6 ms·

And note i believe they just increased the recommended age of administration up to ~40yo? Throat cancer sucks. Get the vax.

deleted 1y ago
[deleted]
sillyfluke 1y ago
Why is there an age limit on an all encompassing vax, wasn't the famous posterchild for this disease Michael Douglas?
- JumpCrisscross 1y ago
  > Why is there an age limit on an all encompassing vax Vaccines are subject to stringent safety standards since they’re administered to healthy people. The age limit may suggest that at the time of the recommendation, in the relevant jurisdiction, the manufacturer had not studied its safety and efficacy in >40 year olds. (I also don’t think it’s an age limit as much as the upper end of a recommendation.)
  - LorenPechtel 1y ago
    It's an age limit to the approval caused by a lack of studies. To study it in over 45s you need suitable over 45s--but there aren't a lot of over 45s with risk but not prior exposure.
  - loeg 1y ago
    E.g., the Shingles vaccine simply hasn't been tested in <50 populations. But if you're under 50 and you've had the chicken pox, you should ask your PCP to prescribe the shingles vaccine off-label and go get it, because shingles sucks and the vaccine definitely works.
    - _heimdall 1y ago
      I don't follow your logic here. The GP comment is saying that the vaccine isn't available for populations it hasn't been tested for. Why are you recommending people ignore the fact that safety and efficacy testing isn't available for their population? And how can you say the vaccine definitely works for populations it hasn't been tested on?
- JohnTHaller 1y ago
  It's likely that they haven't tested it as thoroughly in older folks and that most older folks have already been exposed to HPV.
  - codr7 1y ago
    Already exposed without having any issues from it.
    - tehjoker 1y ago
      That last part doesn't matter. You can develop cancer later.
- ZeroGravitas 1y ago
  This is mostly guesswork but I think you need to get the vaccine before you catch it and lots of people have it as they get older. If you have a limited supply the greater bang per buck would be to start with the young people who almost certainly haven't caught it yet and then work your way up.
  - OneDeuxTriSeiGo 1y ago
    It's less that and more "we just haven't tested it in older populations yet". Sure you are more likely to have it the older you are but even then you are unlikely to have all the strains. The vaccine covers like 9 or 10 different strains so it can protect you from the other strains even if you already have one of them. It's generally only when you get into the 60s and up that the justification for not recommending the vaccine changes. Once you get into those later years the immune response changes a bit and you get new concerns. An example being herpes zoster (chickenpox) where after a certain age you are recommended to get the shingles vaccine instead of the chickenpox vaccine since the way the disease presents and how the body reacts to it changes with age (technically shingles can happen at any age but generally herpes zoster presents as shingles instead of chickenpox the older you get).
    - ranma42 1y ago
      > you are recommended to get the shingles vaccine instead of the chickenpox vaccine since the way the disease presents and how the body reacts to it changes with age (technically shingles can happen at any age but generally herpes zoster presents as shingles instead of chickenpox the older you get). If the underlying virus is the same, what is different between the vaccines? How it presents shouldn't matter as much?
      - OneDeuxTriSeiGo 1y ago
        > what is different between the vaccines? The shingles vaccine is a larger/more aggressive dose than the chickenpox vaccine. And nowadays chickenpox vaccine uses live attenuated viruses (i.e. modified to be non-infectious but still look the same) whereas the shingles vaccine uses recombinant proteins. This allows the shingles vaccine to deliver the higher viral load that they want for inoculating against shingles without putting a bunch of live viruses into the body. It's also worth noting that the recombinant vaccine is more effective for shingles compared to the equivalent viral load live vaccine by a significant margin. It's something like 90% reduction in incidence vs 50%. ---------- > How it presents shouldn't matter as much? It's not an all or nothing thing but it's a matter of percentages. And the big reason why they present differently is that chickenpox kind of attacks every part of the body since it's new. It of course does best at infecting the skin and nerves but it mildly affects every part of the body. But then it goes dormant in the nerves because that's where it's most "compatible" and the body is the worst at fighting it. So then with shingles your body still has the immunity but the reactivated virus is able to out-compete your immunity in the nerves and it wakes up in whatever specific nerve and spreads along that nerve. This is why shingles generally presents in a band on the body. It's spreading along a specific nerve "line" rather than spreading throughout the whole body, blood, and all. And so the because the infection can't spread broadly throughout your body it ends up concentrated in that location and presumably the higher viral load combined with focusing on the specific proteins rather than the whole virus increases the body's sensitivity to these flair ups, catching them before they can reach momentum. And then that focused immune training sits on top of the body's existing immunity for the initial "whole body" presentation of the virus.
- Fomite 1y ago
  To be blunt: Cost-effectiveness.
  - vharuck 1y ago
    In the US, recommendations come from the United States Preventive Services Task Force. They explicitly do not consider cost in their decisions. They look at harm vs benefit, usually with a focus on mortality reduction. Most insurance companies will base their coverage on the USPSTF. https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.htm...
    - fsckboy 1y ago
      if you suspect that the cdc has been captured by big pharma, "and we don't care about cost of these recommended drugs" should pretty much seal the deal for you :)
      - epistasis 1y ago
        Oh wow how the conspiracy theories change. There used to be fears of "death panels" controlling access to medical care when Clinton tried to propose universal health care. The CDC and FDA are about safety, not cost management. And they get significant complaints about how much they regulate pharma and are impediments to pharma for that! Now the conspiracy theorists of the other side seem to be having their day in the public mind.
        fsckboy 1y ago
        clear financial incentives are never conspiracy theories: always follow the money. thinking that they are conspiracy theories? that's a conspiracy theorist.
        epistasis 1y ago
        There's no clear financial incentive on the decisions here. If there were, it would be collusion, and not in the open, and therefore not clear.
- phkahler 1y ago
  Conspiracy theory: they want old people to die.
  - user432678 1y ago
    Finally, affordable housing!
    - pixelpoet 1y ago
      Yeah, screw those old people with their houses! We should deliberately kill them off so that we can have cheaper houses! But please, don't let the next generation do that to us when housing turns out to be expensive for them too! Brilliant.
      - user432678 1y ago
        Fun fact, that’s what happened in my country of birth, which is USSR. To some extent.
      - robocat 1y ago
        I have yet to see my government subsidise dangerous recreations based on a cost benefit analysis. I think government costs for a retiree are about NZD27000 a year. A government should be subsidising a good deadly recreation for say NZD10000 a year. Assume expected life remaining is 10 years, assume recreation has a 10% chance of clean death, assume low chance of expensive ongoing chronic outcomes. Suggestions: Car racing, climbing, fentanyl habit, boat racing, ocean sports, Russian roulette, foreign legion soldiering, free climbing, wingsuiting. Maybe a better way would be to allow people to gamble with their lives to win a few tens of thousands (need to balance costs against expected savings). Pay out to winners, but saves the government their expected lifetime of expenses for the losers. Let the old and unhappy roll-the-dice and the winners get to live it up a little . . .
      - attila-lendvai 1y ago
        we're joking here... but GAVI is bill gates, who is saying very similar things in his "there are too many of us" talks... makes one wonder...
- BjoernKW 1y ago
  The rationale is that most sexually active people have already been infected with HPV anyway, so the largest benefit of administering the vaccine is at a young age.
- colingauvin 1y ago
  A lot of replies that are mostly true, or somewhat true, or simply missing the real reasons. There are two factors here: 1) Vaccine-derived immunity is a function of the individual's immune response, which in general, weakens significantly with age. It is not unrealistic for a vaccine to simply fail to elicit any response in someone old enough. 2) It is very, very difficult to recruit folks without HPV that are over 40 for a clinical trial. Most people of that age, who were never immunized, most likely have had it. This significantly convolutes the signal. 3) This is all especially confounded once something becomes "standard of care". Every year there are fewer and fewer people age 40+ with HPV. For these reasons, the vaccine is currently officially ??? in people over 40. Most doctors will prescribe it anyways if you ask. It may or may not infer immunity. It almost certainly will not harm you.
vidarh 1y ago
In the UK, the recommendation is up to 45, but there are providers that offer it without an upper limit.

deleted 1y ago

[deleted]

sillyfluke 1y ago

Why is there an age limit on an all encompassing vax, wasn't the famous posterchild for this disease Michael Douglas?

JumpCrisscross 1y ago
> Why is there an age limit on an all encompassing vax Vaccines are subject to stringent safety standards since they’re administered to healthy people. The age limit may suggest that at the time of the recommendation, in the relevant jurisdiction, the manufacturer had not studied its safety and efficacy in >40 year olds. (I also don’t think it’s an age limit as much as the upper end of a recommendation.)
- LorenPechtel 1y ago
  It's an age limit to the approval caused by a lack of studies. To study it in over 45s you need suitable over 45s--but there aren't a lot of over 45s with risk but not prior exposure.
- loeg 1y ago
  E.g., the Shingles vaccine simply hasn't been tested in <50 populations. But if you're under 50 and you've had the chicken pox, you should ask your PCP to prescribe the shingles vaccine off-label and go get it, because shingles sucks and the vaccine definitely works.
  - _heimdall 1y ago
    I don't follow your logic here. The GP comment is saying that the vaccine isn't available for populations it hasn't been tested for. Why are you recommending people ignore the fact that safety and efficacy testing isn't available for their population? And how can you say the vaccine definitely works for populations it hasn't been tested on?
JohnTHaller 1y ago
It's likely that they haven't tested it as thoroughly in older folks and that most older folks have already been exposed to HPV.
- codr7 1y ago
  Already exposed without having any issues from it.
  - tehjoker 1y ago
    That last part doesn't matter. You can develop cancer later.
ZeroGravitas 1y ago
This is mostly guesswork but I think you need to get the vaccine before you catch it and lots of people have it as they get older. If you have a limited supply the greater bang per buck would be to start with the young people who almost certainly haven't caught it yet and then work your way up.
- OneDeuxTriSeiGo 1y ago
  It's less that and more "we just haven't tested it in older populations yet". Sure you are more likely to have it the older you are but even then you are unlikely to have all the strains. The vaccine covers like 9 or 10 different strains so it can protect you from the other strains even if you already have one of them. It's generally only when you get into the 60s and up that the justification for not recommending the vaccine changes. Once you get into those later years the immune response changes a bit and you get new concerns. An example being herpes zoster (chickenpox) where after a certain age you are recommended to get the shingles vaccine instead of the chickenpox vaccine since the way the disease presents and how the body reacts to it changes with age (technically shingles can happen at any age but generally herpes zoster presents as shingles instead of chickenpox the older you get).
  - ranma42 1y ago
    > you are recommended to get the shingles vaccine instead of the chickenpox vaccine since the way the disease presents and how the body reacts to it changes with age (technically shingles can happen at any age but generally herpes zoster presents as shingles instead of chickenpox the older you get). If the underlying virus is the same, what is different between the vaccines? How it presents shouldn't matter as much?
    - OneDeuxTriSeiGo 1y ago
      > what is different between the vaccines? The shingles vaccine is a larger/more aggressive dose than the chickenpox vaccine. And nowadays chickenpox vaccine uses live attenuated viruses (i.e. modified to be non-infectious but still look the same) whereas the shingles vaccine uses recombinant proteins. This allows the shingles vaccine to deliver the higher viral load that they want for inoculating against shingles without putting a bunch of live viruses into the body. It's also worth noting that the recombinant vaccine is more effective for shingles compared to the equivalent viral load live vaccine by a significant margin. It's something like 90% reduction in incidence vs 50%. ---------- > How it presents shouldn't matter as much? It's not an all or nothing thing but it's a matter of percentages. And the big reason why they present differently is that chickenpox kind of attacks every part of the body since it's new. It of course does best at infecting the skin and nerves but it mildly affects every part of the body. But then it goes dormant in the nerves because that's where it's most "compatible" and the body is the worst at fighting it. So then with shingles your body still has the immunity but the reactivated virus is able to out-compete your immunity in the nerves and it wakes up in whatever specific nerve and spreads along that nerve. This is why shingles generally presents in a band on the body. It's spreading along a specific nerve "line" rather than spreading throughout the whole body, blood, and all. And so the because the infection can't spread broadly throughout your body it ends up concentrated in that location and presumably the higher viral load combined with focusing on the specific proteins rather than the whole virus increases the body's sensitivity to these flair ups, catching them before they can reach momentum. And then that focused immune training sits on top of the body's existing immunity for the initial "whole body" presentation of the virus.
Fomite 1y ago
To be blunt: Cost-effectiveness.
- vharuck 1y ago
  In the US, recommendations come from the United States Preventive Services Task Force. They explicitly do not consider cost in their decisions. They look at harm vs benefit, usually with a focus on mortality reduction. Most insurance companies will base their coverage on the USPSTF. https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.htm...
  - fsckboy 1y ago
    if you suspect that the cdc has been captured by big pharma, "and we don't care about cost of these recommended drugs" should pretty much seal the deal for you :)
    - epistasis 1y ago
      Oh wow how the conspiracy theories change. There used to be fears of "death panels" controlling access to medical care when Clinton tried to propose universal health care. The CDC and FDA are about safety, not cost management. And they get significant complaints about how much they regulate pharma and are impediments to pharma for that! Now the conspiracy theorists of the other side seem to be having their day in the public mind.
      - fsckboy 1y ago
        clear financial incentives are never conspiracy theories: always follow the money. thinking that they are conspiracy theories? that's a conspiracy theorist.
        epistasis 1y ago
        There's no clear financial incentive on the decisions here. If there were, it would be collusion, and not in the open, and therefore not clear.
phkahler 1y ago
Conspiracy theory: they want old people to die.
- user432678 1y ago
  Finally, affordable housing!
  - pixelpoet 1y ago
    Yeah, screw those old people with their houses! We should deliberately kill them off so that we can have cheaper houses! But please, don't let the next generation do that to us when housing turns out to be expensive for them too! Brilliant.
    - user432678 1y ago
      Fun fact, that’s what happened in my country of birth, which is USSR. To some extent.
    - robocat 1y ago
      I have yet to see my government subsidise dangerous recreations based on a cost benefit analysis. I think government costs for a retiree are about NZD27000 a year. A government should be subsidising a good deadly recreation for say NZD10000 a year. Assume expected life remaining is 10 years, assume recreation has a 10% chance of clean death, assume low chance of expensive ongoing chronic outcomes. Suggestions: Car racing, climbing, fentanyl habit, boat racing, ocean sports, Russian roulette, foreign legion soldiering, free climbing, wingsuiting. Maybe a better way would be to allow people to gamble with their lives to win a few tens of thousands (need to balance costs against expected savings). Pay out to winners, but saves the government their expected lifetime of expenses for the losers. Let the old and unhappy roll-the-dice and the winners get to live it up a little . . .
    - attila-lendvai 1y ago
      we're joking here... but GAVI is bill gates, who is saying very similar things in his "there are too many of us" talks... makes one wonder...
BjoernKW 1y ago
The rationale is that most sexually active people have already been infected with HPV anyway, so the largest benefit of administering the vaccine is at a young age.
colingauvin 1y ago
A lot of replies that are mostly true, or somewhat true, or simply missing the real reasons. There are two factors here: 1) Vaccine-derived immunity is a function of the individual's immune response, which in general, weakens significantly with age. It is not unrealistic for a vaccine to simply fail to elicit any response in someone old enough. 2) It is very, very difficult to recruit folks without HPV that are over 40 for a clinical trial. Most people of that age, who were never immunized, most likely have had it. This significantly convolutes the signal. 3) This is all especially confounded once something becomes "standard of care". Every year there are fewer and fewer people age 40+ with HPV. For these reasons, the vaccine is currently officially ??? in people over 40. Most doctors will prescribe it anyways if you ask. It may or may not infer immunity. It almost certainly will not harm you.

vidarh 1y ago

In the UK, the recommendation is up to 45, but there are providers that offer it without an upper limit.