Hpv vaccine is safe to use

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This essay has been submitted by a student. This is not an example of the work written by our professional essay writers.

Preface

In this Case Study I am going to be investigating whether HPV vaccine is safe to use. I will also be putting forward the arguments for and against it. I am going to be using various scientific information, newspaper articles, journals etc. within this case study. I will also be talking about the HPV vaccine, cervical cancer, the death of Natalie Morton, from Coventry and whether there is a link or not.

I will conclude with my views from the evidence on whether I think there is a link between HPV and the current worry about the safety issues.

I have chosen this topic because as I believe it is quite fascinating, along with the media hype which has gone with it, the controversies which have arisen as a result, and also as I am very interested to find out whether the HPV vaccine did cause the death of Natalie Morton. The reason being the HPV vaccine is given to most young girls and it would be very interesting to know if these children are at risk from the vaccine.

I personally believe there is no link between HPV vaccinations and the death of Natalie Morton. To make sure I am not biased in any way is will be using reasonable point to argue for and against the statement "The HPV Vaccine .... How Safe Is It?"

What Is Immunisation?

Immunisation protects children (and adults) against harmful infections before they come into contact with them in the community.

Immunisation uses the body's natural defence mechanism - the immune response - to build resistance to specific infections. Nine diseases can be prevented by routine childhood immunisation - diphtheria, tetanus, whooping cough, poliomyelitis (polio), measles, mumps, rubella, Haemophilus influenzae type b (Hib) and hepatitis B. All of these diseases can cause serious complications and sometimes death.

Immunisation is usually given as an injection or, in the case of polio vaccine, taken as drops by mouth. Immunisation helps children stay healthy by preventing serious infections.

Immunisation and Vaccination Explained

Technically 'vaccination' is the term used forgiving a vaccine - that is, actually getting the injection or swallowing the drops. 'Immunisation' is the term used for the process of both getting the vaccine and becoming immune to the disease as a result of the vaccine. Most people use the terms 'vaccination' and 'immunisation' interchangeably but their meanings are not exactly the same because immunity follows vaccination in most, but not all, cases. For the purposes of this book, we have always used the term 'immunisation' because this is the expression most commonly used in the community.

What Is In Vaccines?

Some vaccines contain a very small dose of a live, but weakened form of a virus. Some vaccines contain a very small dose of killed bacteria or small parts of bacteria, and other vaccines contain a small dose of a modified toxin produced by bacteria. Vaccines may also contain either a small amount of preservative or a small amount of an antibiotic to preserve the vaccine. Some vaccines may also contain a small amount of an aluminium salt which helps produce a better immune response.

How Does Immunisation Work?

All forms of immunisation work in the same way. When someone is injected with, or swallows, a vaccine, their body produces an immune response in the same way it would after exposure to a disease but without the person getting the disease. If the person comes in contact with the disease in the future, the body is able to make an immune response fast enough to prevent the person getting sick.

The New Immunisation (HPV Vaccination)

The HPV vaccination programme started in September 2008 with all 12 to 13 year old and 17 to 18 year old girls being offered the vaccine. A catch-up programme was also announced at this time with 13 to 18 year old girls being offered the vaccine over the following two academic years. As this is a new strategy- its effectiveness has not been evaluation yet but it is very likely that the amount of women developing cervical cancer will be reduced due to this vaccination.

Side Effects of HPV Vaccination

Following clinical trials, the vaccine used in the UK HPV vaccination programme (Cervarix) was shown to cause side effects in some people.

Very Common Side Effects

Very common side effects are:

  • Pain or discomfort at the injection site.
  • Redness or swelling at the injection site.
  • Headaches.
  • Aching muscles, muscle tenderness or weakness (not caused by exercise).
  • Tiredness.

These may occur in more than one per 10 doses of vaccine.

Common Side Effects

Common side effects are:

  • Gastrointestinal symptoms including nausea, vomiting, diarrhoea and abdominal pain.
  • Itching, red skin rash or hives (urticaria).
  • Joint pain.
  • Fever (a body temperature of 38°C or over).

These may occur in less than one per 10 doses of the vaccine but more than one per 100 doses. Uncommon Side Effects

Uncommon side effects are:

  • Upper respiratory tract infection (infection of the nose, throat or windpipe),
  • Dizziness.
  • Other injection site reactions such as a hard lump, tingling or numbness.

These may occur in less than one per 100 doses of the vaccine but more than one per 1,000 doses. Very Rare Side Effects

In very rare cases, it is possible for someone who has the vaccine to experience a more severe allergic reaction, known as an anaphylactic reaction. Signs of an anaphylactic reaction include difficulty breathing and collapse.

However, it should be stressed that severe reactions of this nature are very rare and, when they do occur, the health professional who is giving the vaccine will have been fully trained in how to effectively deal with it. If your child has an anaphylactic reaction following treatment, they will usually fully recover within a few hours.

What is Cervical Cancer?

  • Cervical Cervical cancer is the second most common cancer worldwide after breast cancer.
  • Around 2,800 women are diagnosed with cervical cancer each year, with more than 1,000 women dying of the disease annually.
  • The cancer develops in the cells lining the cervix, which is the canal which connects the uterus to the vagina.
  • There are two main types of cervical cancer - squamous cell cancer and adenocarcinoma - named after the type of cell that becomes cancerous.
  • The primary cause of cervical cancer is the virus Humanpapillomavirus (HPV), which is a common infection transmitted through sexual intercourse.
  • Cervical cancer gained media attention recently when reality TV star Jade Goody was diagnosed with the disease.
  • A nationwide cervical screening programme helps to pick up the cancer through regular testing. Smear tests detect pre-cancerous changes called CINs, as well as cancers themselves.
  • According to Cancer Research UK, the cervical screening programme saves around 5,000 lives every year.
  • If caught at their earliest pre-cancerous stage, abnormal cervical cells can be dealt with using either freezing or heat to scour the cells from the cervix.
  • Options to clear the cancer can include surgery to remove abnormal tissue or the entire womb, including the cervix. If the cancer spreads beyond the wall of the womb, radiotherapy and chemotherapy may be considered. Unknown (2008), What Is Cervical Cancer? [Online Through Times Online].

Health chiefs have launched a "full and urgent" investigation into the death of a 14-year-old girl after she was given a cervical cancer vaccine at school.

  • Natalie Morton died in hospital on Monday 28 September 2009 after receiving the Cervarix jab at the Blue Coat Church of England School in Coventry.
  • Head teacher Dr Julie Roberts paid tribute to her as a "happy easy-going child who worked hard".
  • Post-mortem tests into the exact cause are expected to be held on Tuesday.
  • "Staff and students are shocked and deeply saddened at what's happened," said Dr Roberts.
  • "As a Christian school we look to God in these times of trouble, and our thoughts and prayers go to Natalie, her family and friends."
  • Coventry City Council's educational psychologists and the school's chaplains had been offering support to staff and pupils, she added.
  • There have been 4,657 suspected reactions to Cervarix from more than 1.4m doses, according to experts.
  • The Medicines and Healthcare Regulatory Agency added it had received 2,137 reports between 14 April 2008 and 23 September this year.
  • However, the risk of severe, potentially life-threatening reactions is estimated at no more than one per million doses of vaccine.
  • And it is possible that Natalie's death was due to an underlying health problem, or was a coincidence and nothing directly to do with the vaccine.

Dizziness and Nausea

  • The batch of the vaccine used has been placed into quarantine as a "precautionary measure".
  • The local NHS also confirmed the vaccination programme would continue, but after a "short pause".
  • Dr Caron Grainger, joint director of public health for NHS Coventry and Coventry City Council, said their sympathies were with the girl's family and friends.
  • She said: "The incident happened shortly after the girl had received her HPV vaccine in the school. No link can be made between the death and the vaccine until all the facts are known and a post-mortem takes place.
  • "We are conducting an urgent and full investigation into the events surrounding this tragedy."
  • A small number of girls at the school had also reported mild symptoms such as dizziness and nausea but were not admitted to hospital.
  • The injection - part of a national immunisation programme - protects against the human papilloma virus (HPV), a sexually transmitted disease linked to most cervical cancers.
  • A routine programme of vaccinating 12 and 13-year-old girls started in September 2008 across the UK using the Cervarix vaccine made by GlaxoSmithKline. A catch-up campaign is now under way for older girls.
  • It is thought about a million girls have already safely received the jab.
  • Dr David Elliman, a consultant in community paediatrics at Great Ormond Street Hospital, told the BBC it was important to investigate "very quickly" to allay people's fears about the safety of the jab.
  • He said: "Once in a while you will expect someone to have a severe allergic reaction to a vaccine, just as with food or any medication.
  • "At this stage we don't know what was the tragic cause of this child's death, so whether or not it's linked we cannot say, but these are the sort of things one would look for - a severe allergic reaction or more likely a coincidence."
  • When the national immunisation project was announced, there was some controversy about the selection of Cervarix over Gardasil, which is used by the majority of vaccination programmes worldwide.
  • Dr Pim Kon, medical director at GlaxoSmithKline UK, which makes Cervarix, said: "Our deepest sympathies are with the family and friends of the young girl.
  • "We are working with the Department of Health and MHRA (Medicines and Healthcare products Regulatory Agency) to better understand this case, as at this stage the exact cause of this tragic death is unknown."
  • The global pharmaceutical company added that the vast majority of suspected adverse reactions have related either to the symptoms of recognised side-effects or were due to the injection process and not the vaccine itself.
  • In the UK, about 3,000 women are diagnosed with cervical cancer every year and about 1,000 die from it.
  • The department said Cervarix had a strong safety record.
  • Shadow health secretary Andrew Lansley said the tragedy needed to be investigated "as a matter of urgency".
  • There are more than 100 types of HPV but only 13 of them are known to cause cancer.
  • Cervarix protects against two strains of HPV that cause more than 70% of cases of cervical cancer in women.
  • Vaccination is not compulsory and consent is required before it is administered to the under-16s.
  • Cervarix was licensed for use in Europe in September 2007.
  • (2009) Cancer Jab Alert after Girl Dies. http://news.bbc.co.uk/1/hi/8279855.stm

Latest Press Statements

Comments made for the media following death of schoolgirl Natalie Morton, in Coventry.

Statement issued 11am on 01/10/09:

Dr Caron Grainger, Joint Director of Public Health for NHS Coventry and Coventry City Council, said: "The pathologist has confirmed today at the opening of the inquest into the death of Natalie Morton that she died from a large malignant tumour of unknown origin in the heart and lungs. There is no indication that the HPV vaccine, which she had received shortly before her death, was a contributing factor to the death, which could have arisen at any point."

"We hope that this news will reassure parents that the vaccine is safe and that they should continue to encourage their daughters to be protected against cervical cancer. The HPV vaccination programme will continue as planned in the city from Monday."

Dr Caron Grainger, Joint Director of Public Health for NHS Coventry and Coventry City Council: - (9pm 29/09/09)

  • "The preliminary post mortem results have revealed a rare serious underlying medical condition which was likely to have caused death.
  • "We are awaiting further test results which will take some time. However indications are that it was most unlikely that the HPV vaccination was the cause of death.
  • "We would again like to reiterate our sincere sympathies to the family and friends of Natalie Morton during this difficult time."

Editors notes:

  • A post mortem examination was carried out at University Hospital in Coventry by an independent forensic pathologist.
  • The family have been informed of the preliminary result.

Statement from NHS Coventry on status of other girls reported to have experienced mild symptoms following administration of HPV Vaccine.

A spokesman at NHS Coventry said: "Nine pupils at Blue Coat School reported feeling unwell following the administration of their HPV Vaccine on Monday 28th September. Following the sad death of a pupil at the school, NHS Coventry has had contact with all of these pupils over night and this morning. Local doctors and the Walk-in centre staff have provided advice and have reported that the pupils have experienced mild symptoms in line with usually reported side effects."

Press Statement (29/09/09 - 13.45pm)

A spokesman said:"NHS Coventry can confirm that Natalie Morton's post mortem examination is taking place today (Tuesday, 29th of September) at University Hospital in Coventry and is being conducted by an independent forensic pathologist. The PCT will share any interim findings at the appropriate stage in the coming days."

Press Statement (29/09/09 - 12.30pm)

A spokesman for NHS Coventry said: "NHS Coventry has not suspended its local HPV Programme in the city. We have taken the decision to reschedule the catch up clinics planned for today and tomorrow (Tuesday and Wednesday) to be able to brief our frontline clinicians who are responsible for delivering the vaccine programme in the community, so that they are prepared to handle any enquiries they may get. We fully expect to resume the programme in the coming days."

Press Statement (29/09/09)

A statement on behalf of the Morton family issued via NHS Coventry:

"On behalf of all of Natalie's family we would like to extend our thanks to all those who have shown concern and sympathy following Natalie's tragic death. We would ask for time and privacy now to mourn a precious daughter, sister and granddaughter".

Press Statement (28/09/09)

Dr Caron Grainger, Joint Director of Public Health for NHS Coventry and Coventry City Council, said: "A 14-year-old girl took ill at a school in Coventry and was taken to University Hospital in the city where she later sadly died. Our sympathies are with the girl's family and friends at this difficult time.

"The incident happened shortly after the girl had received her HPV Vaccine in the school. No link can be made between the death and the vaccine until all the facts are known and a post mortem takes place. NHS Coventry has taken the proactive step to quarantine the batch of vaccine being used as a precautionary measure only and have informed the regulatory authority. We are conducting an urgent and full investigation into the events surrounding this tragedy."

For The Use of HPV Vaccine

  • HPV vaccine - Press Release - The DEPARTMENT OF HEALTH
  • Press Release 2007/0172

HPV VACCINE

  • Cases of cervical cancer will be reduced by up to 70 per cent with the introduction of a new vaccine into the national immunisation programme.
  • The Department of Health has agreed, in principle, to accept JCVI advice that HPV vaccines should be introduced routinely for girls aged around 12-13 years, subject to independent peer review of the cost benefit analysis.
  • Funding for this will be considered in the context of the Comprehensive Spending Review.
  • Human Papilloma Viruses cause 99 per cent of invasive cervical cancer. The vaccine protects against the viruses responsible for about 70% of cases.
  • Routine vaccination of girls could start as early as autumn 2008. Details of the programme will be finalised over the next few months, following further advice from JCVI and discussions with the NHS on the implementation of the programme.
  • Public Health Minister Caroline Flint said:
  • "Cervical cancer is the second most common cancer of women worldwide. In the UK alone, the lifetime risk of developing cervical cancer is one in 116.
  • "It is great news that vaccines have been developed that protect women against this form of cancer and I am delighted to announce that we intend, in principle, to introduce an HPV vaccine into the national immunisation programme.
  • "The benefits of introducing this vaccine will be felt by women and their families for generations to come. In England, 2221 new cases of invasive cervical cancer were diagnosed in 2004 alone. In addition around 200,000 women in England are identified through the cervical screening programme (smear tests) as having a pre-cancerous change.
  • "This vaccine will prevent many women from catching the HPV virus in the first place, potentially saving hundreds of lives.
  • "A significant amount of planning is required before we can introduce the immunisation into our programme. We are still working on the details and logistics, and will work closely with the NHS to ensure the vaccination can be delivered effectively. However, we are hoping that girls will start being vaccinated from as early as 2008."
  • The highly successful and comprehensive cervical screening programme (smear tests) will continue after an HPV vaccine has been introduced. This is because of the gap between the age of vaccination and age of first screening. Also, screening will be required as the vaccine does not protect against all HPV types that may cause cervical cancer.
  • HPV Vaccine May Prevent a Variety of Cancers - In Men and Woman
  • Written by Tom Spears, CanWest News Service, Canada
  • Cancer doctors are starting to believe that the human papilloma -- or HPV -- vaccine, intended to prevent cervical cancer, will likely prevent other cancers as well -- and in men as well as women.
  • Recent research is linking the human papilloma virus to a variety of cancers in the head and neck, and the urinary-genital tract, says Dr. Glenn Bauman, chairman of oncology at the University of Western Ontario faculty of medicine.
  • If so, the vaccine usually given to girls at the beginning of their teenage years could also benefit boys.
  • Boys so far have not been offered HPV vaccine, although some experts argue both sexes should be vaccinated to slow the spread of papilloma. The virus is estimated to cause 70% of cervical cancers and 90% of genital warts.
  • Cervical cancer is the second-most common cancer for Canadian women aged 20 to 44.
  • A variety of recent studies has been finding the DNA from the common virus inside cancer tumours.
  • "What's interesting is that we're finding -- and we've known this for a while, but we're beginning to appreciate it -- that HPV plays a role in other 'mucosal' cancers," Dr. Bauman said.
  • This means a variety of cancer types in the tonsils, pharynx, and the base of the tongue, the upper digestive tract; also the vulva, penis, vaginal and anal canals. None is as common as cervical cancer. HPV doesn't appear to cause prostate cancer
  • HPV vaccine is too new for anyone to measure its success yet in preventing these cancers. But a wave of recent studies has indicated a connection between HPV infection and developing such cancers in the first place:
  • - A 2007 study at Johns Hopkins Kimmel Cancer Centre found oral HPV infection is "the strongest risk factor" for a relatively uncommon throat cancer called oropharyngeal cancer. The virus raised the risk of the cancer by 32 times compared to people with no HPV infection;
  • - In 2004, the Journal of the National Cancer Institute reported DNA from the HPV virus was present in 10% to 20% of all head and neck squamous cell tumours; and
  • - The Dartmouth Medical School in New Hampshire reported HPV may cause a common type of skin cancer. It cautions that sun exposure is still the main cause.
  • Tom Spears, CanWest News Service, Monday, January 25, 2010. http://www.nationalpost.com/news/canada/story.html?id=2480874

Against the Use of HPV Vaccine

Alliance for Natural Health calls for an urgent scientific inquiry into the HPV vaccine used in the UK.

The Alliance for Natural Health (ANH) today calls for an independent Inquiry into the safety of HPV vaccine, and appeals to all Members of Parliament to press for this.

The ANH says: "Young girls in the UK-as well as their parents and guardians-deserve to have the full facts on the risks and benefits of this vaccine to help them make properly informed choices."

Reports of serious and even lethal adverse reactions to the Human Papilloma Virus (HPV) vaccine, Cervarix, manufactured by GlaxoSmithKline, raise grave concerns over the safety of the vaccine. While its closely related vaccine, Gardasil, manufactured by Merck, is recognised by the US Centers for Disease Control (CDC) to trigger severe reactions, including permanent disability, life-threatening illness and death, equivalent data in the UK appears not to be publicly available.

The tragic case of 14-year-old Natalie Morton's death just two hours following her vaccination, which was reported by the pathologist in her post mortem as being completely independent of the vaccine, has been described as "implausible", and raises further questions about the accuracy of reporting.

The role of the HPV vaccine in the development of disabling symptoms in the cases of Stacey Jones (18), Rebecca Ramagge (13), Lisa Wickenden (13), Carly Steel (13) and Ashleigh Cave (13) appears to be unresolved and circumstantial evidence would suggest that Cervarix may have been at least a contributing factor in their respective conditions.

Dr Diane Harper of the University of Missouri, who was directly involved in clinical trials on HPV vaccines, is among a growing number of scientists who have publicly expressed their concerns over the vaccines' safety.

Cervarix was approved for use in the European Union in September 2007 for the prevention of precancerous changes of the cervix in girls and women between the age of 10 and 25. The vaccination programme started in September 2008 for girls aged 12 to 13, delivered in three injections over 6 months. There is a new, accelerated catch-up programme for girls aged 15 to 18 years starting in September 2009, due to complete by end of the academic year 2010.

Given the number of girls, the lack of transparency on the frequency and type of adverse reactions, as well as the possibility of long-term effects on the reproductive system, the Alliance for Natural Health is requesting all Members of the UK Parliament to put pressure on the Government to initiate an independent and fully transparent scientific inquiry on the short and long term effects of the vaccine.

The Alliance for Natural Health is an international campaign organisation comprised of scientists, doctors, lawyers, practitioners and consumers. Working to promote natural and sustainable approaches to health through the use of 'good science' and 'good law'.

Executive Director of the Alliance for Natural Health, Robert Verkerk, stated; "Presently, there are no adequate data available on the comparative risks of Cervarix and Gardasil. Nor is there adequate information on the factors which may predispose certain individuals to serious adverse reactions, or on the duration and effectiveness of immunity following single and multiple vaccinations. It is in the public interest that these key questions be answered urgently by an independent review panel".

ANH Medical Director Dr Damien Downing said; "When leading scientists involved in the development of HPV vaccine lose faith in its efficacy, and reports of serious reactions and deaths following vaccination mount, parents are entitled to independent information on these concerns before submitting their children to vaccination". Press Release (2009) Urgent Call for HPV Vaccine Inquiry

Conclusion

After careful consideration of the medical evidence and public health implications that I have read, I find it critical that we understand the context of the debate as it is no less important to the task of responding to the public concerns.

School health personnel currently have the front line role in the discussion about HPV immunization with parents. Being able to clearly articulate the arguments presented by parents can help authorities' responsiveness to parents and community groups as the dialogue about this particular health issue evolves further.

Controversy is grounded in moral, religious, political, economic, and social-cultural arguments including whether concerns that the vaccine increases sexual risk taking, sends mixed messages about abstaining from sexual intercourse, usurps parental authority, and increases the potential for development of new health inequalities are offset by the value of administering a cost-effective, age-appropriate public health measure targeting a life-threatening problem.

After hunting for evidence of support for the HPV vaccine i discovered that this was a rather hard task to accomplish, i believe this is because many professionals and medical / scientific bodies do not want to put their reputations on the line to back the vaccine until more evidence is gathered. Having said this i did find these two articles.

Finally I believe more testing should be completed especially as they are now considering rolling the vaccine out to the males at secondary school now.

Bibliography

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  • http://www.nhs.uk/Conditions/HPV-vaccination/Pages/Side-effects.aspx
  • http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_what_is_cervical_cancer_8.asp
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  • http://news.bbc.co.uk/1/hi/8279855.stm
  • http://www.imperialcancer.co.uk
  • http://www.cancerhelp.org.uk
  • http://www.cervicalcancerinfo.co.uk/index.asp
  • http://www.anhcampaign.org/
  • http://www.nationalpost.com/news/canada/story.html?id=2480874
  • http://www.immunisation.nhs.uk/Library/News/HPV_vaccine_Press_Release_20-06-07
  • The HPV Vaccine Controversy: Sex, Cancer, God, and Politics: A Guide for Parents, Women, Men, and Teenagers Shobha S Krishnan Praeger Publishers 2008
  • http://www.dailymail.co.uk/health/article-1167803/How-safe-cervical-cancer-jab-Five-teenagers-reveal-alarming-stories.html Rachel Porter 05/04/09
  • http://www.independent.co.uk/life-style/health-and-families/health-news/dont-panic-over-cancer-jab-charity-urges-1794865.html Mark Bulstrode 29 September 2009
  • http://www.guardian.co.uk/commentisfree/2009/oct/04/hpv-vaccine-media-natalie-morton Tom Sheldon 4 October 2009
  • http://content.nejm.org/cgi/content/full/359/8/861 Charlotte J. Haug, M.D., Ph.D. 21st August 2008
  • http://www.kaiseredu.org/topics_im.asp?id=609&imID=3&parentID=72
  • http://jama.ama-assn.org/cgi/content/full/302/7/795 Charlotte Haug, MD, PhD, MSc 19th August 2009
  • http://www.naturalnews.com/HPV_vaccine.html
  • http://childhealthsafety.wordpress.com/2009/05/31/germany-hpv/
  • http://www.sciencebasedmedicine.org/?p=98
  • http://www.medicinenet.com/script/main/art.asp?articlekey=104789
  • The HPV Vaccine: Framing the Arguments FOR and AGAINST Mandatory Vaccination of All Middle School Girls Vamos, C. A. McDermott, R. J. Daley, E. M. BLACKWELL PUBLISHING LTD 2008
  • www.immunisation.nhs.uk/files/HPV_conf_report.pdf
  • http://www.vaccineriskawareness.com/The-Herd-Immunity-Theory-Treating-Our-Children-Like-Cattle
  • http://www.firstscience.com/home/news/breaking-news-all-topics/who-s-afraid-of-the-hpv-vaccine_77273.html
  • http://www.guardian.co.uk/society/2007/jun/19/cancercare.health Kira Cochrane 19 June 2007
  • http://www.britishscienceassociation.org/NR/rdonlyres/26679A38-177B-45CD-BFA7-483D5FA2B5D8/0/BrowniePointsandSTEMinParliament.pdf
  • http://www.medworm.com/rss/search.php?qu=Ceravix+Gardasil++(%2B(HPV+%22human+papillomavirus%22+%22human+papilloma+virus%22+(%2Bcervical+%2B+cancer*))+%2B(vaccin*+jab*+immunization*+immunisation*))&t=Cervical%20Cancer%20Vaccine&f=vaccines&s=Search&r=Any&o=d&page=37
  • http://www.independent.co.uk/extras/big-question/the-big-question-is-the-cervical-cancer-vaccine-safe-and-should-girls-stop-taking-it-1795184.html?action=Popup
  • Unknown (2008), What Is Cervical Cancer? [Online Through Times Online]

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