Vaccine for Girls Raises Thorny Issues

For poor uninsured children, Merck this week announced it had reached an agreement with federal health officials to make the vaccine available at a discounted price to state programs for the indigent.

After the insurance issue is resolved, experts say another complication will be the logistics of getting pre-pubescent and teenage girls into a doctor's office three times within a six-month period for the shots. Unlike for infants, there are no standard office visits for girls in that age group that would facilitate three separate shots.

Then there is the issue of safety. While the vaccine has been tested on thousands of women who were followed for as long as five years, some parents want more time to go by to be sure.

"There just isn't enough information on it yet to make a call about whether it's safe," said Gina Catizone of Northbrook, Ill., mother of a 10-year-old. "I'm not rushing out to do this."

And although studies show the most effective way to use the vaccine is before girls become sexually active, some parents and pediatricians balk at that idea, saying girls that age are too young to have the subject broached.

"It's almost an assault on their innocence to be talking about those things when they do not even know what I'm talking about," said David Castellan, a Lewisburg, Pa., pediatrician.

A Question of Timing

Some parents and pediatricians worry the vaccine may give girls a false sense of security.

"If they think they are protected against one venereal disease, they may think they're protected against all venereal diseases," said Ravinder Khaira, a Sacramento pediatrician. "That's just the way some kids think."

Others say they are not convinced the protection will last into adulthood. So some pediatricians are advising parents who are confident their daughters will be abstinent until they are older, perhaps even until marriage, to wait.

"I would like to protect them at the point of being exposed -- like what travelers do before heading off to a country with endemic disease," said Joseph Zanga, a professor of pediatrics at East Carolina University in Greenville, N.C.

Merck's Haupt acknowledged that studies have documented immunity for only five years, but said evidence suggests the immunity is long-lasting. "We have ongoing surveillance studies suggesting it will have a durable immune response," he said.

Supporters argue that parents have no way of really knowing when their daughters will become sexually active or whether they may be sexually assaulted. And even if they remain abstinent until marriage, their husbands may be infected.

"It really does make the most sense to immunize girls when they are 11 or 12," said Susan Rosenthal, a professor of pediatrics at the University of Texas Medical Branch in Galveston. "That way you're done, and you know they are protected." ·

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