Gardasil or Meningococcal Vaccine: Which Would Spock Choose?

Editor's note: this is an updated version of the original article which appeared in August 2016.

At the routine well child visit at age 11-12 years I routinely recommend 3 vaccines: Tdap, Gardasil, and a quadravalent meningococcal vaccine. As often as not, the parent doesn't question the need for Tdap and the meningococcal vaccine, but wants “to wait” or outright refuses the HPV vaccine, Gardasil. When I ask the parent, “What is your concern with Gardasil,” I often get the comment, “Oh, it's a new vaccine.” I inform mom the vaccine was approved in 2006, so it isn't really a new vaccine and millions of doses have been given all over the world.

To emphasize a point, you might ask the parent in your office in what year they think the conjugate meningococcal vaccine was licensed, because you know it was in:

A. 1974

B. 2000

C. 2005

D. 2009

Please click "next" for answer and next question.

The correct answer is: C. 2005

The present meningococcal vaccine was approved one year before Gardasil's introduction. The very first meningococcal vaccine, a polysaccharide vaccine, was introduced in 1974. While that vaccine, Menomune, is still available, the conjugate vaccine is the one recommended for use in teens.

I think the real reason for the hesitation in many parents is based on an emotional response:  HPV is a sexually transmitted disease and my child won't get it. Of course, that’s not a logical response. According to the CDC 80% of Americans will end up infected with one or more HPV strains over a lifetime. Meningitis is very scary, but to be honest, meningococcal disease is rare in the United States, roughly 1000 cases a year and fewer than 200 deaths. 

Gardasil 9 has the potential to reduce the 12,000 new cases and 4,000 deaths a year from cervical cancer in the US by about 90%. That statistic may be a strong selling point for mothers of young female patients. What about some back-up for boys?

Most lay persons are unaware that HPV causes more than 70% of a more common cancer, oropharyngeal cancer, with 48,000 cases a year and responsible for more than 9,000 deaths estimated for 2016.

The incidence of oropharyngeal cancers has increased in recent years. If you can answer this next question correctly, you may be able to caution parents who bring in their sons for routine well-child vaccinations that Gardasil protection is not only for girls.

What percentage of oropharyngeal cancers occur in males?

A. 40%

B. 50%

C. 60%

D. 80%

Please click "next" for answer and next question.

The correct answer is D. 80%

According to the CDC about 81% of these cancers occur in men. Some have estimated that by 2020 more men will be dying from HPV-caused cancers than women. Overall, there are more than 30,000 new cases of HPV-caused cancers every year.

What percentage of human cancers are caused by HPV?

A. 1%

B. 2% 

C. 5%

D. 10%

Please click "next" for answer and discussion.

The correct answer is: C. 5%

And, HPV 16 is the major culprit. I find this statistic to be very helpful in discussing the benefits of the vaccine with parents.

If we were to ask Mr. Spock, the Star Trek character nearly devoid of emotion and ruled by reason, which vaccine is more important, Gardasil or the meningococcal vaccines, his answer would be the logical one:  Gardasil. And if the original Spock, Dr. Spock were alive today, I suspect he would concur.

For you youngsters out there, ask your parents or grandparents about the venerable Dr. Spock.

Resources

Data on the incidence of meningococcal disease http://www.cdc.gov/vaccines/pubs/pinkbook/mening.html

The American Cancer Society's estimates of morbidity and mortality in 2016 from oropharyngeal cancers. http://www.cancer.org/cancer/oralcavityandoropharyngealcancer/detailedguide/oral-cavity-and-oropharyngeal-cancer-key-statistics

CDC data on HPV caused cancers. https://www.cdc.gov/cancer/hpv/statistics/cases.htm

For the next installment in the Patient Care Pediatric Vaccines Special Report, please click below:

"How to Pump up the Volume on Gardasil"