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A new report in the British Medical Journal is bound to ruin the day of company officials (and shareholders) of the current human papilloma virus (HPV) vaccine manufacturer, Merck, who were undoubtedly pleased that an FDA committee recently recommended that the government agency okay the use of Gardasil in males against genital warts.

An economic analysis of the cost effectiveness of vaccinating boys for HPV in order to prevent cervical cancer caused by certain HPV variants in girls was done at the Harvard School of Public Health.  The researchers concluded that vaccinating girls resulted in a cost of $50,000 per quality adjusted life year (QALY), which means that for every additional year of perfectly healthy life that is gained via the vaccine, the cost is $50,000.00.  The cost for including boys in the HPV vaccination efforts raised the cost of one QALY to over $100,000, which “…exceeds conventional thresholds of good value for money,” the researchers said.

The researchers made the calculations assuming 75% vaccination coverage rate, and also assumed that the immunity to the cancer-causing variants of HPV that the vaccine is supposed to confer lasts a lifetime, which is of course unknown at this stage, since the vaccines in question have only been in use for a few years.

The immunity conferred by every other vaccine appears to wane over time, so until we have evidence to the contrary, it is rational to assume that any immunity conferred by Gardasil and Cervarix will wane as well.  If repeated vaccination is necessary, this will raise the cost of each QALY even further.

Nonetheless, it seems likely that the current push to recommend the use of HPV vaccines in males will continue with a simple shift in focus on genital warts instead of cervical cancer.

The two currently FDA approved vaccines for human papilloma virus are manufactured by Merck & Co.  (Gardasil, ) and GSK, GlaxoSmithKlein (Cervarix).

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I was reading a New York Times article this moring about the State of New York’s recent mandate that all healthcare workers receive the swine flu vaccine.

It was shocking to learn that hospitals incent healthcare workers to get vaccines by offering them time off work or the chance to win a vacation or holiday trip. It reminds me of parents offering their children ice cream if only they eat their broccoli.

It’s probably more appropriate in a non-paternalistic state to offer healthcare workers good reasons to have the shots than to offer them bribes.  Good reasons would include: 1)  evidence that the shot is necessary (meaning that we have good reason to believe that this strain of flu is particularly dangerous or virulent),  2) evidence that the shots are effective, and 3) evidence that the shots have been adequately tested and are safe.

The article also says that workers who decline vaccines even when they are “voluntary” are often punished by having notes concerning their noncompliance with the vaccine recommendations put into their personnel file or else they are forced to wear face masks at all times.

The CDC just recently released an update on the  H1N1 Swine Flu situation on their website, and it’s quite clear that as of now, the dire straits over Swine Flu are not materialising as expected.

For example, it turns out that visits to physicians for influenza-like illness are massively up.  That’s not surprising to me, and can probably be explained by all the panic in the press over this new killer influenza.  Lots of people who would have probably stayed home and toughed it out with chicken soup are now probably racing to the doctor just to make sure death isn’t imminent.

Hospitalisations for influenza are “similar to or lower than”  expected rates for regular, seasonal flu.  But they are higher for this time of year.  We’ll have to wait to see if this just a flu bug that is hitting earlier than usual, or whether this is going to develop into more cases of flu than usual. It’s too soon to know for sure.

Deaths attributed to influenza and pneumonia are “low and within the bounds of what is expected at this time of year.”   That’s even better news.

I’m not sure that the continued tremendous fear of this influenza strain is warranted.  However, it’s always good to make sure you have enough Vitamin D.

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