Rubella, HPV, and Sex
Both vaccines address consequences of sexual behavior yet only one is controversial in that regard.
Perhaps the Rubella vaccine has been a victim of its own success. The virus was eliminated as being endemic to the U.S. in 2004. Most people today don’t seem to know that the “R” in the MMR vaccine refers to Rubella and what that disease entails. That is the only thing I can think of as to why this vaccine is accepted as part of the routine immunization schedule without much thought by parents who vaccinate, when some of those same parents hesitate when it comes to HPV vaccines like Gardasil.
How is sex involved in Rubella? Rubella is a mild illness. A lot of times you wouldn’t even know you had it, especially children. If that was all there was to it, a vaccine probably wouldn’t be warranted. But if you are pregnant, it is a grave concern. It causes serious birth defects known as Congenital Rubella Syndrome. In most cases pregnancy doesn’t happen without sex.
When the Rubella vaccine was first introduced in 1969 we could have gone the route currently happening with HPV. Only girls get pregnant, no need to vaccinate boys (boys can also get HPV related cancers so this is a bit different for HPV). Maybe even, my daughter is a responsible person, let it be her decision on getting the vaccine before becoming sexually active. The huge down side of this approach is that the Rubella virus would always be endemic. That is a problem because not all pregnancies are planned, no vaccine is 100% effective in all cases, and some people who can’t be vaccinated may still want children. By including the vaccine as part of the vaccination schedule for all children, Rubella was eliminated from the U.S. We no longer hear about the tragic results of Congenital Rubella Syndrome.
As with Rubella, HPV is only a worry after sexual activity. I say sexual activity because HPV can be transmitted by more than just intercourse. The initial HPV vaccines protected against HPV strains that cause 70% of their related cancers. That has led to great success in stemming the rate of cervical cancers. In 2015, a new version was introduced that can protect against the HPV strains that cause 90% of their related cancers. Since boys can also develop HPV related cancers, both the American Cancer Society and the CDC recommend all children be vaccinated.
The HPV vaccines also hold out the potential for the elimination of HPV related cancers. With a solid vaccination campaign, perhaps by making it a part of the vaccine schedule, these cancers could be a thing of past in the U.S. The American Cancer Society recommends such a program, with a worldwide focus.
I suppose the root of the hesitancy around this boils down to being uncomfortable in thinking about certain folks as sexual beings. Children are not fond of thinking of their parents in such a manner and the reverse is true too. Parents don’t want to think their kids will also become sexual as they mature. The idea of two people who have not engaged in any kind of sexual activity meeting and then being each other’s only sexual partner is a fairy tale. Most people have more than one partner.
The other factor is immediacy. Birth defects happen to younger people. That is, people of child-bearing age. This engenders a visceral response. Parents can also imagine that horror and want to protect their children from that outcome. Cancer is thought to affect older people. That is not true , but it puts that off into the future and lessens the immediacy. Both cancer and birth defects are terrible, but somehow birth defects seem worse. That might be part of the reason why the Rubella vaccine was added to the schedule so quickly while the HPV vaccine is still optional. I have no data for this, it is just my own emotional response.
In conclusion, both HPV and Rubella are connected to sexual activity. For both vaccines, it isn’t about sexual mores or impropriety, it is about preventing birth defects and cancer. There is no reason to accept one and not the other. Both protect children and our community from dreadful outcomes. Get vaccinated.
Elimination of Rubella From the United States: A Milestone on the Road to Global Elimination: http://pediatrics.aappublications.org/content/117/3/933
Pregnancy and Rubella: https://www.cdc.gov/rubella/pregnancy.html
Teens Who Don’t Have Sex Still at Risk for HPV Infection: https://www.livescience.com/22141-hpv-infection-sexual-intercourse-teens.html
Human Papillomavirus (HPV) Vaccines: https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet
A decade on, vaccine has halved cervical cancer rate: http://www.bbc.com/news/world-australia-37211349
FDA Approves Gardasil 9 HPV Vaccine: https://www.cancer.org/latest-news/fda-approves-gardasil-9-hpv-vaccine.html
American Cancer Society Updates HPV Vaccine Recommendations to Include Males: https://www.cancer.org/latest-news/american-cancer-society-updates-hpv-vaccine-recommendations-to-include-males.html
HPV Vaccines: Vaccinating Your Preteen or Teen: https://www.cdc.gov/hpv/parents/vaccine.html
Eliminating Death from Cervical Cancer: https://www.acscan.org/policy-resources/eliminating-death-cervical-cancer
Key Statistics from the National Survey of Family Growth — N Listing: https://www.cdc.gov/nchs/nsfg/key_statistics/n.htm
Cervical Cancer Rates Among Young Women in the United States: https://www.cdc.gov/cancer/dcpc/research/articles/cervical-young-women.htm