One of the few vaccines to prevent a sexually transmitted disease - and the only one to possibly prevent cancer - is opening debate in homes and doctors' offices across Greater Cincinnati and Northern Kentucky.
At issue: Should preteen girls be given a shot against the human papilloma virus, or HPV? Or, are 11- and 12-year-olds too young? And if parents want the vaccine for their young daughters, as a Centers for Disease Control and Prevention committee recommends, how much detail do they need to get into?
Questions have been raised nationwide since June, when the government recommended that physicians begin immunizing girls "before the onset of sexual activity." The vaccine, Gardasil, protects against the four most common types of HPV, which are known to cause 70 percent of cervical cancers.
As local pediatricians begin administering the vaccine, they're hearing opinions on all sides.
Dr. Donald Nofziger, of Shalom Pediatric Associates in Mount Auburn, began administering the vaccine two weeks ago and has 25 patients on a waiting list.
"I had parents calling me saying, 'I want my daughter to have it as soon as it comes out,' " Nofziger says.
Diane Penny of Pleasant Run plans to immunize her 11- and 13-year-old daughters now. Her 10-year-old will receive the vaccine next year.
But some parents are choosing to delay the vaccine until the topic of sex and sexually transmitted disease seems more plausible.
"I don't think it would be remotely necessary yet," says Amy Groff of Wyoming, who has an 11-year-old daughter. "Maybe I'm being naïve. I know things happen. But I'm not for (the vaccine) at this age."
Some physicians agree.
"I don't necessarily start talking about (sexually transmitted diseases) at 11 or 12. I'm in a suburban area. But if I was in a Children's Hospital clinic, I'd be talking about it," says Dr. Kathryn O'Malley, a pediatrician with Muddy Creek Pediatrics in Mason.
Focus on the Family, a Judeo-Christian-based religious organization, encourages abstinence and faithfulness in marriage as the "best and primary practice" to prevent sexually transmitted diseases. However, it also supports the "widespread availability of HPV vaccines" and "parents' rights to be the primary decision maker and educator for their children," according to a statement issued by the ministry.
Dr. Jessica Kahn, an associate professor of pediatrics at the University of Cincinnati and a lead researcher into physician and parental acceptance of the HPV vaccine, sees the immunization as an opportunity to open the lines of communication with both her patients and her 11-year-old daughter.
"Preteens are still influenced by parents, so I think it's a really good time to talk to them about sex and sexuality and your values," Kahn says. "Once they get to (age) 13, 14, 15, 16, when parents feel more comfortable talking about it, they care more about what their peers think."
Kahn's daughter will receive the vaccine at her next medical checkup.
Limited disclosure may be the answer for parents such as Penny who want their daughters to receive the vaccine but don't want to discuss sexually transmitted diseases.
"If she asks, I'll just say that it's like when you have a cold and you're contagious. HPV can be contracted just as well by skin-to-skin contact," Penny says.
Because the immunization can be administered at the same time as the vaccine for bacterial meningitis and the tetanus booster shot, which girls already receive at ages 11 and 12, physicians hope the HPV vaccine will become much like the vaccine for hepatitis B, which is administered to infants.
"If it were given in a package with two other vaccines, it would just be, 'This is what you get at this age,' " says Amy Bailes of Blue Ash. Bailes will decide whether to immunize her 11-year-old daughter at her annual check-up next summer.