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The golden age for HPV vaccination is from 9 to 14 years old.

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Cervical cancer is the most common gynecological malignancy in low- and middle-income countries. According to the latest data from the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO), there were about 570,000 new cases of cervical cancer diagnosed worldwide in 2018, and more than 310,000 women died of cervical cancer throughout the year. That is to say, in less than a minute, one person was diagnosed with cervical cancer worldwide, and in less than two minutes, one woman died of cervical cancer. But in fact, cervical cancer is a curable and preventable cancer.

Pre-sexually active period vaccination is the most valuable

Women are 40% to 80% more likely to be infected with HPV at some point in their lives. The main route of transmission of HPV is "special stories between men and women" (occasionally through contact with dirty sanitary ware or clothing). So once women start having sexual contact, there is a theoretical possibility of HPV infection.

Current HPV vaccines are preventive vaccines, which can prevent specific types of HPV infection, but have no therapeutic effect on existing HPV infection. Therefore, the World Health Organization believes that women are most valuable to be vaccinated with HPV before entering the sexually active phase.

On the one hand, global epidemiological data show that the risk of high-risk HPV infection among women has been increasing since the age of 15. Vaccination before HPV infection can produce protective antibodies as early as possible. Once exposed to viruses after having sex, existing neutralizing antibodies can remove viruses, so the protection effect is the best.

On the other hand, clinical trial data showed that after three doses of HPV vaccine, the immune response level (i.e. the titer of protective neutralizing antibody) was the highest among girls aged 9 to 15. The titers of neutralizing antibodies produced by women of this age group are more than twice that of the older group. Therefore, WHO recommends that girls aged 9 to 14 be the primary target population for HPV vaccination.

Girls aged 9 to 14 are the age at which sexual maturity starts. Most girls begin to have menarche. Since then, their impulses and possibilities to have "special stories" with men have increased due to the high levels of hormones in the body and the temptation of external sound, color and light. So girls of this age group need special protection most.

Low vaccination rate due to three main reasons

At present, adult women are more active in HPV vaccination in China. There are not many parents who vaccinate their daughters against HPV in the age range of 9 to 14. The main reasons are as follows.

First, mothers are great. Since the emergence of HPV vaccines, which are not limited to HPV vaccines in fact, there have always been voices against vaccines in the world. From time to time, sensational rumors have erupted, exaggerating the side effects of HPV vaccines and questioning their effects, including articles published anonymously by Swedish scholars in the Indian Journal of Medical Ethics and recently microblogged by a mechanic. Although experts on the Internet have refuted rumors, the scope and influence of rumors are obviously greater. Some mothers thought that although they approved the HPV vaccine, they were worried about its side effects. I would be a "mouse" first. If there were no serious adverse reactions in my body, I would give it to my daughter. This is the same truth as the ancients'saying, "If you have a disease, try medicine first". So maternal love is great.

Second, parents are confident. Generally speaking, daughters are good girls in the eyes of their parents. Therefore, parents feel that their daughters are very simple, unlikely to have bad contact with men, unlikely to be infected with HPV, or hope and so on. However, from the author's nearly 30 years of medical experience, sometimes these girls are not as simple as you think. In outpatient and emergency clinics, doctors often get beaten up by their parents when they ask a female patient whether she has sex or not, but later it is confirmed that the female patient has ruptured an ectopic pregnancy or has been pregnant for several months. In fact, for an adolescent girl, only in her interaction with a boy, in her conversation with her friends, can you find that she may have a world you don't know. Their language and expression are more direct than parents can imagine.

Third, worry about disguising and encouraging children to "learn badly". Some people worry that after vaccinating their children with HPV, they will be fearless and more likely to have "special events". It's really not easy to grasp. Just as universities, communities or hotels distribute condoms free of charge or at a fee to prevent AIDS. But I think it's better to talk to your children in a positive way than to adopt the "ostrich" strategy. One of my colleagues once said that when her daughter came to menstruation, she would put a ring on her under anesthesia so that she would not lose face in future abortions. This traumatic protective operation is still out of the question, but HPV vaccination should be feasible.



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