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Your Child

Why the HPV Vaccine is Important for Girls and Boys

1:45

The human papillomavirus (HPV) vaccine has been embroiled in controversy almost from the day it was announced.  Many parents found the idea of giving their young daughter or son a vaccine to prevent a sexually transmitted disease (STD) repugnant. When some states included the vaccine as a requirement for school entry, the cry of government overreach rang out loud and clear.

However, as more information about the benefits of the vaccine becomes known, vaccinations have slowly been climbing.  Health officials say that compliance is nowhere near what it should be and that the opportunity to reduce 6 cancers is being lost.

Cancers linked to the sexually transmitted HPV keep rising in the United States, even though most cases are preventable, health officials said in a recent report.

Cancer experts say the public perception of the vaccine needs to change.

"In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer," said Electra Paskett. She is co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer in Columbus.

"Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes -- and we would have a dramatic decrease in HPV-related cancers across the globe," Paskett added.

At current rates, these sexually linked cancers are developing in almost 12 of every 100,000 persons, the CDC said. In the previous five-year period, fewer than 33,500 of these HPV-linked cancers were diagnosed annually.

Using data from national cancer registries, CDC analysts looked for certain cancer types -- cervical, head and neck, and anal, among them -- that have links to HPV.

When looked at closely, researchers confirmed the HPV connection in 79 percent of cases.

The agency estimates that as many as 28,500 of these were preventable with recommended HPV vaccination.

The American Academy of Pediatrics recommends routine HPV vaccination of males and females at 11-12 years of age. The vaccine is most effective if administered before the onset of sexual activity, and antibody responses to the vaccine are highest at ages 9 through 15 years. Immunization of children against HPV infection will help prevent cancers and genital warts caused by HPV.

Even though no parent likes to think about their child growing up and being sexually active- most children will become young adults and eventually have families of their own. This vaccine protects against HPV, a disease that is strongly linked to 6 deadly cancers. It is most effective when administered to children between the ages of 9 and 15. That is why it is important for young boy and girls – as simple as that.

Story sources: Margaret Farley Steele, http://www.webmd.com/cancer/news/20160707/hpv-linked-cancers-still-climbing-in-us

https://www.aap.org/

Your Child

Teeth Grinding and Children

2:00

When parents check in on their sleeping child, the grinding sound of teeth is not what they expect to hear.  While it may be a bit unsettling for parents, it’s not uncommon. 

The medical term for this condition is called bruxism and 2 to 3 out of every 10 kids will grind their teeth or clench their jaws during sleep, according to experts.

Bruxism often occurs during deep sleep phases or when kids are under stress.

None knows for sure why bruxism happens. In some cases, kids may grind because the top and bottom teeth aren't aligned properly. Others do it as a response to pain, such as from an earache or teething. Kids might grind their teeth as a way to ease the pain, just as they might rub a sore muscle. Many kids outgrow these fairly common causes for grinding.

Children under stress may also grind their teeth or clench their jaw. Worry over a test or a change in routine can be released through teeth grinding during sleep. More serious family problems or being the recipient of bullying can prompt bruxism. Some kids who are hyperactive also have bruxism. And sometimes kids with other medical conditions (such as cerebral palsy) or who take certain medicines can develop bruxism.

The suspected reasons are many.

The effects of undetected teeth grinding can vary as well. Sometimes, kids have little or no effect from light teeth grinding.  However, other children may experience headaches or earaches. In some cases, nighttime grinding and clenching can wear down tooth enamel, chip teeth, increase temperature sensitivity, and cause severe facial pain and jaw problems, such as temporomandibular joint disease (TMJ).  Most kids who grind, however, don't have TMJ problems unless their grinding and clenching happen a lot.

Most of the time kids aren’t aware that they are grinding their teeth. A sibling or parent usually discovers it.

What should you do if your child has bruxism? You can talk with pediatrician about it and a visit to the dentist is a good idea. Your dentist can check for chipped enamel and unusual wear and tear on your child’s teeth as well as misaligned teeth.

Most children will outgrow bruxism, but a combination of parental observation and dental visits can help keep the problem in check until they do.

If your child’s grinding and clenching is caused by, or is causing, a dental problem, the dentist may prescribe a special mouth guard that is worn at night. It looks similar to protective mouthpieces worn by athletes. While it may take a little time to get used to, positive results typically happen quickly.

For bruxism that's caused by stress, ask about what's upsetting your child and find a way to help. For example, a kid who is worried about being away from home for a first camping trip might need reassurance that mom or dad will be nearby if needed.

If the issue is more complicated, such as moving to a new town, discuss your child's concerns and try to ease any fears. Talk to your pediatrician if you’re concerned that your child may need professional help with discussing what is bothering him or her.

In rare cases, basic stress relievers aren't enough to stop bruxism. If your child has trouble sleeping or is acting differently than usual, your dentist or doctor may suggest further evaluation. This can help find the cause of the stress and a proper course of treatment.

Because some bruxism is a child's natural reaction to growth and development, most cases can't be prevented. Stress-induced bruxism can be avoided, though. So talk with kids regularly about their feelings and help them deal with stress. Taking kids for routine dental visits can help find and treat bruxism.

Story source: Kenneth H. Hirsch, DDS, http://kidshealth.org/en/parents/bruxism.html#

Your Child

Promising New Peanut Allergy Patch

1:30

Peanut allergies can be life-threatening for some children, but a new “peanut patch” may be the solution their parents have been searching for.

The small skin patch – known as Viaskin® Peanut -is applied to the child’s skin and appears to offer safe and effective protection against this serious condition.

“This is exciting news for families who suffer with peanut allergies because Viaskin represents a new treatment option for patients and physicians,” study author Hugh A. Sampson, a doctor at Kravis Children’s Hospital at Mount Sinai, said in a statement.

Based on the principle of epicutaneous immunotherapy (EPIT), the patch delivers small doses of peanut proteins when placed on patients’ skin.

The team of researchers completed a double blind, placebo-controlled randomized Phase IIb trial in which 221 individuals with peanut allergies underwent the therapy for a year.

The patch exposed patients to a small dose of peanut protein, ranging from 50 to 250 micrograms, for the course of the study.

The 250 µg peanut patch shows the most promise for researchers. “After one year of therapy, half of the patients treated with the 250 micrograms patch tolerated at least 1 gram of peanut protein – about four peanuts —which is 10 times the dose that they tolerated in their entry oral peanut challenge,” Sampson explained.

Compliance was greater than 95% and less than 1% of the participants dropped out of the study due to adverse symptoms. In fact, there were no serious adverse reactions related to the patch treatment.

Overall, children treated with the larger patch experienced a robust increase (19 fold) in peanut-specific IgG4 levels, the antibody associated with protection following immunotherapy.

“EPIT appears safe, well tolerated and effective. That’s good news for families who suffer from food allergies,” Sampson said.

While the results are promising, researchers will continue to follow the participants for another year. It could be several more years before the patch become available for consumers, but there is hope on the horizon.

Source: http://www.aaaai.org/about-the-aaaai/newsroom/news-releases/peanut-patch.aspx

Justin Worland, http://time.com/3718529/peanut-patch-allergy/

Your Child

Pre-teen Football Linked to Brain Changes in NFL Players

2:00

The start of a new school year also brings after-school sports programs. Late summer and fall is prime football season for many middle and high schools. In some states, it’s a hallowed tradition that boys and girls look forward to participating in whether it’s running down the field or cheering on the team.

While school football doesn’t typically offer the same ferocious body beating and brain –rattling that are seen in the National Football League (NFL), a new study shows that brain development can still be affected by playing football at a young age.

The study looked at the possible connection between a greater risk of altered brain development in NFL players who started playing football before the age of twelve as opposed to those players who began playing later in life.  The study is the first to show a link between early repetitive head trauma and future structural brain variations.

The study was small but interesting. It included a review of 40 former NFL players between the ages of 40 and 65 who played over 12 years of structured football with a minimum of 2 years at the NFL level.

One half of the players took up football prior to the age of 12 and half started at age 12 or later. The number of concussions suffered was very similar between the two groups. All of these players had a minimum of six months of memory and cognitive issues.

"To examine brain development in these players, we used an advanced technique called diffusor tensor imaging (DTI), a type of magnetic resonance imaging that specifically looks at the movement of water molecules along white matter tracts, which are the super-highways within the brain for relaying commands and information," study author Dr. Inga Koerte, professor of neurobiological research at the University of Munich and visiting professor at Harvard University, said in a press release.

The researches believe their findings add to the growing amount of scientific evidence that shows the brain may be especially vulnerable to injury between the ages of 10 and 12.

"Therefore, this development process may be disrupted by repeated head impacts in childhood possibly leading to lasting changes in brain structure," said study author Julie Stamm, currently a post-doctoral fellow at the University of Wisconsin School of Medicine and Public Health.

Despite finding a link to the brain development window where kids are more likely to suffer brain injury by repeated head impacts, the small size of the study means the results may not necessarily apply to non-professionals.

"The results of this study do not confirm a cause and effect relationship, only that there is an association between younger age of first exposure to tackle football and abnormal brain imaging patterns later in life," said study author Martha Shenton, a professor of psychiatry at Harvard Medical School.

Because of the intense publicity about and the findings of many studies on the short and long-term dangers of concussions, many school sports programs are looking at changing how they allow students to play in games associated with head injuries.  Where it was once common for coaches to let players continue playing after a particularly rough tackle or head butting, they are more likely now to insist that a field medical professional examine the child. Some schools are also implementing no tackle policies to protect very young players.

While traditional football isn’t likely to become extinct, parents and coaches can educate themselves about brain injuries and learn how to best protect young players from the chances of long and short-term disabilities.

Source: Brett Smith,  http://www.redorbit.com/news/health/1113407634/pre-teen-football-linked-to-more-severe-brain-changes-in-nfl-players-081115/

 

 

Your Child

Study: Exercise, Once Again, Improves Kid’s Learning Skills

2:00

While the debate on whether to bring back recess to school curriculums continues across the U.S., a small study from the Netherlands once again shows that adding exercise to a child’s school day can improve their learning skills.

Researchers worked with 500 children in second and third grade, giving half of them traditional lessons while the rest received instruction supplemented with physical activity designed to reinforce math and language lessons.

The approach was a creative and unique way to helping children better comprehend math and spelling.  Instead of taking a recess break – exercise was actually incorporated into the lesson.

After two years, children who got the physically active lessons had significantly higher scores in math and spelling than their peers who didn't exercise during class.

"Previous research showed effects of recess and physical activity breaks," said lead study author Marijke Mullender-Wijnsma, of the University of Gronigen in The Netherlands.

"However, we think that the integration of physical activity into academic lessons will result in bigger effects on academic achievement," Mullender-Wijnsma added in an email to Reuters Heath.

Mullender-Wijnsma and colleagues developed a curriculum that matched typical lessons in academic subject matter but added physical activity as part of instruction. They tested it in 12 elementary schools.

Here’s how it worked.

Lessons involved constant practice and repetition reinforced by body movements. For example, children jumped in place eight times to solve the multiplication problem 2 x 4.

Children in the exercise group received 22 weeks of instruction three times a week during two school years. These lessons were up to 30 minutes long, and evenly split between math and spelling instruction.

During the first year of the study, there wasn’t a great deal of difference found between the students receiving exercise during the class and those that didn’t, when speed was the focus in the math tests.

However, after two years, children who received exercise-based instruction had significantly higher scores on the math speed exams than students who didn't. The difference over two years equated to more than four months of additional learning for the students who had physically active lessons.

When the focus was on lesson comprehension, students receiving exercise outperformed students who did not receive the exercise instruction in both the first and second year. Again, the progress amounted to about four more months of learning.

For spelling, there wasn't a significant difference between the student groups after one year. But by the end of the second year they did have significantly better test scores, once again, adding an additional four more months of learning.

For reading, there wasn’t much difference between the two groups. It's possible that physical activities may be more beneficial to learning that involves repetition, memorization and practice of lessons from previous classes, the researchers conclude.

Researchers did point out that there were limitations that could have impacted the results of the study during the first year. The exercise group received specially trained teachers and individual schools administered the tests.

The research team did not examine why exercise might have helped students do better during tests.

 Sara Benjamin Neelon, of Johns Hopkins University and colleagues write in an accompanying editorial that it’s not clear whether these types of classes would work in countries where the population is larger, more diverse and students come from different socioeconomic backgrounds.

"However, the take-home message for parents and teachers is that physically active lessons may be a novel way to increase physical activity and improve academic performance – at the same time," Benjamin Neelon said by email.

More and more studies show that exercise appears to help the brain function better in children and adults. Whether all U.S. school administrations will see adding recess or exercise back into school curriculums is anybody’s guess, but according to science – it sure couldn’t hurt and might even help students develop stronger learning skills.

The study was published in the online journal Pediatrics.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-children-fitness-learning-idUSKCN0VX26V

Your Child

The Debate: Homework or No Homework?

1:45

Does homework improve a student’s academic achievement or does it interfere with family time and create a negative learning experience? That’s part of the debate that is currently going on over whether homework is a good or bad thing for students.

Brandy Young, a second grade teacher in Godley, Texas, recently made the news when a letter she gave to her student’s parents, went viral on social media.

Young said that she was dropping homework from her curriculum for the new school year.

"Research has been unable to prove that homework improves student performance," Young wrote. "Rather, I ask that you spend your evenings doing things that are proven to correlate with student success. Eat dinner as a family, read together, play outside, and get your child to bed early."

That made a lot of Young’s students very happy.

According to the Association for Supervision and Curriculum Development (ASCD), homework has had a fluid history.

“Throughout the first few decades of the 20th century, educators commonly believed that homework helped create disciplined minds. By 1940, growing concern that homework interfered with other home activities sparked a reaction against it. This trend was reversed in the late 1950s when the Soviets' launch of Sputnik led to concern that U.S. education lacked rigor; schools viewed more rigorous homework as a partial solution to the problem. By 1980, the trend had reversed again, with some learning theorists claiming that homework could be detrimental to students' mental health. Since then, impassioned arguments for and against homework have continued to proliferate.”

The case for homework involves several studies noting that student’s academic achievements improve when they are given meaningful homework and they complete assignments. A number of synthesis studies have been conducted on homework, spanning a broad range of approaches and levels of selectivity.  One such account, known as The Cooper Study, included more than 100 firsthand research reports, and the Cooper, Robinson, and Patall (2006) study included about 50 empirical research reports. Conclusions from their studies stated,  “With only rare exceptions, the relationship between the amount of homework students do and their achievement outcomes was found to be positive and statistically significant. Therefore, we think it would not be imprudent, based on the evidence in hand, to conclude that doing homework causes improved academic achievement.”

The case against homework also cites several studies that suggest homework doesn’t improve students’ learning but instead overvalues work to the detriment of personal and familial wellbeing.

Some no-homework activists say that extended school hours work better for helping students learn and retain knowledge.

Several popular books have been written taking the no-homework stand; one is The Homework Myth: Why Our Kids Get Too Much of a Bad Thing by Alfie Kohn. 

If homework needs to be assigned, Kohn suggest teachers should make sure that the assignments are beneficial, ideally involving students in activities appropriate for the home, such as performing an experiment in the kitchen, cooking, doing crossword puzzles with the family, watching good TV shows, or reading. Kohn also urged teachers to involve students in deciding what homework, and how much, they should do. One idea is that family participatory homework exercises can help students learn practical applications with school subjects and receive more bonding time in the process.

Many education experts believe homework provides valuable tools for student learning but also agree that meaningful homework should always be the goal and not assigned as a matter of policy.

Research has also shown that while students are typically assigned homework from Kindergarten to 12th grade, there has been no specific consensus on the benefits of homework at the early elementary grade levels, however, older students do improve their grades with homework.

Many parents are still uncertain about how they feel about homework. Some will tell you that their child has far too much assigned during the week and over the weekends, but they are not quite ready to chuck homework altogether. 

It’s an interesting debate that will continue to garner attention.

Whether you believe homework is necessary for better learning or is an obstacle to student achievement, one thing both sides can agree on is that parental involvement is the key ingredient to a happier and more prepared student.

Story source: Robert J. Marzano and Debra J. Pickering,

http://www.ascd.org/publications/educational-leadership/mar07/vol64/num06/The-Case-For-and-Against-Homework.aspx

 

 

Your Child

The Most Common Childhood Injuries

2:00

Like many folks, most of my injuries happened when I was a child. Kids - with their excess energy - like to run, climb, jump, hide, swim, dive, bike, rollerblade, skateboard, and fall from heights – to name just a few activities!

Hands, elbows, and knees are the places most likely to get hurt. You can treat minor bumps and bruises at home.

For cuts and scrapes, rinse the area under running water until it’s clean. You can use mild soap. Apply some antibiotic ointment and cover it with a bandage. Call the doctor if the cut is large, deep, or if the area becomes red and swollen, or you see pus -- these are signs of infection. 

For bruises, soothe the swelling with an ice pack wrapped in a wet cloth. If your kid has trouble walking or moving, or the swelling doesn’t go down, call the doctor.

A relatively new phenomenon in kids’ injuries is back and shoulder problems from carrying backpacks. If your child lugs around a backpack that’s too heavy or carries it on one shoulder, he or she can develop back, neck, and shoulder pain, along with posture problems. The American Academy of Pediatrics (AAP) recommends that kids always use two shoulder straps, and backpacks shouldn’t weigh more than 10% to 20% of the child’s body weight. (You can use the bathroom scale: If your child weighs 80 pounds, the backpack should weigh between 8 and 16 pounds.)

What child doesn’t eventually pick up a splinter in the hand? It’s relatively easy fix if you can keep your child’s hand steady. Use a needle sterilized with rubbing alcohol to gently prick the skin over it, then pull it out with clean tweezers. If that doesn’t work, try touching the area with tape to see if that helps get it out. Once the splinter is removed, use an antibiotic ointment to help keep it from getting infected.

Various sports can cause strains and sprains in young athletes.  Baseball, soccer, gymnastics, football, tennis, even golf can lead to torn muscles, ligaments and tendons.

If it happens to your kid, they’ll need to rest the injured location.. Apply ice, wrap it snugly, and keep it raised. Over-the-counter pain medication like acetaminophen or ibuprofen can help. Call the doctor if he or she can’t walk or move the injured area. It could be broken, and may need to be X-rayed.

Fractures are more serious. They can happen in a variety of ways. Skateboard, monkey bar and bicycle falls as well as many contacts sports can lead to broken bones. Breaks are most common in arms because it’s natural to throw your hands out to try to break a fall. The area will swell and be painful to press on or move. Call 911 if you can see the bone through the skin. If you suspect your child has broken a bone, take him or her to an ER.

Concussions are a hot topic and unfortunately, a fairly common injury. Kids in the U.S. have 1 million to 2 million sports and recreation-related head injuries each year. For children under 14, the top causes are cycling, football, baseball, basketball, and skateboards or scooters. If your child has taken a hit to the head, keep an eye on him. Symptoms of concussion usually show up right away, but not always. 

Call the doctor immediately if your child loses consciousness, appears dazed, or complains of blurry vision or a headache that won’t go away.

A busted mouth and broken teeth are painful, but not unique as a childhood injury. It’s probably a good thing we get two sets of teeth. Another common childhood injury is broken, chipped, and knocked-out teeth. Nearly 50% of kids will have some type of tooth accident during childhood. The reasons: trips, falls, sports, and, yes, fights. The front teeth take the brunt of it. 

Call the dentist if a tooth is broken, loose, or sensitive. If a baby tooth is completely knocked out, don’t try to place it back in the gums. But if it’s a permanent tooth, rinse it with clean water, put it back in the socket as fast as possible, and head to the dentist. It may save the tooth.

There are other injuries that childhood enthusiasm can produce, but these are some of the most common. Fortunately, most of us survive this chaotic time with bumps, bruises and maybe a few stiches. Anytime you’re uncertain about how severe your child’s injury may be; it’s best to have him or her checked out by a doctor.

Story source: http://www.webmd.com/children/ss/slideshow-kids-injuries

Your Child

Botox Injections for Young Migraine Sufferers?

1:45

Botox injections are typically thought of as beauty enhancers for adult men and women, but a small study in California, suggests that the injections may also help children find relief from migraines. 

The new findings are based on testing among just nine children, aged 8 to 17. Currently, Botox is only approved as an adult migraine treatment and research has shown that for some people, it’s been effective.

The new study may provide hope for a young migraine sufferer looking for an alternative treatment, since the one approved preventative medication, topiramate, is only available to adolescent patients.

"When children and teens have migraine pain, it can severely affect their lives and ability to function," said study author Dr. Shalini Shah, chief of the division of pain medicine at the University of California, Irvine, 

"They miss school, their grades suffer and they are left behind, often unable to reach their full potential," she added in an American Society of Anesthesiologists' news release. "Clearly, there is a need for an alternative treatment for those who haven't found relief.”

After the treatments with Botox, Shah noted, "we saw improvement in functional aspects in all of the children and teens. In fact, one patient was hospitalized monthly for her migraine pain prior to Botox treatment and was expected to be held back in school. After treatment, she only has one or two migraines a year, and is excelling in college."

Researchers said that before treatment, the participating patients experienced migraines between roughly eight and 30 times per month.

The kids and teens were given Botox shots to the front and back of the head and the neck every 12 weeks for five years. Once treated, the study volunteers had migraines between two and 10 times a month.

Researchers said the patients experienced less pain and the duration of the migraine attacks decreased. No severe side effects were reported and another study is already being launched.

Shah recently presented the findings at a meeting of the American Society of Anesthesiologists in Boston. Findings presented at meetings are typically viewed as preliminary if they haven't been published in a peer-reviewed journal.

Story source: Alan Mozes, https://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/botox-may-offer-new-hope-for-young-migraine-sufferers-727788.html

Your Child

AAP Recommends HPV Vaccine for Boys

2.00 to read

In 2006 the American Academy of Pediatrics (AAP) recommended that girls, ages 11-12, receive the human papillomavirus (HPV) vaccine. HPV can cause cervical cancer, and girls have been the prime focus for the vaccination.

The AAP has published new guidelines for the use of the HPV vaccine and now recommends that adolescent boys also receive the vaccine. The vaccine has been available to boys for two years but Tuesday’s vote was the first to strongly recommend routine vaccination.

The new recommendations were prompted by evidence that the HPV vaccine is effective as a treatment against genital warts in both males and females. HPV infection has been associated with an increased risk for not only cervical, but anal and some throat cancers as well.

The AAP recommends that the vaccine be administered at 11 to 12 years of age in both boys and girls. Their rationale is two-fold: First, the vaccine is most effective if it is administered before the individual begins engaging in sexual activity, mainly because the vaccine is inactive against HPV strains acquired before vaccination. Second, children mount the most robust antibody responses to the vaccine when they are between the ages of 9 and 15 years.

Two HPV vaccines are currently available in the United States, but there are differences in their approved indications. Quadrivalent HPV vaccine (HPV4, Gardasil, Merck) is the only vaccine approved for use in boys.

Bivalent HPV vaccine (HPV2, Cervarix, GlaxoSmithKline) is only approved for use in girls; HPV4 is also approved for girls.

Some of the updated AAP recommendations are:

  • Girls aged 11 to 12 years should be routinely immunized using 3 doses of the HPV4 or HPV2 vaccine, administered intramuscularly at 0, 1 to 2, and 6 months.
  • Girls and women aged from 13 to 26 years who have not been previously immunized or who have not completed their vaccinations should finish the series.
  • Boys aged 11 to 12 years should be routinely immunized with HPV4, using the same schedule as for girls.
  • Boys and men aged from 13 to 21 years who have not already been immunized or who have not completed their vaccines should finish the series.

Some health insurance policies now pay for the vaccine. If you do not have insurance and your child is not eligible for free immunizations, the HPV vaccine is expensive. Check with your pediatrician about your area’s cost.

The recommendations are published online and in the March print issue of Pediatrics.

There is a lot of online information available on HPV and the vaccine; some is very helpful and some can be unreliable. If you have concerns or questions, please talk with your pediatrician.

The vaccine is recommended for adolescents who are not yet sexually active. Many young people believe that oral sex is safer than vaginal sex and some believe that oral sex is not sex at all. A sharp rise in throat cancer among younger men has been linked to HPV. Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer, but they do not treat or get rid of existing HPV infections.

For more facts on the HPV vaccine and HPV in general, check out the Center for Disease Control and Prevention’s website at: http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm

Sources: http://www.medscape.com/viewarticle/759223  http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm

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