Guarding girls' health.

Byline: The Register-Guard

CORRECTION (ran Feb. 12, 2007): The human papillomavirus vaccine Gardasil is administered in a three-shot sequence over six months. The duration of the sequence was incorrect in a Friday editorial.

An important debate is under way in Oregon and the rest of the nation over whether states should require young girls to be vaccinated against the sexually transmitted human papillomavirus, or HPV.

While there are significant issues associated with adding to the list of vaccinations required for school attendance, health professionals overwhelmingly support advising parents to have their 11- and 12-year-old daughters vaccinated with Gardasil. The new medication, which was approved by the U.S. Food and Drug Administration in June, is highly effective at preventing two strains of HPV that account for about 70 percent of all cervical cancer cases.

In January, Gardasil was put on the 2007 "recommended immunization schedule" issued by the American Academy of Pediatrics, American Academy of Family Physicians and the Advisory Committee on Immunization Practices of the Centers for Disease Control. That prompted a number of state legislatures to consider adding Gardasil to the list of mandatory vaccinations for school attendance.

The timing of the vaccination is important. The immunization, given in three shots over eight months, is most effective if it's administered before a girl becomes sexually active.

In Oregon, about 200,000 people are infected with HPV, including 15 percent in the 15- to 19-year-old age group. Nationally, about 20 million women are infected, and some 6.2 million people contract the HPV infection each year, making it the most common sexually transmitted disease in the United States.

About 10,000 new cases of cervical cancer from HPV occur yearly. Though the incidence of cervical cancer is declining in the United States, it still kills about 3,700 American women every year. Worldwide, it's the second most common cancer in women, resulting in 233,000 deaths a year.

Clearly, the arrival of Gardasil offers a momentous opportunity to prevent up to 70 percent of these deaths. But that doesn't mean the vaccination should be made mandatory so soon after its introduction.

School immunization requirements were created to protect children from outbreaks of contagious diseases in the school setting, not simply to compel beneficial vaccinations. With a brand new vaccine such as Gardasil, there hasn't been nearly enough time to educate the public or to allow for the possibility that undiscovered adverse effects will surface.

Texas Gov. Rick Perry, a conservative Republican, became the canary in the coal mine for mandatory Gardasil vaccinations, issuing an executive order last week requiring the immunization for girls entering the sixth grade as of September 2008. Right now, the canary looks like it came out on the short end of a fight with an alley cat.

Conservatives lambasted Perry's decision, saying it will increase sexual promiscuity - a nonsensical objection to a drug that will save young women's lives. But Perry also has drawn unexpected criticism from the 41,000-member Texas Medical Association and from the American Academy of Pediatrics; those doctors believe it's too soon to make Gardasil mandatory. The TMA noted that the quickest a vaccine has gone from approval to mandatory in Texas was the chickenpox vaccine, which took 5 1/2 years.

Oregon legislators don't need to decide the mandatory immunization issue right now, but they should waste no time setting up a program that would make this lifesaving vaccine available to every girl in the state, regardless of ability to pay the $360 cost.

A bulk vaccine purchase, possibly in conjunction with the state of Washington, could lower the cost substantially.

The initial state-level action on Gardasil should focus on universal access and education. It will take more data and real-world experience to determine whether Gardasil fits the criteria for a mandatory immu- nization.