Medical experts who are helping develop the vaccines conceded that some parents might find the idea of shielding their young children from future STDs hard to accept. But they said the overriding goal is to save lives by boosting children's immune systems before they are exposed to the viruses that cause such diseases.

"For most parents, the moral decision is to protect their children," said Dr. Gregory Zimet, a professor of pediatrics and clinical psychology at Indiana University School of Medicine who has studied parents' views on the immunizations.

Julietta Bolivar, a mother of three adolescents - ages 10, 12, and 15 - said she does not know how she feels about the vaccines.

"I would have to think about it," Bolivar said. "I want to learn about it before I make a decision. I guess I would have to talk to my doctor about it first, then talk to my kids too and hear what they think."

Bolivar's uneasiness may foreshadow the challenge ahead for public-health officials. Some parents say that at an age when most children are content playing video games or sports, preventive measures against sexual activity should be the last thing on children's minds.

"I appreciate a parent's concern that their kid is not sexually active. They may not be now, but they will be in the future," said Julie Morita, medical director at the Chicago Department of Public Health. "The point is we are not assuming that all 11- or 12-year-olds are having sexual relations, (but) we assume they will be in the near future."

Guarding children against such diseases is not a completely new idea. The federal Centers for Disease Control and Prevention already recommends the hepatitis B vaccine for adolescents 11 to 15 years old. Although generally not considered an STD - infection can be passed from mother to baby during birth or through use of dirty needles - hepatitis B primarily is spread through unprotected sex.

The new vaccines are fueling a moral battle as conservative groups promoting abstinence say they will fight recommendations that children get the shots.

"Sexually transmitted diseases in the United States will not be contained by injecting vaccines into pre-adolescents in anticipation of promiscuous behavior," Scott Phelps, executive director of Abstinence & Marriage Education Partnership, wrote in a recent statement.

Generally, schools do not teach sexual education until junior high. By then, however, immunizations against STDs may be ineffective.

Research on the vaccines has shown they work best when administered before adolescents become sexually active. Experts said they do not know whether the shots would work on even younger children because the studies so far have not included pre-adolescents.

Drugmaker Merck's studies showed that Gardasil, its new vaccine against human papillomavirus, or HPV, was 100 percent effective in preventing precancerous disease, but only when given to women and girls who had never engaged in sex at the time of the shots.

A new vaccine being developed for genital herpes works only if administered before individuals are exposed to the type 1 virus, the strain that causes cold sores, according to a study sponsored by the National Institute of Allergy and Infectious Diseases and the vaccine's manufacturer, GlaxoSmithKline Biologicals. But experts estimate that 50 percent of Americans contract the type 1 virus by the time they reach adolescence, which makes it more urgent to vaccinate younger children.

Even opponents of the vaccines have struggled with the evidence of public-health benefits.

The Family Research Council, a Christian organization that promotes conservative views on sexual behavior, initially was against giving adolescents vaccines against STDs. In a statement released in February, the group said that adolescents would view the vaccines as "a license to engage in premarital sex."

But after criticism that such opposition amounted to turning a blind eye to cancer risks, the council changed its stance, insisting it only was against mandatory vaccination.

"As a vaccine we do not have a problem with it; it all depends on how it is implemented," said Pia de Solenni, the group's director for life and women's issues.

Still, other conservative groups have stood firm against the idea of targeting children with such vaccines.

"If you tell a 13-year-old, `You are protected against this STD,' will she suddenly start thinking she is protected against all STDs, and therefore does not worry about having premarital sex and becomes sexually active?" said Leslee J. Unruh, founder and president of the Abstinence Clearinghouse.

The drugmakers say the vaccines are no substitute for educating children about sexual activity.

There are more than 100 different types of HPV, making it the most common cause of sexually transmitted infection. Condoms cannot always protect against HPV, as the virus is spread by genital contact. According to the CDC, approximately 20 million people are infected with HPV in the United States, and at least half of sexually active men and women will acquire the virus in their lifetime.

HPV types 16 and 18 cause about 70 percent of cervical cancer and cervical dysplasia - abnormal cells on the surface of the cervix. The American Cancer Society estimates that about 3,700 women in the U.S. die each year of the disease.

The drugmakers are pushing for a CDC recommendation that would urge health-care providers to recommend the vaccination and encourage health plans to cover the cost.

But mainstream use of the vaccines will depend on parental acceptance, experts said.

Articles in the September issue of the Journal of Adolescent Health showed that most parents and their adolescents were amenable to STD vaccinations. The reports also found that parents became supportive after learning about the health benefits of the vaccine or hearing a doctor recommending the vaccine.

Some parents said they wanted to wait until their children were older. But that may be too late, said Morita of the Chicago Public Health Department.

"These are horrible diseases that we want to prevent people from getting," Morita said. "Giving (the vaccine) to people (before) they are at higher risk is important."

---

(c) 2005, Chicago Tribune. Distributed by Knight Ridder/Tribune News Service.