Newsgroup: it.salute
Titolo: Vaccino HPV, qual e' la situazione in Italia?

Negli USA c'è un dibattito sull'uso di questo vaccino per le ragazze,
nonostante l'alta mortalità dell'HPV: da una parte c'è chi si oppone alla
obbligatorietà di un vaccino per una malattia che si trasmette
sessualmente, dall'altra c'è chi mette in guardia dal diffondere una
"cultura del rifiuto" e l'idea che i vaccini siano una scelta facoltativa a
cui si può dire sì o no come preferisce.
E in Italia?
http://www.washingtonpost.com/wp-dyn/content/article/2007/03/03/AR2007030301356.html
Parents Question HPV Vaccine
Push to Mandate Shots Rapidly Creates Backlash
By Susan Levine
Washington Post Staff Writer
Sunday, March 4, 2007; Page C01
In barely nine months, the first cancer-specific vaccine to win federal
approval has gone from licensing and the enthusiastic embrace of dozens of
states to a widespread backlash against moves to mandate immunization for
adolescent girls.
Health experts are dismayed by the controversy over Merck's Gardasil, which
protects against two common forms of the sexually transmitted virus that
causes cervical cancer. But it has hardly surprised them. Never has
compulsory use of a drug been pushed with such breakneck speed -- with
concerted lobbying by its manufacturer. Never have such efforts advanced
largely through political and legislative channels instead of medical
authorities and public education campaigns.
Votes to require the three-dose vaccine before students enter the sixth
grade remain likely in the District and numerous jurisdictions. On Friday,
Virginia Gov. Timothy M. Kaine (D) announced he would sign the first bill
in the country to prescribe vaccination, albeit with an opt-out provision.
However, doctors question whether there will be adequate funding and access
to support these measures, and some fear that the opt-out clauses, included
to counter opponents' concerns, could erode support for immunizations in
general.
If parents are given broad opportunity to exempt their 11- and 12-year-old
daughters from the vaccine for the human papillomavirus, or HPV, will they
be less willing to have children of any age inoculated against other, more
communicable diseases?
"The message that we send to parents is exceedingly important," said Gary
Freed, a professor of pediatrics and health policy at the University of
Michigan and chairman of the federal government's National Vaccine Advisory
Committee. "Are we going to be creating a culture of vaccine refusal that's
not going to serve us well?"
Few people dispute the promise of the new vaccine, which clinical trials
proved to be highly effective against two HPV strains that cause nearly
three-quarters of the 10,000 annual cervical cancer cases in the United
States. About 40 percent of women who receive the diagnosis die. Low-income
and minority women are most affected, with African American mortality rates
more than twice that of whites.
Still, for some parents those numbers might not be great enough to justify
state intervention. Maureen Siegel of Manassas, who has a 10-year-old
daughter, acknowledged she must learn more. "I don't know everything there
is to know about the basics," she said. "I also don't know if cervical
cancer is a big enough epidemic to make [vaccination] mandatory."
Because the virus is transmitted through intimate contact, the arguments
for required vaccination differ from the rationale for enforcing shots
against diseases easily spread in schools, such as measles. They are less
about safeguarding the public and more about safeguarding individuals.
"Why is this happening so fast? Why is there a mandate when this is such a
different kind of disease?" asked Barbara Loe Fisher, president of the
National Vaccine Information Center, a nonprofit consumer organization that
opposes HPV legislation. Most states did not add the chickenpox vaccine to
schoolchildren's immunization schedules until several years after its
approval in the mid-1990s, she noted.
Yet the backlash is also about the age of children targeted. Although the
government approved Gardasil for women up to 26, it recommended routine
administration to girls 11 and 12 to ensure they be protected before they
become sexually active. The vaccine is most effective when given before
first sexual contact. Its duration is unclear.
Some people argue that vaccination could encourage adolescents to be more
promiscuous. More believe that parents' authority over their daughters'
health care would be usurped. Others point out that cervical cancer will
occur in only a fraction of the more than 7.5 million girls and young women
estimated to be infected with the virus in this country.
A Maryland state senator retreated quickly in January after being deluged
by irate letters about her bill for mass HPV vaccination before middle
school. Still pending is a second bill to create a task force of
legislators, teachers and health professionals to study the issue through
2008.
"I thought it was imperative to continue the conversation," explained Del.
Joseline Peña-Melnyk (D-Prince George's), who introduced the study
initiative. "People need to be educated on the issue in order to be able to
support it."
In the District, a mandatory immunization bill could be voted out of the
D.C. Council Health Committee as early as Friday. One sponsor, council
member Mary Cheh (D-Ward 3), has heard mixed reaction from residents, with
the positive responses coming "almost uniformly from women."
"I really hope people don't lose sight of the fact that this is the first
time we've ever had a vaccine against a cancer," Cheh said. "You seize and
take advantage of it."
Local health experts urge more deliberate consideration. "There has to be a
period of awareness," said Joseph Wright, executive director of the Child
Health Advocacy Institute at Children's Hospital in Northwest Washington.
The hospital has not decided its position on the council's pending bill.
"Legislators would be wise to recognize the way the public winds are
blowing and build in a very strong public education campaign before
stressing the mandatory aspect."
Kim Koontz Bayliss, for one, was initially angered by the proposal, seeing
it as an intrusion on her judgment of what is best for her 11-year-old,
Nell. The Cleveland Park resident has come around some in the past month.
After a television commercial on Gardasil prompted questions from her
daughter, she read up on HPV and the vaccine. Nell is due soon for her
annual checkup, and her mother plans to discuss it with the doctor.
But, she added, "I'm not going to make a move until I talk to the
pediatrician."
Virginia's legislation would not take effect for most sixth-grade girls
until the 2009-2010 school year. (In Texas, an executive order recently
issued by Gov. Rick Perry (R) would begin mandatory HPV immunization there
in September 2008.) Proponents say the lengthy notice will allow enough
time to watch for complications as the vaccine is used more broadly. In the
clinical trials, in which 11,000 girls and women participated, a slight
soreness at the site of injection was the only identified side effect.
Recent reports suggest some cases of fainting, dizziness, fever and nausea.
"It's a very cautious approach," said Del. Phillip A. Hamilton (R-Newport
News), who championed the bill. It passed with no organized opposition.
Both he and Kaine have stressed the opt-out clause, which will allow
parents to say no without explaining why. Some contend that if enough
children are excluded, there will be little strength left in the
requirement.
"We have no clue yet what the uptake will be for this vaccine," said Jon
Abramson, chairman of the committee that advises the federal Centers for
Disease Control and Prevention on immunization practices. The panel never
addressed the issue of inoculation as a condition of school attendance.
Abramson, who also is a professor of pediatrics and infectious diseases at
Wake Forest University medical school, does not support the legislative
moves.
Although mandates help reduce disparities in health care, he agreed, they
have to be funded. And cost is a key concern in his mind: A three-dose
regimen of Gardasil, given over six months, runs $360 or more, and a
significant part of the population would have to pay out of pocket because
families lack private insurance or do not qualify for a subsidy through the
federal Vaccines for Children program. Dollars often follow mandates, but
they are not guaranteed. Virginia is unusual in that Kaine has added $1.4
million to the budget for coverage.
"It's very, very unclear to me that states have the money to pay for it,"
Abramson said, "and I would be very concerned that kids would be kicked out
of school because parents can't pay."
Maryland's recent experience with older students and vaccines provides
little reassurance of early compliance. Thousands of teens were barred from
school for weeks in January because they didn't get newly required
chickenpox and hepatitis B shots -- despite extensive publicity and free
clinics.
Abramson advised Merck & Co. not to lobby lawmakers over Gardasil. Merck
disregarded his and others' suggestion, until its role became such a
distraction that the company stopped two weeks ago.
"Politics are not a good driver of health-care recommendations," Abramson
said. "Time will help us decide what's the best policy."
Staff writers Theola Labbé and Christy Goodman contributed to this report

 
http://www.ministerosalute.it/imgs/C_17_comunicati_1138_testo.rtf
Dunque non obbligatoria, mi par di capire.  

 No, non obbligatoria, ma consigliata e aggiungerei anche un "fortemente".
Opt-in (devi chiedere se la vuoi) oppure opt-out (devi chiedere se non la
vuoi)?
-- 

 compimento del 12mo anno.
E se i genitori non lo sanno o non ci pensano? Non sarebbe preferibile
almeno un opt-out, cioè vaccinazione per tutte salvo per chi chiede di
essere esentato?