CDC Rescinds Mandatory HPV Vaccine for Immigrant Girls

The Associated Press reports (below) that the Centers for Disease Control and Prevention (CDC) will no longer require immigrant girls and women to be vaccinated against the human papillomavirus (HPV). The CDC’s discriminatory administrative directive MANDATING immigrant girls who posed no risk to the community to be vaccinated with Merck’s HPV Gardasil vaccine was put into effect, July, 2008.

The CDC’s newly adopted criteria to determine which vaccines will be required for immigrants: the vaccine must protect against a disease that has the potential to cause an outbreak, has been eliminated in the U.S. or is in the process of being eliminated from the country.

In addition to removing the HPV vaccine mandate, the CDC change also means the Zoster vaccine to protect against shingles won’t be required of immigrants 60 or older.

As acknowledged by Dr. Katrin Kohl, deputy director in the CDC’s division of global migration and quarantine,  cervical cancer and shingles “are not easily transmissible.” Furthermore,  “They don’t fit into the whole public health spirit of outbreak prevention.”

In August, 2009, the Alliance for Human Research Protection received a frantic plea for help from a 22-year old immigrant woman with an underlying neurological condition for which she is being treated. Her well-founded, informed concern that the vaccine’s potential adverse effects could jeopardize her health and her safety, was justified.

She emigrated from an industrialized country, was about to be married, and has regularly had PAP tests to screen for cervical cancer–and they were negative.  However, she could not find a physician in the U.S. who would back-up her concerns in a letter to the Immigration authorities.

AHRP turned to the physician / scientist whose expertise about the HPV vaccine is indisputable: matched by the ethical standard guiding her conscience and her practice of medicine. 

Publications Re: papillomavirus co-authored by Diane Harper, MD:

Villa LL, Costa RL, Petta CA, Andrade RP, Ault KA, Giuliano AR, Wheeler CM, Koutsky LA, Malm C, Lehtinen M, Skjeldestad FE, Olsson SE, Steinwall M, Brown DR, Kurman RJ, Ronnett BM, Stoler MH, Ferenczy A, Harper DM, Tamms GM, Yu J, Lupinacci L, Railkar R, Taddeo FJ, Jansen KU, Esser MT, Sings HL, Saah AJ, Barr E.
Prophylactic Quadrivalent human papillomavirus (types 6, 11, 16, and 18) L1 virus-like particle vaccine in young women: a randomised double-blind placebo-controlled multicentre phase II efficacy trial.  Lancet Oncology. 6(5):271-8, 2005 May.

Villa LL, Ault KA, Giuliano AR, Costa RL, Petta CA, Andrade RP, Brown DR, Ferenczy A, Harper DM, Koutsky LA, Kurman RJ, Lehtinen M, Malm C, Olsson SE, Ronnett BM, Skjeldestad FE, Steinwall M, Stoler MH, Wheeler CM, Taddeo FJ, Yu J, Lupinacci L, Railkar R, Marchese R, Esser MT, Bryan J, Jansen KU, Sings HL, Tamms GM, Saah AJ, Barr E.
Immunologic responses following administration of a vaccine targeting human papillomavirus Types 6, 11, 16, and 18.  Vaccine. 2006 Jul 7;24(27-28):5571-83. Epub 2006 May 15.

Garland S, Hernandez-Avila M, Wheeler CM, Perez G, Harper DM, Leodolter S, Tang GWK, Ferris DG, Steben M, Bryan J, Taddeo F, Railkar R, Esser MT, Sings HL, Nelson M, Boslego J, Sattler C, Barr E, and Koutsky LA, for the FUTURE I Investigators.  Efficacy of a quadrivalent HPV (Types 6/11/16/18) L1 VLP Vaccine against external anogenital, vaginal, and cervical disease. A randomized controlled trial.  NewEngl J Medicine.  2007: 356(19):1928-43.

Garland SM, Steben M, Hernandez-Avila M, Koutsky LA, Wheeler CM, Perez G, Harper DM, Leodolter S, Tang GWK, Ferris DG, Esser MT, Vuocolo SC, Nelson M, Railkar R, Sattler C, and Barr E on behalf of the 012 Study Investigators.
An evaluation of non-inferiority in antibody response to human papillomavirus (HPV) 16 in subjects vaccinated with monovalent (HPV 16) and quadrivalent (HPV 6, 11, 16, 18) L1 virus like particle vaccines.  Clinical and Vaccine Immunology. 2007.

Joura EA, Leodolter S, Hernandez-Avila M, Wheeler CM,  Perez G, Koutsky LA, Garland SM, Harper DM, Tang GWK, Ferris DG,  Steben M, Jones RW, Bryan J, Taddeo FJ, Bautista OM, Esser MT, Sings HL, Nelson M, Boslego J, Sattler C, Barr E, Paavonen J.  Efficacy of a quadrivalent prophylactic human papillomavirus (types 6/11/16/18) L1 virus like particle vaccine against high-grade vulval and vaginal lesions: A combined analysis of three clinical trials.  Lancet 2007.

Cutts FT, Franceschi S, Goldie S, Castellsague X, de Sanjose S, Garnett G, Edmunds WJ, Claeys P, Goldenthal K, Harper DM, Markowitz L. Human Papillomavirus and HPV vaccines: a review. Bulletin of the World Health Organization. 85(9):719-26, 2007 Sep.

Vera Hassner Sharav

 

ASSOCIATED PRESS
CDC will no longer require HPV vaccine for immigrant girls and women
By Anabelle Garay, AP
November 16th, 2009

Green card seekers won’t have to get HPV vaccine

DALLAS — Immigrant girls and women will no longer have to be vaccinated against a sexually transmitted virus to get their green cards.

Starting Dec. 14, the HPV, or human papillomavirus vaccine will no longer be on the list of immunizations female immigrants ages 11 to 26 must receive before becoming legal permanent residents.
he U.S. Centers for Disease Control and Prevention made the change on Friday. The CDC said it will require immunizations for which there is a public health need either at the time the person immigrates or changes their status to green card holder.

“More than half of the immigrants who come to the U.S. seeking opportunity are women,” Silvia Henriquez, executive director of the National Latina Institute for Reproductive Health, said in a statement. “We thank the CDC for restoring their dignity and reproductive justice.”

Girls and women seeking to become legal permanent U.S. residents were required to get at least the first dose of the HPV vaccine, which protects against some strains of the virus blamed for cervical cancer. It was added to the list of required vaccinations for immigrants in July 2008.

Soon after, a coalition of more than 100 immigrant, health and women’s advocacy groups challenged the requirement, saying it was unfair to require the HPV vaccine for immigrants but not for most U.S. citizens.

Attempts to require the vaccine for American girls has brought emotional debate and complaints that such mandates intrude on family decisions about sex education. In Texas, lawmakers fought off a 2007 order by Gov. Rick Perry requiring the shots for sixth-grade girls amid questions about vaccine’s safety, efficacy and cost.

At a price of $400 to $1,000 for the three-shot series, the vaccine also was an added burden on green card applicants already paying more than a thousand dollars in application fees and hundreds of dollars for mandatory medical exams. Insurance companies do not cover health services required for immigration purposes, advocates pointed out.

“It also put the financial burden on the individual woman and her family,” Gabriela Valle, senior director of community outreach and mobilization for California Latinas for Reproductive Justice, said Monday. “Not only are you taking my rights to make an informed decision over my body, over myself, over my daughter, but you’re having me pay for it as well.”

The U.S. Food and Drug Administration approved Merck & Co.’s Gardasil in 2006 to protect against the human papillomavirus. The CDC immunization advisory committee quickly followed up by recommending it for girls and young women.

For U.S. citizens, the committee’s recommendations serve only to provide guidance on vaccines. But a 1996 change to the nation’s immigration laws required anyone seeking permanent residency to get all the vaccinations recommended by the committee.

The CDC’s newly adopted criteria to determine which vaccines will be required for immigrants says the vaccine must be age appropriate. It also must protect against a disease that has the potential to cause an outbreak, has been eliminated in the U.S. or is in the process of being eliminated from the country.

Aside from removing the HPV vaccine mandate, the change also means the Zoster vaccine to protect against shingles won’t be required of immigrants 60 or older.

“They are not easily transmissible,” Dr. Katrin Kohl, deputy director in the CDC’s division of global migration and quarantine, said of the two. “They don’t fit into the whole public health spirit of outbreak prevention.”

However, the agency continues to recommend both vaccines, Kohl said.