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【社会人文】为什么没有更多女孩获得HPV疫苗？
Why aren't more girls getting the HPV vaccine?
By Ruby L. Bailey
Detroit Free Press
(MCT)
DETROIT - Perhaps concerned about cost, long-term effects or moral issues, fewer girls and young women than expected are requesting a vaccine that can prevent strains of a virus that causes cervical cancer, local physicians and others said.
The vaccine, called Gardasil, on the market for nearly a year, protects against two strains of the human papillomavirus (HPV) that are responsible for about 70 percent of all cervical cancers. It also protects against two other HPV strains that cause about 90 percent of cases of genital warts.
Parents have debated the message sent by vaccinating girls as young as 9 against a sexually transmitted disease, and some may remain skittish, said Dr. Ronald Strickler, chair of the obstetrics and gynecology department at Henry Ford Hospital in Detroit.
But over time, Strickler said he believes demand for the vaccine will pick up as more parents realize the risks to their daughters of contracting HPV.
"Your daughter may be a virgin when she goes on her honeymoon, but unless her husband was pristine, he may bring the virus to the marriage bed," Strickler said. "One has no ability to protect themselves from the virus."
The drug was approved in June by the U.S. Food and Drug Administration for girls and women ages 9-26. The manufacturer, Merck & Co., almost immediately began a TV marketing campaign and lobbied for states to pass legislation requiring the vaccine for middle-school-age girls. The Michigan Legislature is again considering measures after bills stalled last year.
By the end of 2006, Merck had shipped 2 million doses nationally, said spokeswoman Jennifer Allen. Still, word of the vaccine hasn't reached some in the targeted age group.
Ariane Adrian, 17, of Beverly Hills said she hadn't heard about Gardasil until recently and her friends at Detroit Country Day School also were unaware of it and of the dangers of HPV.
"I think most people are oblivious to it," Ariane said. She decided to get the vaccine after talking with her mother but said many of her friends haven't considered it.
HPV infections show no signs or symptoms. Experts estimate 11,150 women in the United States will be diagnosed with cervical cancer this year and about 3,670 will die of the disease.
This month, the Visiting Nurse Association of Southeast Michigan began offering the vaccine by appointment. But of the public health agencies in the tri-county area, only the Macomb County Health Department carries it.
"People aren't running in to get it," said Kevin Lokar, medical director for the Macomb department. "It's been kind of a slow uptake."
Last week, the department had 682 of the 1,600 doses it ordered last fall, all of which are earmarked for females 18 and younger through the Medicaid insurance program for poor children. The department administered 256 of the doses and sent 662 to area physicians who requested them. In addition, the department has administered 47 of an additional 90 doses it purchased for non-Medicaid patients.
The vaccine is expensive - at least $360 for the three required doses - and may not be fully covered by insurance. Health Alliance Plan and Blue Cross Blue Shield said some of their plans pay 100 percent of the cost, but some do not. Costs that might be passed on to patients vary by plan; Medicaid pays the entire cost.
"I'm hoping that over the next few years, the price will come down," said Dr. Rebecca Williams, a Bingham Farms, Mich., gynecologist. Williams said she doesn't offer Gardasil because it's not fully covered by some health care plans and she speculates that other doctors won't offer it for that reason as well.
"If the insurance isn't going to cover the full cost, then a lot of physicians are not going" to absorb the difference, Williams said.
Dr. Elmer Kozora said few patients at his Farmington Hills, Mich., office have asked for Gardasil. "Maybe one out of 10 or 15 people will ask for it," he said. "It's not a whole bunch."
The vaccine has not yet been approved for use in males in this country, though Merck continues to study it in clinical trials and authorities in Australia and the European Union have approved it for both sexes.
For now, getting the word out may be the biggest hurdle.
Despite Merck's national ads, Alex Hutting didn't hear of the vaccine until her mother mentioned it a few weeks ago. She also didn't know about a recent study that found one in four U.S. women ages 14 to 59 is infected with HPV.
The study, by the federal Centers for Disease Control and Prevention (CDC) in Atlanta, found that nearly 45 percent of HPV infections were discovered in females within the recommended age range for the vaccine.
Hutting, a 21-year-old Wayne State University junior, plans to be vaccinated, though she is unsure her insurance will cover the cost.
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作者:admin@医学,生命科学 2011-05-05 17:46
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