gardasil vaccine banned in what countries

gardasil vaccine banned in what countries

Both had received vaccines from the same batch, the authorities said. The Latvian health authorities announced Monday that it would go further, pressing pause on the entire AstraZeneca vaccine rollout as an "additional precaution" for two weeks. It's true that there have been 24,000 reports of adverse events with Gardasil. Read more:Shipping the COVID-19 vaccines is creating huge business opportunities for previously unknown players here are 10 companies that could become household names. Some parents have always cited concerns about safety for declining to get the HPV vaccine for their kids. Perhaps most telling are the revelations of Dr. Bernard Dalbergue, a former pharmaceutical industry physician with, Gardasil manufacturer Merck. The Human Papillomavirus (HPV) vaccine was integrated into Japan's national immunization program (NIP) in April 2013. Access this article for 1 day for:30 / $37 / 33 (excludes VAT). Gardasil is a vaccine intended for girls and young women between the ages 9 to 26 to protect against human papillomavirus (HPV), a virus which is currently linked to an estimated 70% of known. If you are unable to import citations, please contact Tradename: Gardasil Manufacturer: Merck & Co., Inc Indications: Prevention of vulvar and vaginal cancer Vaccination in females 9 through 26 years of age for prevention of the following diseases. Gardasil is a vaccine that protects young women from the strains of human papillomavirus (HPV) that cause 70% of cervical cancers. David Mikkelson founded the site now known as snopes.com back in 1994. The most common serious side effects of HPV vaccination are dizziness and fainting. Gan To Kagaku Ryoho. Spanish Minister of Health Carolina Darias said Monday that Spain would also suspend the use of the AstraZeneca vaccine for at least 15 days due to concerns about possible side effects. It was administered to around 16,000 girls in the district, many of whom stayed in state government-run hostels meant for tribal students. by Carmen Phillips, December 2, 2022, The study looked at data from 2015 to 2018, Dr. Vanderpool noted, well before the COVID-19 pandemic and rising hesitancy around COVID-19 vaccines. Today 6 months after her vaccination, her blood platelets have gone from a low of 100,000 to 132,000 (150,000 to 400,000 is normal). Gardasil has been banned in Japan. The researchers specifically looked at Guillain-Barr Syndrome, a neurological disorder that had been linked to a bad batch of flu shots; there wasn't a signal that this was a problem with Gardasil. However, like any medicine, this vaccine can cause side effects but the risk of serious side effects is extremely low. Such skewed coverage also triggers a chorus of populist politicians to chime in with equally vacuous additions. But Dr. Harper also noted that the risks of death surrounding the administration of Gardasil were "very rare," and that she "agrees with Merck and the CDC that Gardasil is safe for most girls and women. 19 August 2009. See here for a complete list of exchanges and delays. Get up-to-the-minute news sent straight to your device. At least three EU countries Austria, Estonia and Lithuania have suspended use of a specific batch of AstraZeneca's COVID-19 vaccine as a precaution following the death of a vaccinated person. The German government announced Monday that it was suspending the use of AstraZeneca's vaccine as a "precaution" and on the advice of Germany's national vaccine regulator, the Paul Ehrlich Institute, which called for further investigation of the cases, the Associated Press reported. Results from the study were published September 17 in JAMA Network Open. Additionally, certain strains can cause changes in DNA that encourage the formation of cancers in both males and females. These physicians may also be more likely to broach the subject with parents, and recommend the vaccine, if they themselves better understand that relatively few parents avoid vaccinating due to concerns over sexual activity. GARDASIL 9. Such was the response to the show that the Health Service Executive had to issue a statement on it to address the panic it induced. Unauthorized use of these marks is strictly prohibited. But by 2018, that percentage had risen to 23%. Scroll down for the full list. The Human Papillomavirus (HPV) vaccine was integrated into Japan's national immunization program (NIP) in April 2013. Careers. Although vaccination rates have been rising since the first HPV vaccine was approved by the Food and Drug Administration (FDA) in 2006, only 59% of 13- to 17-year-olds were fully vaccinated in 2020. Amid questions about the safety of the HPV vaccine Gardasil one of the lead researchers for the Merck drug is speaking out about its risks, benefits and aggressive . Since that licensing the "CDC and FDA have been closely monitoring the safety of the HPV vaccine" and found that: All serious reports for Gardasil have been carefully analyzed by medical experts. Next year, the World Health Assembly will discuss a Draft Global Strategy for the elimination of cervical cancer as a public health issue, presented for approval, which will provide countries with targets and strategic actions for countries in their efforts. 22 April 2009. Some of this is based on simple misunderstandings, but a significant proportion is down to the success anti-vaccine campaigners have in sharing their claims online and across social media. Other commonly reported symptoms include gastrointestinal symptoms, malaise, headache, dizziness and injection-site reactions, the Health Products Regulatory Authority said. The HPV vaccine can protect against nine cancer-causing strains of HPV. Cervical cancer vaccine introduced in Lao PDR, Learn more about WHOs work on cervical cancer. Anders Tegnell, Sweden's state epidemiologist, announced Tuesday that the country had paused its AstraZeneca vaccine rollout as a "precautionary measure" until the EMA had completed its investigation into whether blood clots and low platelets were caused by the shot. This site needs JavaScript to work properly. Bariatric Surgery May Reduce Risk of Common Cancers, U.S. Department of Health and Human Services. Like all clinical compounds, Gardasil has been extensively tested for years, constantly monitored for potential adverse effects. The safety of these vaccines, as with all medicines, continues to be carefully monitored, and [the monitoring] will take into account any future new evidence of side effects that becomes available., Paul Cullen is Health Editor of The Irish Times, Covid-19 inquiry should not be used to find scapegoats, Gabriel Scally says, Call to tackle GP crisis by giving medical students more exposure to general practice, Longford woman battling rare cancer seeks to raise over 450,000 for treatment in Mexico, HSE reform unworkable unless staff pay award is honoured, says union, Wexford hospital fire: Weeks to months before full service resumes, says Taoiseach, Before I would have held my husbands hand walking around the streets. Access your favorite topics in a personalized feed while you're on the go. It added that if it permanently suspended AstraZeneca's vaccine, it would push back its vaccination plan by about four weeks. Luxembourg's Ministry of Health said Tuesdaythat Luxembourg had "temporarily" suspended vaccination with AstraZeneca's COVID-19 shot to align itself with other EU countries who had done the same. Broadly speaking, opposition can be separated into two distinct categories, the first of which expresses itself as moral concern. And there is no way to tell if a particular side effect is linked to the vaccine. Indonesian officials said Monday the country would delay its rollout of AstraZeneca's vaccine, local media reported. It a complete failure of journalism to present them as equally valid opposing views, a glaring error known as false balance. There are also resources like smartphone apps, she added, that teach health care providers effective strategies for talking with parents about the HPV vaccine. A new study of survey data finds that only a minority of parents choose not to immunize their children against the sexually transmitted, Study outlines top reasons parents choose not to immunize their children against #HPV, . The recommendations from WHOs Strategic Advisory Group of Experts on immunisation (SAGE), come just months after the UK began immunising boys aged 12-13 against the virus. "FDA Approves Expanded Uses for Gardasil." There is no evidence yet that the AstraZeneca vaccine causes blood clots. Very few know that the Federal Drug Administration reported 85 deaths from Gardasil between June 2006 and June 2013. Keywords: Snopes and the Snopes.com logo are registered service marks of Snopes.com. CDC says HPV down by 56% among teenagers since vaccine introduction, Conservatives' HPV vaccine dilemma: are they anti-cancer, or just anti-sex? David Robert Grimes Over 90% of cervical cancers are caused by HPV. In Japan, around 10,000 women develop cervical cancer each year,. The EMA noted two other "thrombotic events" in people who had received the vaccines, without giving details. When the researchers looked at the data by state, they found that the number of parents citing safety concerns increased in 30 states and more than doubled in California, Mississippi, South Dakota, and Hawaii. The VAERS program collects and analyzes reports on adverse events following immunizations in order to help track the safety and efficacy of various vaccines. Suspected adverse effects after human papillomavirus vaccination: a temporal relationship. In one respect, this is understandable: the cases are emotive, even if all evidence suggests Regret are misguided in their attempt to blame the vaccine. As Matthew Herper wrote for Forbes about the reported "deaths caused by Gardasil" phenomenon: [L]et's take a look at those 20,000 adverse events and 100 deaths and figure out what they mean. Common Gardasil 9 side effects may include: pain, swelling, redness, itching, bruising, bleeding, and a lump where the shot was given; nausea, diarrhea, stomach pain; headache; The public health and cancer control communities should be thinking about how to address this potential outcome through both health communication research and public health practice, Dr. Vanderpool added. It would continue administering both Pfizer-BioNTech and Moderna's COVID-19 vaccines, it said. The HPV vaccine uptake rate has dropped to near zero because of this insanity. Whether this is borne of genuine ignorance or cynical vote-chasing we can only speculate, but it risks adding to the public perception there is some genuine debate over the safety and efficacy of the vaccine when this is resoundingly not the case. Would you like email updates of new search results? Investigating the reported incidents, the Vaccine Adverse Reactions Review Committee (VARRC)-an MHLW advisory committee-found no high-quality evidence supporting a causal relationship between the reported events and the HPV vaccination. U.S. Food and Drug Administration. Meanwhile, the rate of nonserious health issues following HPV vaccination reported in VAERS dropped from 43 to 28 per 100,000 vaccine doses. The 100 countries cover only 30% of the global target population. It is also irresponsible: we need only cast our minds back to the damage done by baseless scare stories reported about the MMR vaccine to be reminded of this fact. There is no evidence that HPV vaccines lead to infertility or autoimmune diseases, although these are common myths. Kirby alleges that her daughter suffered horrendous adverse effects after being given the vaccine, and Regret claim that upwards of 140 girls are suffering severe non-specific reactions to the vaccination, from fainting spells to fits. Video: Get the facts, get the HPV vaccine! Over 90% of cervical cancers are caused by HPV. In 2015, 13% of parents had cited safety concerns as the main reason for declining the HPV vaccine. To learn more about HPV vaccine and the diseases it prevents . Centers for Disease Control. It said that it would pause the rollout until the EMA's decision on whether or not AstraZeneca's vaccine causes blood clots, which is expected later this week. 3 May 2012. Low-income and lower-middle-income countries have introduced HPV vaccine at much lower rates than high-income countries, reflecting global disparities in cervical cancer incidence and mortality. Tegnell said that there had been no similar cases in Sweden. Gardasil is demonstrably safe and demonstrably effective in preventing cancer. Thai Prime Minister Prayuth Chan-o-cha and members of his government were due to become the first people in the country to receive AstraZeneca's vaccine during a ceremony Friday morning. A recent VSD study of the 9-valent HPV vaccine (Gardasil 9), for example, tracked new vaccinations over a 2-year period and identified no new safety issues. The study did result in the FDA advising doctors to watch adolescents after they get their shots, because some faint. Gardasil is a vaccine for use from the age of 9 years for the prevention of: premalignant genital lesions (cervical, vulvar and vaginal), premalignant anal lesions, cervical cancers and anal cancers causally related to certain oncogenic Human Papillomavirus (HPV) types; genital warts (condyloma acuminata) causally related to specific HPV types. Federal government websites often end in .gov or .mil. Bookshelf None of these adverse events were found to be any more common after HPV vaccination than among the comparison groups. You can download a PDF version for your personal record. CBS News. One TD (member of the Irish parliament), seemingly unfamiliar with the old adage about prevention being better than cure, even questioned why there was a need for a vaccine when we have smear tests for cancer. Here Is How We Know Gardasil Has Not Killed 100 People." That article grossly misrepresents what Dr. Harper actually said. ", Additional information: It didn't specifically say whether these were the same as the two incidents reported in Austria. Based on that analysis, it seems that of those dozens of deaths, only a handful could possibly be linked to Gardasil. Unfortunately, VAERS data is notoriously spotty better than nothing, but there's no way to insure that potential side effects are reported. Herper, Matthew. and transmitted securely. It's absolutely clear that these are for the most part not side effects from Gardasil. She told CBS it is essentially useless. It then said Monday it had reversed the decision and administer the first doses of AstraZeneca's vaccine Tuesday. In 2016 there were responses from 1,633 parents of girls and 2,255 parents of boys age 13-17. Indications: Indicated in girls and women 9 . They did note 2 cases of unusual neurological symptoms similar to Lou Gehrig's disease, and there was an increase in patients who had potentially dangerous blood clots, although 90% of those patients had a risk factor for those clots, such as taking birth control pills, that might explain the increase. Cyprus announced Monday that it would temporarily postpone vaccinations until the EMA had concluded its investigation. It has not yet been issued emergency-use authorization in the US. Copyright 2023 BMJ Publishing Group Ltd, HPV: WHO calls for countries to suspend vaccination of boys, Birmingham and Solihull Mental Health NHS Foundation Trust: Consultant Psychiatrist General Adult - Orsborn House CMHT, NHS Tayside: Salaried GP with Special Interest in Drug Use, Harm and Reduction, Birmingham and Solihull Mental Health NHS Foundation Trust: Consultant Psychiatrist General Adult - Northcroft CMHT, Brent Area Medical Centre: Salaried GP - Brent Area Medical Centre, Womens, childrens & adolescents health. government site. STN: 125508. As the CDC stated in its 2009 article on "Reports of Health Concerns Following HPV Vaccination," before the Gardasil HPV vaccine was licensed it was studied in five clinical trials involving over 21,000 girls and women of ages 9 through 26. So to try to make use of this data, researchers compare the rates at which negative side effects are reported for different vaccines. Ireland on Sunday suspended the use of the shot after receiving a safety alert from the Norwegian Medicines Agency the day before. Latvia initially suspended the use of a specific batch of AstraZeneca's COVID-19 shot on March 9. The Health Ministry said in December it was working on improving leaflets on the vaccine, but had no time table for a return to regular immunization. Even though vaccine hesitancy appears to be rising, there is a subset of people who have misgivingsabout vaccines but are open to changing their minds, Dr. Vanderpool noted. The Victoria Times Colonist. The HPV vaccine saves lives, as it can prevent most cervical cancer cases. Beavis says that their findings demonstrate that parents are less concerned with the HPV vaccines relation to gender and sexual activity, and that public health campaigns should focus on persistent concerns about safety and necessity of the vaccine for both boys and girls in order to be responsive to parents true concerns. Human papillomavirus (HPV) has long haunted humankind; almost all sexually active adults carry some of HPVs 170 strains. The groups attempt to obtain an injunction for a withdrawal of Gardasil made it to the Irish High Court, and although it was refused, the movement shows no signs of abating if anything, they have received an incredibly sympathetic media airing. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Tokyo Governor Yuriko Koike and eight other regional leaders signed a letter supporting HPV vaccination. Officials said in a statement that the EMA would ultimately decide "whether and how the new information will affect the authorization of the vaccine.". And on Sunday, the Dutch said there had been six new reports of clotting and thrombocytopenia low platelet count in adults under 50 in Denmark and Norway over that weekend. It was really shocking to me to see this parallel analysis of parental perceptions and statements about safety and the actual safety results, and theyre going in opposite directions," said Robin Vanderpool, Dr.P.H., chief of NCIs Health Communication and Informatics Research Branch, who wasnt involved in the study. And although many of these are harmless, amongst the myriad mutants there are those, which claimed the lives of 270,000 women in 2012, at least 99% effective against the four most odious subtypes, have stagnated far below the optimum levels for protection, the first of which expresses itself as moral concern, advocating abstinence in lieu of vaccination, evidence to date clearly indicates that abstinence programmes simply dont work, sexual activity is not elevated in the vaccinated group, Gardasil has been extensively tested for years, a 2015 report based on data from over a million individuals, success anti-vaccine campaigners have in sharing their claims online, the falsehood that Gardasil has been banned in Japan, Regret claim that upwards of 140 girls are suffering severe non-specific reactions to the vaccination, even been invited to address the Irish parliament, questioned why there was a need for a vaccine. Unable to load your collection due to an error, Unable to load your delegates due to an error. migraines, severe headaches, persistent gastrointestinal discomfort, widespread pain of a Chris Dutil, Stockbridge The U.S. Food and Drug Administration approved the vaccinebeginning at age 9in 2006 for females . Okuhara T, Okada H, Goto E, Tsunezumi A, Kagawa Y, Kiuchi T. Vaccines (Basel). As of December 31, 2008, there have been 32 U.S. reports of death among females who have received the vaccine. Each year, about 10,000 Japanese women are newly diagnosed with the cancer while 3,000 die from it. There has been a rise in negative and incorrect informationalso called misinformationabout HPV vaccines on social media in recent years, Dr. Sonawane noted. Since it was introduced in Ireland, in 2010, more than 690,000 doses of the vaccine have been distributed, and 230,000 girls have received the full course. Dr. Diane Harper is one of the leading researchers in biomedical science, an individual who has spent her life studying vaccines. Rositch and her colleagues, including Anna Beavis, M.D., M.P.H., and Kimberly Levinson, M.D., M.P.H., both assistant professors in the Department of Gynecology and Obstetrics at the Johns Hopkins University School of Medicine; and Melinda Krakow, M.P.H., Ph.D., a former masters of public health student at the Johns Hopkins Bloomberg School of Public Health, sorted the answers into reason categories, separating the data by year and by childrens gender. HPV can be transmitted by other means than sexual intercourse. But now I wouldnt, Why AIB didnt treat ordinary borrowers the way it treated DJ Carey, Paul Mescals visit to alma mater wasnt just a homecoming it was a return to where his career began, Race to get last children out of Bakhmut as city becomes hell on earth, Russian attack on Bakhmut intensifies as civilians flee on foot, URC: Connacht make lucky escape to beat spirited Dragons, Rory McIlroy charges into contention with bogey-free 68 at Bay Hill, Greece train crash: Station masters court appearance delayed, Rian ONeill stars as Armagh fight hard to beat Donegal, URC: Ulster on track for home quarter-final with convincing win over Cardiff. HPV infection can cause cervical, vaginal, and vulvar cancers in women and penile cancer in men. as well as other partner offers and accept our. Experts have not found a common medical pattern to the reports of serious adverse events reported for Gardasil that would suggest that they were caused by the vaccine. Ida Marie Odgaard/Ritzau Scanpix/AFP via Getty Images, Ritzau Scanpix/Liselotte Sabroe via REUTERS, NOW WATCH: Drugmakers are developing coronavirus vaccines in record time but it will still be months before one is available, Experts say any risks are outweighed by the shot's benefits, Shipping the COVID-19 vaccines is creating huge business opportunities for previously unknown players here are 10 companies that could become household names, the vaccine, developed by AstraZeneca and Oxford University, Ireland on Sunday suspended the use of the shot, the National Immunisation Advisory Committee (NIAC) said, The Netherlands said Sunday it would stop using AstraZeneca's COVID-19 vaccine, Thailand on Friday became the first Asian country to suspend use of AstraZeneca's COVID-19 vaccine, Thai Health Minister Anutin Charnvirakul said. Before The health ministry for the Democratic Republic of Congo said Friday that it was delaying the launch of AstraZeneca's vaccine, Reuters reported. The recommended dosing schedule for the vaccine now involves two injections if the first is administered before age 15, or three injections if the first is administered after age 15. It would continue administering both Pfizer-BioNTech and Moderna's COVID-19 vaccines, it said. A total of 758 serious health problems that arose after HPV vaccination were reported in VAERS during that time. The presence of a safety signal information about a new or known adverse reaction that requires investigation does not directly mean that a medicinal product or vaccine has caused the reported adverse reaction or event., Published studies are also reviewed, as relevant evidence is assessed in order to establish where a causal relationship exists between the vaccine and the reported event, she said. "Reports of Health Concerns Following HPV Vaccination." August 19, 2009 / 5:13 PM / CBS. But there are also trouble spots, including France, where 1 in 3 people disagree that vaccines are safe, and Ukraine, where only about half of the population thinks that vaccines work. Portugal suspended use of AstraZeneca's vaccine Monday. She has the academic training and research credibility at a level that if she said "Gardasil is dangerous," many of us would stand up and begin to wonder. Independent Oversight and Advisory Committee, Major milestone reached as 100 countries have introduced HPV vaccine into national schedule. | Jill Filipovic, Original reporting and incisive analysis, direct from the Guardian every morning, uman papillomavirus (HPV) has long haunted humankind; almost all sexually active adults carry some of HPVs 170 strains. To look at trends in health issues reported after HPV vaccination, the researchers turned to the Vaccine Adverse Event Reporting System (VAERS), a website operated by CDC and FDA. Letter: Dangerous Gardasil drug should be banned in US, A fungus wiped out 3.5 billion American chestnut trees. The case for the safety of the HPV vaccine is buttressed by swathes of clinical evidence and years of data, whereas the opposing side is comprised of anecdotes, emotive appeals and easily debunked assertions. Francis JKR, Rodriguez SA, Dorsey O, Blackwell JM, Balasubramanian BA, Kale N, Day P, Preston SM, Thompson EL, Pruitt SL, Tiro JA. The HPV vaccine has been a political lightening rod in Japan, where claims of side effects prompted the government to halt active recommendation of the shots in June 2013. Official . By clicking Sign up, you agree to receive marketing emails from Insider Thai officials said Monday that the country had reversed the decision after other countries said there was no link between the blood clots and the vaccine, Reuters reported. 2022 Apr 29;10(5):701. doi: 10.3390/vaccines10050701. In Ireland, a familiar list of opposition politicians from Sinn Fein to independents have regurgitated the claims verbatim, and speakers from Regret have even been invited to address the Irish parliament. The majority of these infections resolve without symptoms. We have to be cautious about interpreting VAERS data and not make any causeeffect associations, she said. Epub 2020 Apr 27. Austrian authorities said March 7 that a 49-year-old woman had died as a result of severe coagulation disorder after taking the shot, and that a 35-year-old had developed blood clots in the lungs, but was recovering. The findings highlight an urgent need for doctors and public health leaders to address these concerns with parents, according to the scientists who led the study. What is the evidence? The U.S. Food and Drug Administration approved the vaccinebeginning at age 9in 2006 for females and in 2009 for males. There have also been 60,000 reports of death with the mumps, measles, and rubella vaccine, and 26,000 following vaccination with Pfizer's Prevnar, for pneumococcus bacteria. In November, ruling party legislator Junko Mihara, a cervical cancer survivor, said lawmakers would hold talks on the vaccine this summer. Consequently, the arguments for the suspension of the HPV vaccine recommendation are not ethically appropriate. There had been no incidences of blood clots following vaccination in Latvia, and there was "no cause for concern" for people who had received the shot, they said. The authority saidthat there was good evidencethe vaccine, developed by AstraZeneca and Oxford University, was safe and effective, but that it must react to reports of possible serious side effects. at the National Institutes of Health, An official website of the United States government, Despite Proven Safety of HPV Vaccines, More Parents Have Concerns, only 59% of 13- to 17-year-olds were fully vaccinated in 2020, who declined the HPV vaccine for their kids due to safety concerns nearly doubled, Health Communication and Informatics Research Branch, Vaccine Adverse Event Reporting System (VAERS), new vaccinations over a 2-year period and identified no new safety issues, information about HPV vaccines and cancer found online and on social media is inaccurate, are less likely to vaccinate their children, CDCs Vaccinate with Confidence program, have misgivingsabout vaccines but are open to changing their minds, NCIs Health Systems and Interventions Research Branch, there has been a steady increase in HPV vaccination rates, Drug Targets Common Mutation in Pancreatic Cancer. 30 June 2006. (To illustrate this concept, we offer the following [admittedly far-fetched] scenario: A man who received a flu vaccination and then accidentally hit his hand with a hammer a few hours later might legitimately report that soon after he received the flu vaccine, his hand began to throb painfully. Hpv Vaccine Banned In Europe. Her pediatrician filed a report with the Centers for Disease Control and Prevention about the effects Gardasil had on her; her doctor recommended that she not get the second dose. Vaccines (Basel). This slightly twisted assumption is flatly contradicted by the data it operates on a strange, moralistic consequences of sex principle, a mantra that abstinence trumps pragmatism. Just because a health problem is reported in VAERS doesnt mean the vaccine caused it, Dr. Sonawane cautioned. Gardasil 9 Gardasil 9 is currently the only HPV vaccine available in the United States. Tracking the global spread of vaccine sentiments: the global response to Japan's suspension of its HPV vaccine recommendation. NIS-Teen collects information from a nationally representative sample of parents about their childrens vaccine usage, with vaccine rates verified with information collected from each childs physician. It is important to note that reports collected by VAERS are raw data; they do not in themselves establish causal connections between vaccines and adverse medical issues such determinations cannot be made until the reports have been investigated, evaluated, and analyzed. Graa Freitas, head of health authority DGS, told a news conference that the side effects being evaluted were severe but rare. Enter the characters shown in the image.

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gardasil vaccine banned in what countries