HPV Vaccine Gardasil 9 at The Thai Travel Clinic Bangkok

[Guest]

That's HPV (Human papillomavirus) NOT HIV.     [Almost everyone gets this, but there's often one idiot who misreads it & decides to enlighten us].

 

Whilst getting a covid test at the Thai Travel Clinic last month, I noticed they offer a new version of Gardasil, called Gardasil 9, which protects against 9 strains of HPV.    The previous version protects against 4 strains.

I had the 4 strain version of Gardasil several years ago, in the UK, privately.   At the time, the UK NHS were offering it to schoolgirls only.   I read about it, made my own decisions and decided to pay for private vaccination.   

Now the NHS offers it for school girls of both sexes and men who have sex with men up to the age of 45.   I would have been somewhere near that 45 age when paying for my own vaccine, so the NHS seems to have caught up with my thinking on the subject.   As far as I can tell, they still use the 4 strain version.

At the Thai Travel Clinic, the 9 dose version is quite expensive at 6070 baht per dose and 2 or 3 doses are required.   

Also, there might be an element of shutting the stable door after the horse as bolted with some of our membership, but it's still good to know what's available.

https://www.thaitravelclinic.com/cost.html

 

[I'm sure there have been previous threads on this and extending one of them would be more elegant.   However, the board search facility seems to not work for 3 letter words, such as Hua Hin or HIV.   Searching for vaccines is no longer useful either].

 

[KeepItReal]

In the Unites States most major medical insurance plans now also pay for Gardasil 9 for men who have sex with men up to age 45.  That started in 2019 - so it is a fairly recent development.  I have been recommending it to my younger gay friends and got the shot myself - I had to get two shots about 6 months apart if memory serves. 

 

As always, it is best to consult with a medical professional before you make a final decision.

[Guest]

Interesting to see the same 45 year age limit applied in the US and UK, although the presumably superior Gardasil 9 version is offered in the US.

I wonder why the age limit is 45 ?

(i) Is it assumed over 45s will be monogamous or it's already too late ?

(ii) Not trialed in over 45s (unlikely, as I read about trials in up to 55 year old people)

(iii) Ineffective in over 45s.     I doubt it.  

 

I assume it's (i).  

[KeepItReal]

1 hour ago, z909 said:

Interesting to see the same 45 year age limit applied in the US and UK, although the presumably superior Gardasil 9 version is offered in the US.

I wonder why the age limit is 45 ?

(i) Is it assumed over 45s will be monogamous or it's already too late ?

(ii) Not trialed in over 45s (unlikely, as I read about trials in up to 55 year old people)

(iii) Ineffective in over 45s.     I doubt it.  

 

I assume it's (i).  

I believe it is (ii) - not enough data from trials for those older than 45.  As more data is collected, perhaps this will change.

It is also possible that too many people are exposed to the HPV virus already by the time they reach 45 and that can impact effectiveness.   

[Alsfca]

I am actually looking into getting this myself. The 45 year old limit is because of the parameters used in the clinical trial. People over 45 can still ask their doctor for it but it is "off label" as approved by the FDA, so not covered by insurance in the US and you will have to pay for it out of pocket.

[kokopelli]

I had the original Gardasil maybe 10 years ago; think it was in the USA. Paid for it out of pocket and no questions asked. I must have been 65 at the time.

 

 

[anddy]

On 4/3/2021 at 5:32 AM, KeepItReal said:

It is also possible that too many people are exposed to the HPV virus already by the time they reach 45 and that can impact effectiveness. 

that's the explanation I remember (if I remember correctly) having been given by my gay Thai doctor. Though i find that exceedingly silly, arbitrary and stereotyping. What if someone is (mostly) monogamous? Or otherwise doesn't have that many sex partners? It's just an assumption that most will have caught all strains by 45. I'll use the info about the new 9 strain versiion to consult with my doc here again.

[Guest]

2 hours ago, anddy said:

that's the explanation I remember (if I remember correctly) having been given by my gay Thai doctor. Though i find that exceedingly silly, arbitrary and stereotyping. What if someone is (mostly) monogamous? Or otherwise doesn't have that many sex partners? It's just an assumption that most will have caught all strains by 45. I'll use the info about the new 9 strain versiion to consult with my doc here again.

Where the HPV vaccination is funded by the taxpayer or health insurance, I guess they need to have some guidelines to decide where it's likely to be economic to offer vaccines.   

However, as long as there are reputable organizations prepared to offer vaccines for a fee, then people ought to be allowed to make their own choices, if there is no obvious safety risk.

I just checked the CityDoc website in the UK, as they provided me my Gardasil 4 injection quite a few years ago.  Their website now says men should be given the 9-valent vaccine and can be given it from 9 years to 45 years old.   I don't recall any such mention of a clear upper age cut off when I had my Gardasil 4, but having found the records, I can confirm I was 44 at the time.  

I then found the following on the Lloyds Pharmacy website (below).    Almost Thai levels of logic there.  

Suspect it might be a waste of my money, considering the lifestyle in recent years.   Although what's the probability of having had all 5 of the extra strains ?

[Alsfca]

Interesting.  Apparently, Gardasil 9 was originally approved in 2014 for people between age 9 and 26.  Then clinical study was expanded to include people of age upto 45.  FDA then approved the expanded use of Gardasil to include people upto 45 years old in October 2018.

 

October 05, 2018

The U.S. Food and Drug Administration today approved a supplemental application for Gardasil 9 (Human Papillomavirus (HPV) 9-valent Vaccine, Recombinant) expanding the approved use of the vaccine to include women and men aged 27 through 45 year.

https://www.fda.gov/news-events/press-announcements/fda-approves-expanded-use-gardasil-9-include-individuals-27-through-45-years-old

 

[KeepItReal]

7 hours ago, Alsfca said:

Interesting.  Apparently, Gardasil 9 was originally approved in 2014 for people between age 9 and 26.  Then clinical study was expanded to include people of age upto 45.  FDA then approved the expanded use of Gardasil to include people upto 45 years old in October 2018.

 

October 05, 2018

The U.S. Food and Drug Administration today approved a supplemental application for Gardasil 9 (Human Papillomavirus (HPV) 9-valent Vaccine, Recombinant) expanding the approved use of the vaccine to include women and men aged 27 through 45 year.

https://www.fda.gov/news-events/press-announcements/fda-approves-expanded-use-gardasil-9-include-individuals-27-through-45-years-old

 

Just one side note - health insurance companies won't actually cover a vaccine's cost until it has been approved by the CDC's Advisory Committee on Immunization Practices (ACIP)

So FDA approval is important but you also need CDC approval. I attached the CDC committee's approval here - it took almost a year post FDA approval. 

https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a3.htm

[Cany10011]

I pushed my GP for it  and he said his other physician clients were also requesting and paying for it out of pocket  about 800US as it was outside the recommended age limit. I was about 48 at the time. I didn't care if I was outside the age range, as the age range was bumped up from 20 something a few years prior. 

[Guest]

21 hours ago, KeepItReal said:

Just one side note - health insurance companies won't actually cover a vaccine's cost until it has been approved by the CDC's Advisory Committee on Immunization Practices (ACIP)

So FDA approval is important but you also need CDC approval. I attached the CDC committee's approval here - it took almost a year post FDA approval. 

https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a3.htm

Thank you for posting the link.   Very interesting.

 

For me it would be a simple 2 step decision process:

1  Is the vaccine likely to be effective ?     Possible factors to consider:

    (i) Age.   I suspect people would develop antibodies way beyond 45.   They probably just set that limit to cover an age range where promiscuity is most common. 

    (ii) Prior lifestyle.   One would have thought offing lads from gogo bars and so on is very high risk.    Although the Gardasil 4 vaccine involves protection against strains which cause genital warts and others which cause cancers.   Warts would be visible & I don't recall getting any, before or after the vaccine.

 

2  After considering #1, is the vaccine available at a price that's reasonable considering the risk ?     Even if your health system or insurance does not cover it, sooner or later we would be likely to travel to somewhere where it's likely to be available for a fee.   

e.g. I quickly found a national pharmacy chain in the UK that offers it.   I'd imagine the Thai Travel Clinic would offer it to anyone who is fit and healthy.

 

[KeepItReal]

2 hours ago, z909 said:

Thank you for posting the link.   Very interesting.

 

For me it would be a simple 2 step decision process:

1  Is the vaccine likely to be effective ?     Possible factors to consider:

    (i) Age.   I suspect people would develop antibodies way beyond 45.   They probably just set that limit to cover an age range where promiscuity is most common. 

    (ii) Prior lifestyle.   One would have thought offing lads from gogo bars and so on is very high risk.    Although the Gardasil 4 vaccine involves protection against strains which cause genital warts and others which cause cancers.   Warts would be visible & I don't recall getting any, before or after the vaccine.

 

2  After considering #1, is the vaccine available at a price that's reasonable considering the risk ?     Even if your health system or insurance does not cover it, sooner or later we would be likely to travel to somewhere where it's likely to be available for a fee.   

e.g. I quickly found a national pharmacy chain in the UK that offers it.   I'd imagine the Thai Travel Clinic would offer it to anyone who is fit and healthy.

 

It was a quick and easy decision for me - in my mind the benefits were clear. 

 

I had a surprisingly hard time finding the vaccine in my neighborhood in NYC - none of the Pharmacies or Urgent Care centers had it available. They referred me to local pediatricians. Which was not gonna happen! Lol

 

A week later a business trip took me to Philadelphia and I stopped by a CVS to pick up some bottled water (the condoms and lube just jumped into the basket by themselves, I swear!). They had a CVS MinuteClinic in the back of the store so I asked and they had it available. Done in a few minutes but had to pay out of pocket (was in the days before it was ACIP approved here in the USA).  Got my second shot at the same location a few months later. Business trips can be surprisingly useful!