1. A strict policy; or 
2. Overbooking (leading to long wait times at our office); or 
3. Charging for no shows 

The HPV vaccine is recommended for all children (boys and girls) at the age of 11 or 12 to prevent infection with very deadly strains of HPV. The vaccine is given as a 3 dose series spread out over at least 6 months. It is important that adolescents get all 3 doses of the vaccine to be appropriately protected.  The vaccine is recommended at 11 because it is most effective if given long before an individual is sexually active and potentially already exposed to or infected with HPV.

Disease Description

HPV is a family of viruses that are sexually transmitted and can lead to a variety of diseases. Most commonly they cause genital warts but certain strains of the virus can also lead to cancer. The Centers for Disease Control and Prevention (CDC) estimates that HPV causes 33,000 cancers annually (21,000 in women and 12,000 in men). Every year, about 12,000 women are diagnosed with cervical cancer, and about 4,000 women die from this disease in the U.S. HPV infection causes nearly 100% of cervical cancer and 65% of all vaginal cancers in women. In addition HPV is the cause of 35% of penile cancers in men, and in both men and women it causes up to 90% of anal cancers and 60% of all oropharyngeal cancers (cancers of the back of the throat, including the base of the tongue and tonsils) as well. 

Effectiveness of the Vaccine 

There are two vaccines available that protect against HPV. Gardasil protects against HPV types 6, 11, 16, and 18 and is licensed for use in men and women while Cervarix protects against types 16 and 18 and is only licensed for use in women. There are over 100 different strains of HPV but strains 16 and 18 cause 70% of the HPV associated cancers, and strains 6 and 11 cause 90% of the cases of genital warts. Studies of both vaccines have shown that 99% of individuals develop antibodies to the strains in the vaccines after completing the full 3-dose series, and more importantly the trials demonstrated nearly 100% vaccine efficacy in preventing cervical pre-cancers (abnormal cells which can transform into cancer), vulvar and vaginal pre-cancers, and genital warts in women caused by the vaccine types, as well as 90% vaccine efficacy in preventing genital warts and 75% vaccine efficacy in preventing anal pre-cancers in men. 

Risk of Vaccine 

As with any vaccine there are risks and side effects associated with the vaccine. Studies have shown some common adverse reactions including pain at the injection site, low grade fever, headache, dizziness and nausea.  Syncope (fainting) can occur after any vaccine and is more common in adolescents receiving vaccines than it is for younger children.  Initially when this vaccine was introduced there were increased reports of blood clots and Guillan-Barre syndrome (a disease of nerves causing weakness and paralysis) in people receiving the vaccines.  However surveillance looking for these adverse events in more than 600,000 people receiving the vaccines shows no statistically significant increase in these events when compared to people who do not receive the vaccines.