**3.9 Due to decreased sexual fear, sexually transmitted disease rates increase among vaccinated girls**

From a social, psychologic, and religious angle; parents of vaccinated girls wonder if the protection of the vaccine would urge them to be more sexually active at a younger age. It would be an issue if it was true. In order to answer this, a study published at Pediatrics reported sexually transmitted infections (STI) history of vaccinated girls. Mayhew et al. found that between the 42.5% cases without prior sexual relations and 57.5% cases with prior sexual relations, there was only a difference of OR 0:13 (95% CI: 0.03–0.69) which shows that vaccination did not change their sexual behavior [23].

### **3.10 Autoimmune diseases such as primary ovarian insufficiency and Guillain-Barre have higher rates among the vaccinated girls**

In order to claim that a vaccination developed a disease, it needs to be within 3 years. At the 9th-year mark of HPV vaccines, 170,000,000 doses of vaccines had been done. Out of this large sample size, only six cases in the literature show primer ovarian insufficiency. Looking closer, we see that three of these cases had irregular periods up to 15 years before vaccination. The other three cases had their diagnosis more than 3 years after vaccination [24].

In the placebo-controlled FUTURE III (quadrivalent HPV vaccine) study, in both the vaccinated and AAHS (regular saline, placebo) groups, autoimmune disease rates were at 2.3%. This is the clearest study that shows autoimmune disease rate does not increase in vaccinated population. In addition, in a large meta-analysis study by Genovese et al. (243,289 vaccinated and 248,820 control group) there was no correlation between HPV vaccines and autoimmune diseases [25].

## **3.11 Vaccines that include types 16 and 18 are enough for the rest due to cross-protection effect**

The difference between cross-protection and cross-reaction is an important issue. Bivalent and quadrivalent HPV vaccines both show cross-reaction. Especially in bivalent HPV vaccines, researchers argued for cross-protection due to common ancestry of types 16 and 31 as well as 18 and 45. In bivalent vaccinated girls, HPV 31 and 45 immune response, as well as GMTs and seropositivity rates were considered. Serum GMTs were 20 times higher than natural infections for HPV 31 and 45. This effect, however, is cross-reaction. Because the vaccinated girls and women lose the protection against HPV 31 and 45 by the end of 4th year in these bivalent HPV studies [26–28].

**99**

*HPV Vaccines: Myths and Facts*

HPV type prevalence [30].

*DOI: http://dx.doi.org/10.5772/intechopen.90442*

**the rest of the types will increase**

nonavalent HPV vaccine is sold [29].

In a report by the Centers for Disease Control and Prevention (CDC) in the USA, as of 2018, there are no bivalent or quadrivalent HPV vaccines in the market; only

**3.12 If the vaccines include full protection against some types, cancer rates in** 

This is a baseless theory from anti-vaccination group. Is it necessary to prove the opposite of this theory? Even so, there have been studies on the matter. In 1180 vaccinated cases, anogenital non-vaccinated type HPV and genetic-related HPV 16 and 18 types prevalence are studied. There was no change in the non-vaccinated

Three independent institutes on the CDC Website are continuously monitoring the safety of vaccines and the data is available for both experts and the community. Because in the USA, every drug that is on the market has an obligation for routine control. These vaccine-monitoring systems are: the Vaccine Adverse Event Reporting System (VAERS), the Vaccine Safety Datalink (VSD), and the Clinical Immunization Safety Assessment (CISA) Network; and any person who had an

Vaccines consist of VLPs (virus-like particles) made with recombinant technology, that do not include any DNA but are identical to HPV in terms of structure. They cannot develop HPV infections or HPV-related cancer, as they do not include any DNA to reproduce. On the other hand, weakened or killed bacteria or virus

Side effects include redness in the vaccination site, minor pain, inflammation, and mild fever; like all childhood vaccinations. It could also cause nausea and dizziness. Due to this, vaccinated people are recommended to rest for 15 minutes after. VAERS records show that when divided into critical side effects and non-critical side effects; side effect rates were on a steady decline since 2007. In theory, autoimmune diseases are the most common side effect claims. In a quadrivalent HPV vaccine in 1000 cases of 9–26 year-old girls and women, there were no differences in autoimmune diseases between the vaccine group and the adjuvant or physiologic

When nonavalent HPV vaccine was introduced after the quadrivalent vaccine, which had twice the amount of aluminum (500 μg = 0.5 mg) of the latter, several anti-vaccination physicians theorized that this would worsen the side effects. However, any side effect of the 0.5 mg AAHS in hepatitis B, which has been used for 25 years, has never been proven. In a new study on the safety of aluminum in vaccines, the aluminum in the immunity-booster adjuvants had a high safety factor and did not cause any neurotoxicity [32]. Furthermore, we ingest more aluminum from drinking water (<0.2 ml/L), from many foods such as potatoes and spinach (<5 mg/ kg), from aluminum folio to preserve food, from food with aluminum supplements, and soy-based food (0.4–6 mg/L) compared to the vaccines (https://www.cfs.gov.

Theory that quadrivalent and nonavalent HPV vaccines can cause primary ovarian insufficiency (POI) has been claimed by experts in many places including the social media. As described in detail in the previous section, there have been only 6 POI cases out of 170,000,000 doses of HPV vaccines in over 9 years. What is the incidence rate of POI in a normal population? Spontaneous POI for under

**3.13 Vaccines are not safe; there are deaths associated with the vaccine**

adverse effect from a vaccine can report to them freely.

serum group. Both groups reported a rate of 2.3%.

hk/…/files/RA35\_Aluminium\_in\_Food\_e.pdf).

vaccines do have a minute risk [31].

*Human Papillomavirus*

aborted [22].

**among vaccinated girls**

their sexual behavior [23].

more than 3 years after vaccination [24].

**to cross-protection effect**

reduced reinfection rate at 2.5% compared to 8.5% [16]. According to this data,

**3.9 Due to decreased sexual fear, sexually transmitted disease rates increase** 

From a social, psychologic, and religious angle; parents of vaccinated girls wonder if the protection of the vaccine would urge them to be more sexually active at a younger age. It would be an issue if it was true. In order to answer this, a study published at Pediatrics reported sexually transmitted infections (STI) history of vaccinated girls. Mayhew et al. found that between the 42.5% cases without prior sexual relations and 57.5% cases with prior sexual relations, there was only a difference of OR 0:13 (95% CI: 0.03–0.69) which shows that vaccination did not change

**3.10 Autoimmune diseases such as primary ovarian insufficiency and Guillain-Barre have higher rates among the vaccinated girls**

no correlation between HPV vaccines and autoimmune diseases [25].

**3.11 Vaccines that include types 16 and 18 are enough for the rest due** 

In order to claim that a vaccination developed a disease, it needs to be within 3 years. At the 9th-year mark of HPV vaccines, 170,000,000 doses of vaccines had been done. Out of this large sample size, only six cases in the literature show primer ovarian insufficiency. Looking closer, we see that three of these cases had irregular periods up to 15 years before vaccination. The other three cases had their diagnosis

In the placebo-controlled FUTURE III (quadrivalent HPV vaccine) study, in both the vaccinated and AAHS (regular saline, placebo) groups, autoimmune disease rates were at 2.3%. This is the clearest study that shows autoimmune disease rate does not increase in vaccinated population. In addition, in a large meta-analysis study by Genovese et al. (243,289 vaccinated and 248,820 control group) there was

The difference between cross-protection and cross-reaction is an important issue. Bivalent and quadrivalent HPV vaccines both show cross-reaction. Especially in bivalent HPV vaccines, researchers argued for cross-protection due to common ancestry of types 16 and 31 as well as 18 and 45. In bivalent vaccinated girls, HPV 31 and 45 immune response, as well as GMTs and seropositivity rates were considered. Serum GMTs were 20 times higher than natural infections for HPV 31 and 45. This effect, however, is cross-reaction. Because the vaccinated girls and women lose the protection against HPV 31 and 45 by the end of 4th year in these bivalent HPV studies [26–28].

There are limited number of cases about uses of bivalent and quadrivalent HPV vaccination during pregnancy. Both vaccines are classified as category B due to prior data. Comparison between vaccinated and unvaccinated group did not show an increase in the infant's congenital anomaly rates. However, due to unavailability of more data, vaccination during pregnancy is not recommended. This does not mean that the vaccination is done without knowledge of the pregnancy, that it should be

**3.8 If a pregnancy occurs during vaccination, it should be terminated**

smear or HPV DNA tests are not required prior to vaccination.

**98**

In a report by the Centers for Disease Control and Prevention (CDC) in the USA, as of 2018, there are no bivalent or quadrivalent HPV vaccines in the market; only nonavalent HPV vaccine is sold [29].

## **3.12 If the vaccines include full protection against some types, cancer rates in the rest of the types will increase**

This is a baseless theory from anti-vaccination group. Is it necessary to prove the opposite of this theory? Even so, there have been studies on the matter. In 1180 vaccinated cases, anogenital non-vaccinated type HPV and genetic-related HPV 16 and 18 types prevalence are studied. There was no change in the non-vaccinated HPV type prevalence [30].

## **3.13 Vaccines are not safe; there are deaths associated with the vaccine**

Three independent institutes on the CDC Website are continuously monitoring the safety of vaccines and the data is available for both experts and the community. Because in the USA, every drug that is on the market has an obligation for routine control. These vaccine-monitoring systems are: the Vaccine Adverse Event Reporting System (VAERS), the Vaccine Safety Datalink (VSD), and the Clinical Immunization Safety Assessment (CISA) Network; and any person who had an adverse effect from a vaccine can report to them freely.

Vaccines consist of VLPs (virus-like particles) made with recombinant technology, that do not include any DNA but are identical to HPV in terms of structure. They cannot develop HPV infections or HPV-related cancer, as they do not include any DNA to reproduce. On the other hand, weakened or killed bacteria or virus vaccines do have a minute risk [31].

Side effects include redness in the vaccination site, minor pain, inflammation, and mild fever; like all childhood vaccinations. It could also cause nausea and dizziness. Due to this, vaccinated people are recommended to rest for 15 minutes after. VAERS records show that when divided into critical side effects and non-critical side effects; side effect rates were on a steady decline since 2007. In theory, autoimmune diseases are the most common side effect claims. In a quadrivalent HPV vaccine in 1000 cases of 9–26 year-old girls and women, there were no differences in autoimmune diseases between the vaccine group and the adjuvant or physiologic serum group. Both groups reported a rate of 2.3%.

When nonavalent HPV vaccine was introduced after the quadrivalent vaccine, which had twice the amount of aluminum (500 μg = 0.5 mg) of the latter, several anti-vaccination physicians theorized that this would worsen the side effects. However, any side effect of the 0.5 mg AAHS in hepatitis B, which has been used for 25 years, has never been proven. In a new study on the safety of aluminum in vaccines, the aluminum in the immunity-booster adjuvants had a high safety factor and did not cause any neurotoxicity [32]. Furthermore, we ingest more aluminum from drinking water (<0.2 ml/L), from many foods such as potatoes and spinach (<5 mg/ kg), from aluminum folio to preserve food, from food with aluminum supplements, and soy-based food (0.4–6 mg/L) compared to the vaccines (https://www.cfs.gov. hk/…/files/RA35\_Aluminium\_in\_Food\_e.pdf).

Theory that quadrivalent and nonavalent HPV vaccines can cause primary ovarian insufficiency (POI) has been claimed by experts in many places including the social media. As described in detail in the previous section, there have been only 6 POI cases out of 170,000,000 doses of HPV vaccines in over 9 years. What is the incidence rate of POI in a normal population? Spontaneous POI for under

30-years old is about 0.1%, and for under 40-years old is about 1%. In Australia, out of 5,800,000 doses for 83% school-age girls, there was no relation between HPV and POI [33].

In Japan, there is a two-staged national vaccine program; quadrivalent HPV vaccine was implemented to the first stage in 2010 and was moved to the second stage in April 2013. This allowed only anyone that wanted to be vaccinated. The reason was abnormal uterus bleeding, excessive uterus bleeding, and headache. To address this, 71,117 women were studied and no relation between the symptoms and vaccination were found. As a result, vaccines were reimplemented into the first stage in June 2013 [34].

Considering mortality, CDC Website reports 117 deaths for the 80,000,000 doses of vaccines from the related institutes and 51 of them had a known cause. These known causes were unrelated to vaccines. Recorded death causes included: traffic accident, homicide, epilepsy crisis for epilepsy diagnosed patients, pulmonary embolism, drug overdose for drug abuse patients, acute myocarditis, and meningoencephalitis, influenza B, and diabetic ketoacidosis. There were five reported deaths after nonavalent vaccines were introduced: car accident, suicide, acute lymphoblastic leukemia, septic shock, and an unknown cause. There are many meta-analysis and reviews about vaccine safety readily available. There are no differences in between vaccinated and unvaccinated groups in terms of critical side effects.

### **3.14 Vaccines are not cost-effective; protected patients are not worth the cost**

This is an interesting claim. Every single patient protected is worth the effort. Looking through a scientific perspective, many studies found that even the vaccines based on HPV 6/11 related warts, HPV 16/18 related precancerous lesions, and cervical cancer are cost effective [35–37].
