A question of vaccination

 Sarah was only 16 years old when she was diagnosed with cervical cancer.

She’d been sexually active for just under a year and had been intimate with two partners.

“It’s the last thing you expect as a teenager. Your life is just starting out and suddenly you’re faced with something that could mean the end of your life,” the now 20-year-old Caymanian said.

After treatment to remove cancerous cells from her cervix, she immediately opted to get vaccinated for human papillomavirus, or HPV, which is known to be a cause of cervical cancer.

“I try to tell all the girls I know to get vaccinated. They should get it done as soon as they are old enough. I tell them to get the vaccination and to use condoms,” she said. “I made sure my younger cousin got it, and my mother.”

“I’d had two partners. That’ll let you know easy it is to catch this,” she added.

HPV is a sexually transmitted virus. The Gardasil vaccine protects against four strains of the virus which cause cervical cancer and genital warts. Those four strains – 6, 11, 16, 18 – are believed to cause about 70 per cent of all cervical cancers.

In August, a pilot programme was launched in Cayman to vaccinate 150 girls aged between 11 and 17.

Christine Sanders, director of the Cayman Islands Cancer Society, said so far about 70 girls in Grand Cayman had been vaccinated and another 15 on Cayman Brac.

“We still have some doses available. We are still encouraging people between the ages of 11 and 17 to come and get vaccinated and for the parents to educate them,” she said.

The Cancer Society is giving presentations to groups to give them information on the vaccination.

Following a presentation in Cayman Brac in October, Lily, the mother of an 11-year-old daughter took her child to be vaccinated.

“Dr. Sook Yin did the presentation. She has been my doctor for year and one of things she said that really convinced me was that she gave it to her own daughter. I thought ‘ok, that’s pretty convincing’.

At 11, Lily’s daughter already looks older than her age. “She’s coming to that age… I felt that with her maturity coming as fast as it was coming, why wait? The idea of her having sex scares the hell out of me,” the mother admitted. “Better safe than sorry. It’s one worry gone.”

The daughter’s classmates also opted for the vaccination. “Now the girls on the Brac are saying ‘I’m immunised against cancer.’ What more do you need to say?” Lily asked.

With a small population and tight community, Lily and other mothers are thinking the same thing. If the virus is already on island, how long before their daughters contract it once they become sexually active?

“In a small community, like Cayman Brac, or the Cayman Islands in general, it could spread like wildfire,” said Lily, who admitted she did not worry about the potential long-term side effects of the drug, which was only approved by the Food and Drug Administration in the United States in mid-2006.

“I’m willing to take the risk because cancer is there. It’s not going away. At this stage, what could be worse out there?” she said.

Proponents of the vaccination say the benefits far outweigh the risks.

Ms Sanders of the Cancer Society said: “There has not really been any concerns raised, even at the hospital on Wednesday afternoons, when they do the clinic. A lot of parents are well informed. They have done their homework and research. “

Asked about potential long-term side effects, and whether parents and children were expressing any concerns over that, Ms Sanders said: “It is still considered to be safe and effective.”

Dr. Sook Yin says the only side effects she has noticed is some girls can exhibit soreness in the injection site, but otherwise there have been no adverse effects.

But reports have been emerging in the United States and the United Kingdom of some serious side effects and some rare fatal cases.

According to the US Centres for Disease Control and Prevention, as of 1 September, 2009, more than 26 million doses of Gardasil were distributed in the States, and 15,037 reports of adverse reactions were received. Of these reports, 93 per cent were considered to be non-serious, and 7 per cent were considered serious.

“Based on all of the information we have today, CDC continues to recommend Gardasil vaccination for the prevention of four types of HPV,” a statement by the CDC read.

The CDC stated that there had been reports of girls developing Guillain-Barré Syndrome, a rare disorder that causes muscle weakness, after the vaccinations. The CDC concluded that there is no indication the vaccine increases the rate of GBS in females above the rate expected in the general population, whether or not they were vaccinated.

Progressive Distributors has been bringing Gardasil into Cayman since January 2007.

Kathy Barnett of Progressive Distributors said demand for the vaccine, made by pharmaceutical company Merck, was low until early 2008, but demand has been growing.

“To date, I have supplied 450 doses, which will have vaccinated approximately 150 girls as each patient requires three doses over a six-month period,” she said, adding that theses did not include the doses imported for the pilot programme.

The vaccinations, which are administered in three doses over a six-month period, cost $130 for each injection.

In some quarters, the vaccination has met with resistance from parents who fear giving young girls a vaccination to protect them from a sexually transmitted disease may give them a licence to have unprotected sex.

Sarah warns against this attitude. “The religious and moral stances on this island are very good for children, but a lot of religious households here are not very open to listening to their kids or talking to them about sex.

“The kids whose parents won’t talk to them about sex are normally the first ones to do it… but they don’t know what to do, they don’t know about condoms or what kind of viruses they need to look out for.

“It’s those parents’ jobs to talk to their kids and to go and get their children vaccinated.”

Sarah still gets medical checkups every six months. She recently discovered that a pap smear has revealed that abnormal cells have again been found in her cervix. She is now awaiting further tests that will show if the cancer is back.

Sarah and Lily are not the real names of the women quoted in this story on their request for anonymity.