Despite initial controversy over the Gardasil vaccine, many young women have been opting to protect themselves from the human papilloma virus. In any given week, were administering the vaccine, says Victoria Regina, RN, triage nurse at Womens Medical Care, a private practice in Newburgh, N.Y.
Carole M. Harper, RN, MA, senior vice president and director of clinical services at Planned Parenthood of Greater Northern New Jersey, agrees women are embracing the chance to be vaccinated.
Planned Parenthood nurses, Harper says, help spread awareness by educating patients about the vaccines importance. After all, Harper says, Gardasil protects against the two HPV types that cause 70% of cervical cancer and two HPV types that cause about 90% of genital warts.
Vaccine 101From left, Sarah Cromie, LPN, and Jeanette Wilber, RN
Gardasil (Merck & Co.), licensed by the FDA in 2006, is the first human papilloma virus vaccine. HPV is the most common sexually transmitted infection in the U.S., with about 20 million people infected. The U.S. Centers for Disease Control and Prevention estimates 6.2 million people are infected every year, and women have an 80% chance of getting HPV by the time they are 50.
Gardasil, given in three doses, protects against four HPV types that cause the majority of cervical cancer and genital warts. The CDC recommends the vaccine for 11- and 12-year-old girls, but also encourages it for girls and women ages 13 through 26 who did not get the vaccine when they were younger or did not complete the vaccination series.
The vaccine is not approved for use in males, but might be soon. In September an FDA advisory panel voted 7 to 1 that the vaccine is safe and effective in blocking HPV in males ages 9 to 26.
Ideally, people should get the vaccine before their first sexual contacts when they could be exposed to HPV because it does not work as well for those who were exposed to the specific virus strains before getting the vaccine, the CDC says.
New Jersey and New York are not among the states that have passed legislation requiring that girls who enter sixth grade receive the vaccine, unless their parents or guardians opt out. And they are not among the states that have passed legislation requiring health insurers to provide coverage for the HPV vaccine. However, New Jersey requires the distribution of information about HPV to parents and guardians of seventh- to 12th-graders and pediatricians. The information is available through the New Jersey Department of Health and Senior Services.
Counseling PearlsFrom left, Valerie Portu, LPN; Sarah Cromie, LPN; Sarah VanDyke, LPN; Michelle Conte, LPN
Regina says a physician or nurse practitioner does the initial patient counseling for the vaccine during well-woman exams and other appointments if patients are candidates. Healthcare workers also might mention it to women who have daughters in the age range for the vaccine. We tell them that it covers the most risky HPV viruses but not all HPV viruses, Regina says. Quite a few people have paid for it out of pocket, even though they were not covered by insurance, to make sure they have the protection. So people realize how important it is.
Gardasil candidates are not tested for HPV before vaccination because the HPV test cannot differentiate between different strains of the virus. Counseling the older patients, many who have had sex, is a little different, according to Harper. Women age 26 and younger might be candidates for the vaccine, she says, even though many might not know if theyve had HPV. If they want to take this preventive measure, we encourage them to do so, Harper says.
Nurses often administer the HPV vaccine and say they have seen few and only minor side effects, such as pain at the injection site. Sarah Cromie, LPN, office nurse in the Womens Health Department at Columbia Memorial Hospital in Catskill, N.Y., says nurses there have seen some dizziness and faintness.
Although the HPV vaccine appears safe for pregnant women and the unborn fetus, studies still are being conducted; therefore, pregnant women should not be administered the vaccine, according to Harper.
Cost also can be an issue because the vaccine is relatively expensive and not all insurers cover it.
[Planned Parenthood] charges about $160 per dose, and there are three doses. In other health settings, the fee for one dose can be as high as $400, Harper says. Planned Parenthood participates in the Pharmaceutical Assistance Program, which allows us to provide a dose at the cost of $20 each, which is basically the cost of administering the medication. This is … provided the woman resides in the U.S., is age 18 or older, has no health insurance, and meets the financial criteria for assistance. We find women are taking advantage of this because of the declining economy and high rate of unemployment.
Jeanette Wilber, RN, CPC, nurse coordinator at the Womens Health Department of Columbia Memorial, says follow-up on the phone is important because patients have to come back for two shots within a year after the initial vaccine.
Promoting HPV Awareness
Regina says the Newburgh medical practice posts HPV awareness and prevention flyers in every patient room. Patients also sign an HPV information sheet at every appointment. But patients still need verbal reinforcement about what HPV and the HPV vaccine are, she adds.
Patients also need to be reminded the vaccine protects against HPV and only HPV, Cromie says. We always stress that even though you have the vaccine it doesnt protect you from other [sexually transmitted diseases]. Some people automatically think they dont need to use condoms, and its obviously not true, Cromie says.
Harper says it also is important for nurses to understand that HPV causes cervical cancer. There is no cure for HPV infection, but the conditions it causes can be treated, Harper says. Protection must be used at all times because almost everyone will come into contact with someone with HPV at some point in their lives, Harper adds.