Talk:HPV vaccine

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Missing information about discovery of vaccine

Unlike the article on the polio vaccine, which makes mention of Jonas Salk and his contribution to the development of the vaccine, this article makes no mention of the research behind the vaccine nor the scientists involved, Ian Frazer and Jian Zhou. This vaccine is a significant step in the history of vaccines, with it also linking a virus to cancer. If it's agreed that a section on the history of the development of the vaccine should be added, then someone should write it up. Tczuel (talk) 03:32, 29 November 2010 (UTC)

I pasted new information to the history portion. However I am new to this and I don't know how to citated in the correct format. I apologize for the inconviniece. Also if anyone can guide me to the correct process I will be greatful. Kmacz89 (talk) 15:00, 21 November 2011 (UTC)

I pasted new information on the history portion and Efficacy. However, my referece format are not well formated. Can anyone point me out into the correct dirrection. Once again I apologize for the inconvenience Kmacz89 (talk) 23:43, 27 November 2011 (UTC)

I added new informaiton into the US portion and safety. In addition, thank you for helping me out with my reference edditing Kmacz89 (talk) 13:57, 28 November 2011 (UTC)

You don't have to apologise for being new to editing Wikipedia. If you need help figuring out how Wikipedia's reference system works, you can read WP:CITE. I, for one, am a bit curious which references you mean by [1] and [2] to in these edits. Gabbe (talk) 09:38, 29 November 2011 (UTC)

"However, it wasn’t until Harald zur Hausen, the German researcher who discovered the human papillomavirus, was awarded half of the $1.4 million Nobel Prize in Medicine. " Isn't there a word, perhaps a date, missing? Andygx (talk) 11:34, 11 June 2012 (UTC)

More about the controversy - critical sources

This RS source [1] could be integrated in the article. MaxPont (talk) 11:41, 15 November 2008 (UTC)

This is a press release by the NVIC (i.e. it is lobbying by an anti-vaccination group), not a WP:RS. The quality of their reports has not been high (fail to give necessary context, unbalanced, lack citation of sources, etc.)

• For instance the percentage of VAERS reports for Gardasil mentioned is not unusual (fewer than many), and without knowing how many doses were given, etc. it isn't possible to evaluate.

However the Bloomberg article that it links to is interesting. Zodon (talk) 10:20, 16 November 2008 (UTC)

UPDATE. here is another WP:RS "Gardasil Researcher Drops A Bombshell"[2] MaxPont (talk) 18:10, 30 October 2009 (UTC)

Not a particularly reliable source - it is a newspaper article about a talk at a conference sponsored by the NVIC. Something published in a peer reviewed journal would be a lot better. Zodon (talk) 06:25, 31 October 2009 (UTC)

The Journal of the American Medical Association (JAMA) published this editorial [3], co-authored by JAMA's Editor-in-chief, which argues against the state legislations requiring HPV vaccinations for attending their public school systems.

Additionally, this CBS news report[4] quotes Dr. Diane Harper, (who is already quoted elsewhere within this Wikipedia article):

"Dr. Harper helped design and carry out the Phase II and Phase III safety and effectiveness studies to get Gardasil approved, and authored many of the published, scholarly papers about it."

"Dr. Harper joins a number of consumer watchdogs, vaccine safety advocates, and parents who question the vaccine's risk-versus-benefit profile. She says data available for Gardasil shows that it lasts five years; there is no data showing that it remains effective beyond five years."

"This raises questions about the CDC's recommendation that the series of shots be given to girls as young as 11-years old. "If we vaccinate 11 year olds and the protection doesn't last... we've put them at harm from side effects, small but real, for no benefit," says Dr. Harper. "The benefit to public health is nothing, there is no reduction in cervical cancers, they are just postponed, unless the protection lasts for at least 15 years, and over 70% of all sexually active females of all ages are vaccinated." She also says that enough serious side effects have been reported after Gardasil use that the vaccine could prove riskier than the cervical cancer it purports to prevent. Cervical cancer is usually entirely curable when detected early through normal Pap screenings." 66.41.179.140 (talk) 05:52, 1 March 2012 (UTC)

Source 31 is unverifiable. Especially with the HPV vaccine i doubt that the line by the age of 50, 80% of american women will have a strain of HPV. This line is very ambiguous. —Preceding unsigned comment added by 214.13.141.100 (talk) 10:14, 7 September 2010 (UTC)

Not sure what you mean by saying it is unverifiable. Source 31 is "CDC panel recommends HPV vaccine for boys, too". October 26, 2011. [5] It supports the material in the sentence it is attached to (that the vaccine has been recomended for boys). (A higher quality source might be nice, but it is certainly good enough to support the material.) Perhaps you were thinking of another reference? As far as the 80% - there are four references given to support that. Since the vaccines only target up to 4 types (with some cross-protection) and there are over 100 HPV types it is unlikely that vaccination will signficantly affect that statistic. (Of course most HPV types do not cause cancer, and only a few types cause most of the cancers - i.e., most of the HPV out there has no significant adverse effects that we are aware of.) Zodon (talk) 00:50, 2 March 2012 (UTC)

"The presence of seat belts in cars doesn't cause people to drive less safely." - a statement attributed to Dr. Christine Peterson. I want to somehow work in a reference to Risk compensation, but can't think of a way to do it without editorializing. It seems by no means as obvious as Dr Peterson seems to think that vaccination won't cause people to take more risks. — Preceding unsigned comment added by Bernd Jendrissek (talk • contribs) 20:01, 23 May 2012 (UTC)

What's particularly excellent about that quote is that most people will do a WikiWalk on the Peltzman Effect link, which begins with a quoted statement that the presents of seatbelts does cause people to drive less safely. There's just nothing like both sides of an argument being presented in quick succession. — Preceding unsigned comment added by 75.73.70.113 (talk) 03:46, 15 July 2012 (UTC)

Unfortunately there is a misunderstanding here: nobody proved that the vaccine are efficient in preventing cervical cancer. All the studies done had proved efficiency in preventing PRE-CANCEROUS conditions specifically CERVICAL DYSPLASIA (CIN I, CIN II, and CIN III). This article (http://www.ecomed.org.uk/wp-content/uploads/2011/09/6-wilyman.pdf) written in 2011, is comprehensive about my concern. Sorin62 (talk) 20:02, 2 March 2013 (UTC) And also, please pay attention an the phrases used by MedlinePlus (http://www.nlm.nih.gov/medlineplus/ency/article/007436.htm): ”The HPV vaccine protects against infection by certain strains of the human papilloma virus (HPV). HPV can cause cervical cancer and genital warts”. CDC use the same language. NOWHERE in the official papers will you find directly written that the vaccine are preventing cervical cancer! Sorin62 (talk) 20:15, 2 March 2013 (UTC)

Cancer types in lead

The list of cancers in lead are just the ones for which there is evidence of protection by existing commercial HPV vaccines (which is why head and neck cancer, etc. aren't there). A recent edit suggested adding oropharynx, but I don't think it should be there until there is evidence for prevention. However, reading the lead carefully, the current wording is ambiguous (it just says protection against the types that cause these diseases, rather than that protection against these diseases - or really precursors to these diseases - has been demonstrated.)

I think that if going to list cancers in the lead it better to list the ones that are actually protected against, or at the very least differentiate between those for which protection has been demonstrated and those for which it is a theoretical possibility. At the moment haven't come up with a clearer way to say that. Zodon (talk) 08:09, 14 September 2009 (UTC)

Oropharynx cancer is well known to be associated with HPV type 16. The vaccines are about HPV-types. I'm unaware of any cancer that is 100% associated with HPV, cervical cancer for instance ranges from (90-95%). Please don't make original research.--Nutriveg (talk) 14:20, 14 September 2009 (UTC)

To say that the vaccine prevents oropharyngeal cancer without a reliable source to support it would be original research. As I was pointing out, your edit made it appear that such a link had been established, without providing a citation to substantiate that. Zodon (talk) 21:54, 18 September 2009 (UTC)

What kind of sources, like the Bloomberg one, supporting many of those cited cancers, or that of CDC? Which says the "vaccine that prevents the types of genital human papillomavirus (HPV)".--Nutriveg (talk) 22:10, 18 September 2009 (UTC)

Clarified the list in the lead.

As far as sources showing that HPV vaccine prevents said cancer, either sort would be fine. (Something like the Bloomberg one can usually be tracked back to other sources). Zodon (talk) 23:16, 18 September 2009 (UTC)

Bloomberg is not appropriate by WP:MEDRS, you should be aware of that, my point is that you take extra care about (criticizing) my edits without evaluating the context of surrounding information in the same article. You simple deleted my edits instead of using the appropriate {{fact}} tags, at the same time you accept Bloomberg as a reliable source.

As the CDC said the vaccines prevents HPV types. Where the type (HPV-16) which causes HPV-Oropharyngeal cancer is included. This is well know and I'll find reliable sources later. You're simple obstructing. --Nutriveg (talk) 00:36, 19 September 2009 (UTC)

I did not simply delete the edit. I opened up the matter here for discussion, pointing out the ambiguity in what the article literally said versus what was meant or implied and indicated the problem with the addition which increased the ambiguity, and seeking input/assistance from other editors. The point is to make it clear and improve the article.

When you find citations indicating that the vaccine(s) have been shown to prevent oropharyngeal cancer - great. Then we can add that cancer to that list. At the moment the closest I am aware of sources saying is that in theory the vaccine should prevent such cancer, not that it has been shown to do so in practice. In the meantime, the theoretical link would probably make sense in the body of the article, but I haven't found a good place to insert it. Zodon (talk) 19:05, 20 September 2009 (UTC)

Side effects and reliable sources

I've reverted this series of edits as lacking reliable sources: three links to Youtube and a search of largely unverified reports to the National Vaccine Information Center (pretty much the definition of a POV source) are not sufficient. -- MarcoTolo (talk) 17:04, 13 February 2010 (UTC)

age limits on vaccine

The article leaves several unanswered questions. Why do vaccine approvals have an upper age limit? Why does that age vary by country? Why are age ranges for females different than for males? In the UK, vaccines are licensed for females age 9-26 and males age 9-15. In the USA, it is FDA approved for both females and males age 9-26. This information should be added to the article. That would benefit readers more than making people find it in a cited source. 63.226.240.208 (talk) 23:46, 23 July 2010 (UTC)

The upper age limit is because the vaccine series should be given before starting sexual activity. Since most people in the countries mentioned start sexual activity before age 26, there isn't a lot of reason to approve it for older women. (It also may tend to remove confusion, if sexually experienced women didn't realize that it is unlikely to benefit them they might try to get the vaccination.)

An other factor is that the immunogenicity is better for teens or pre-teens (I would have to look up the age range.)

An other factor is marketing - the makers may try to expand the age range as much as they can so they can sell more doses. Zodon (talk) 06:05, 18 September 2010 (UTC)

State by state table out of date

The table on state by state legislation has become increasingly out of date to the point where may not be that useful. Moving it here so still available to be worked on, but for the time being I think a summary of actions that have been taken may work better, with a link to the NCSL web site for up to date information.

Might want to consider revising table to indicate mandates for insurance coverage, information distribution, making vaccine available, as well as mandates for vaccination. Zodon (talk) 08:11, 7 October 2010 (UTC)

State-by-State

Other states are also preparing bills to handle issuing the HPV Vaccine.

State	Proposal	Status	Opt Out Policy
Alaska	Voluntary vaccination program	Passed	Not Applicable
California	Bill would have required girls entering the sixth grade to be vaccinated.	Withdrawn for further consideration.	Yes
Colorado	Bill would require 12-year-old girls to be vaccinated to attend school.	Pending	Yes
Connecticut	Bill would require girls receive a first dose of the vaccine before entering the sixth grade. Allows parents to opt their daughters out on medical or religious grounds.	Pending	Yes
District of Columbia	Bill would require girls to be vaccinated before they turn 13 to attend school.	Pending	Yes
Florida	Bill would have required 11- and 12-year-old girls to be vaccinated to attend school.	Died in committee	Yes
Georgia	Bill would require girls entering the sixth grade to be vaccinated unless parents can't afford the vaccine or object to it on medical or religious grounds.	Died in Committee	Yes
Illinois	Bill would require girls entering the sixth grade to be vaccinated.	Pending	Yes
Kansas	Bill would require girls entering the sixth grade to be vaccinated. Allows parents to opt their daughters out on medical or religious grounds.	Pending	Yes
Kentucky	Bill would require girls entering middle school to be vaccinated.	Passed House, to Senate	Yes
Maryland	Bill would have required girls entering the sixth grade to be vaccinated.	Withdrawn	Yes
Massachusetts	Bill would require girls entering the sixth grade to be vaccinated. Allows parents to opt their daughters out on religious grounds.	Pending	Yes
Michigan	Bill would require girls entering the sixth grade to be vaccinated.	Pending.	Yes
Missouri	Bill would require girls entering the sixth grade to be vaccinated. Allows parents to opt their daughters out on medical or religious grounds.	Pending	Yes
Minnesota	Bill would require 12-year-old girls to be vaccinated to attend school.	Pending	Yes
Mississippi	Bill would have required girls entering the sixth grade to be vaccinated.	Died. Sponsor planning to re-introduce it with an opt-out clause.	No
Nevada	Bill would require health insurance companies to cover the cost of the vaccine	Passed into law	Not Applicable
New Hampshire	Voluntary program provides vaccine free of charge to girls between the ages of eleven and eighteen.	Passed and presently in effect.	Yes
New Jersey	Bill would require girls in grades seven through 12 to be vaccinated. Allows parents to opt their daughters out on medical or religious grounds.	Pending	Yes
New Mexico	Bill would require nine- to 14-year-old girls to be vaccinated to attend school.	Passed legislature. Vetoed by governor.	Yes
Ohio	Bill would require girls entering the sixth grade to be vaccinated.	Pending	Yes
Oklahoma	Bill would require girls entering the sixth grade to be vaccinated.	Pending	Yes
South Carolina	Bill would require girls entering the seventh grade or 11 years of age to be vaccinated. Allows parents to opt their daughters out on medical or religious grounds.	Pending	Yes
Texas	Governor issued executive order requiring that girls entering the sixth grade be vaccinated.	Texas legislature overrode executive order and barred mandatory vaccination until at least 2011.	Yes
Vermont	Bill would require girls entering the sixth grade to be vaccinated. Allows parents to opt their daughters out on medical, moral or religious grounds.	Pending	Yes
Virginia	Bill requires girls entering the sixth grade to be vaccinated.	Passed the legislature. Goes into effect Oct. 1, 2008; to be implemented in fall of 2009.	Yes
West Virginia	Bill would require girls entering the sixth grade to be vaccinated. Allows parents to opt their daughters out on medical grounds.	Died	Yes

Source: National Conference of State Legislatures, state legislatures

Misleading statements

The introduction states: "Both vaccines protect against the two HPV types (HPV-16 and HPV-18) that cause 70% of cervical cancers, and cause some other genital cancers; Gardasil also protects against the two HPV types (HPV-6 and HPV-11) that cause 90% of genital warts.

This is referenced to the dead page: http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-young-women.htm

HPV-16 and HPV-18 are LINKED to cervical cancers, HPV-6 and HPV-11 are LINKED to genital warts. —Preceding unsigned comment added by 84.114.147.43 (talk) 16:59, 27 February 2011 (UTC)

Links updated. Please put new sections at the BOTTOM of talk pages per WP:TALK. --Steven J. Anderson (talk) 19:05, 27 February 2011 (UTC)

Page title

We might considering page-moving to the unabbreviated name, as spelled in the main article human papillomavirus. ―cobaltcigs 07:00, 10 January 2012 (UTC)

New Paper in Annals of Medicine, December Issue

http://informahealthcare.com/doi/abs/10.3109/07853890.2011.645353

I feel this should be reflected in the article. — Preceding unsigned comment added by 217.162.73.165 (talk) 19:32, 10 February 2012 (UTC)

Excerpt from that page: "Click here to publish in as little as five weeks". Looks like a fringe journal to me. --Steven J. Anderson (talk) 22:54, 10 February 2012 (UTC)

Would help if you indicated what the article says that you think should be included. (The abstract doesn't offer much - just some misleading statements and opinion by a couple of people in neurology.) Zodon (talk) 08:33, 26 February 2012 (UTC)

Possible New changes

Hello guys my name is Marleny Espinosa, I will be working on this page as part of my capstone project. I plan to work on the history making it a little bit more concise, also I want to add a picture of the scientists that discover the vaccine. Furthermore I plan to add a section the talks about the chemistry involved in the vaccine. I am a new Wikipedia user and welcome any type of help and suggestions.--Mespinos (talk) 16:49, 18 February 2012 (UTC)

I have updated the table under state-by-state and I have also added Mexico under the list of countries.--Mespinos (talk) 15:24, 28 April 2012 (UTC)

Additional New Changes

Hey everyone I am Christina Nassisi and I will also be helping to add to this page. This is part of the GGC educational assignment, so please work with me as I know I will definitely need some assistance. Some thoughts I had were to add some more information about the research methods behind both vaccines, as well as give more background information on why Gardasil and Cervarix do not protect against all types of HPV. This includes adding additional tables giving a breakdown of some of the most common strains of HPV, and tables for each vaccine and it's treatment ability. I also want to keep working on connecting more links into and out of the article, so I will need assistance with how to do this. Thanks in advance for your help, and I am welcome to any advice or ideas you may offer. Naprissi (talk) 15:15, 20 February 2012 (UTC)

More information on the strains present in each vaccine is a good idea, but a complete list of all HPV strains probably does not belong in this article. That would make more sense for the main article on HPV. Good luck on your project! MYCETEAE - talk 05:36, 22 February 2012 (UTC)

I added more information about the makeup of Gardasil that allows it to target certain strains of HPV. Naprissi (talk) 18:51, 19 April 2012 (UTC)

Most of the details on Gardasil or Cervarix should be in their respective articles. This article just has a summary. Zodon (talk) 05:27, 20 April 2012 (UTC)

I need help please! I want to continue contributing to this page, but I am currently stumped on what I can expand on. Anyone have any suggestions for adding to the page? Thank you in advance! Naprissi (talk) 17:19, 20 April 2012 (UTC)

One aspect that I have thought would be interesting to cover some is the pricing of the HPV vaccines. Merk priced their vaccine high initially to capitalize on the lead they had before Cervarix became available. (Most vaccines are much less costly.) Gardasil became a cash cow for Merk, prompting them to push for legislation to require vaccination, etc. This may be more apropos the article on Gardasil, but, but Cervarix seems to have copied Merk's pricing, and some of it might go here. Breakdown of manufacturing costs, profit per dose, etc. could be interesting (if one could find sources).

I can't suggest any particular references, but it is a bit of the history/background on the vaccines that seems like could make an interesting addition. Zodon (talk) 07:37, 21 April 2012 (UTC)

Material from theraputic vaccines - too technical

The following was added to the therapeutic vaccines section recently. I am not sure whether it should just be removed, or if there is material here that once simplified might be useful to include.

HPV-associated neoplasia are being used to test antigen specific immunotherapies. Therapies have focused on HPV's susceptibility to immune manipulation. Imiquimod, a toll-like receptor (TLR) 7 agonist, works as an inducer of natural immune responses and has been approved by the FDA as first-line therapy for external genital warts.

Clinical trials of human papillomavirus (HPV)-specific immunotherapy.

Focus has been put on testing T-cell responses to HPV E6 or E7 in intraepithelial lesions. Therapeutic HPV vaccines work to induce increased T-cell responses in humans. In clinical trials, these therapies were administered through different delivery systems such as fusion proteins used alone and with adjuvant, encapsulated polynucleotides, protein with adjuvant, recombinant viruses, DNA constructs, dendritic cells, and chimeric VLP constructs. While patients part of this clinical testing showed limited benefit from therapeutic induced T-cells responses, they were poor targets for antigen-specific therapies. The patients had late-stage disease, giving the tumors more time to develop mutations as well as deletions of genes involved in antigen processing and presentation.

The first paragraph has no obvious relation to vaccines, since it appears to be talking about other types of therapies. If it relates to vaccines somehow, that needs to be clarified. The other paragraph is too technical without enough explanation to make it comprehensible.

Please see WP:MEDMOS, both for language/audience, and a little bit on what should be in a research section. Research sections are not for detailed explanations of the research, but to indicate major directions and progress, if there is coverage in significant sources. (e.g. a review of research in an area might be a decent source, individual research papers - much more problematic). Zodon (talk) 06:41, 1 May 2012 (UTC)

Vaccine implementation

This section seems way too long, and it makes the table of contents box look excessively long as well. Shouldn't the whole of Europe be merged into one section as most of the European countries here are just 1-3 sentences (and not long sentences either) in length? ComfyKem (talk) 13:36, 14 May 2013 (UTC)

Mechanism of action

Mechanism of action isn't credible The reference used is a news copy [6] of another news article[7] diluted of biology posted on a website selling a chemical burn treatment for warts. Consequently the mechanism of action is confused with an explanation of usual viral replication. For example it starts by saying that the vaccine is a hollowed out virus but in the following sentences is talking about wild type virus. Poor grammar is also associated with a lack of credible biological explanation, eg "E1 is a highly conserved protein in the virus, E1 is in charge of the production of viral copies is also involved in every step of replication process." Most likely E1 is not included in the VLP of the vaccine otherwise the vaccine would be replication competent. Ericglare (talk) 06:39, 17 July 2013 (UTC)

This article needs a Criticism or Opposition section

Someone has now created an article on Diane Harper, and while it unfortunately quotes a couple of non-RS sources and gets caught up in tabloid nonsense and also is POV against Gardasil as opposed to Cervarix [translation: the article needs a cleanup and re-write to remove all non-RS material), [update: article has been cleaned up] there are some important RS sources utilized and even quoted, that are more recent and more potent than the ones in this HPV vaccine article. I suggest adding Harper's statements of her strong aversion to and cautions about the HPV vaccine to this HPV vaccine article. Softlavender (talk)

Could you clarify? I've just read each of the journal entries used as sources in that article, and all, including research in which she participated in, produced data contrary to her criticisms of Gardasil. She references one study that uses VAERS as a source, but VAERS stats aren't to be taken as reliable assessments of vaccine risks because of how the program works. An analysis of the deaths following HPV vaccination reported to VAERS demonstrated they all can be explained as being caused by things other the vaccine. & The very paper that uses these VAERS numbers even states two things in the abstract that are contrary to her critiques:

• "Vaccination with qHPV was 90% to 100% effective in preventing precancerous cervical, vaginal, and vulvar lesions and genital warts caused by infection with the relevant HPV types (6, 11, 16, or 18) in women aged 15 to 26 years who were uninfected prior to vaccination."
• "In the clinical trials, the incidence of solicited systemic clinical adverse events following immunization (AEFIs) was similar in the vaccine group (59%) and the placebo group (60%)."

So I really don't understand what's going on here. Does she have a conflict of interest to oppose Gardasil (whilst supporting Cervarix apparently)? Confirmation bias? Regardless of motive, if her views fall under WP:FRINGE, then they are not to be included in this article. Would appreciate more opinions in this discussion. ComfyKem (talk) 09:23, 27 August 2013 (UTC)

We need to use proper sources per WP:MEDRS. Do we have a RS for the above? Please provide links. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:04, 27 August 2013 (UTC)

• There should be a section on criticisms of the vaccine (or opposition to the vaccine), and Harper's criticisms of it should be quoted and cited. [8], [9], [10], [11], [12], [13], [14]. Softlavender (talk) 01:26, 29 August 2013 (UTC)

The popular press is not a reliable source of medical information but could be used to document social and cultural issues such as the vaccine controversy. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:00, 29 August 2013 (UTC)

The sources include and other medical sources. All of the so-called popular press include extensive direct quotes and detailed analysis from Harper, not reporters' opinions. As I mentioned above, this Wikipedia article needs a criticism section. Softlavender (talk) 15:53, 29 August 2013 (UTC)

There aren't sufficient criticisms to be included that wouldn't give undue weight to fringe beliefs. Some "criticisms" out there, although false, included that the vaccines kill women, sterilize men and women, and make women more sexually active. Would these be included? Because then a "criticism" section would just be a "misconceptions/myths about the vaccines" section. Besides, Harper's views are already included in the "Vaccination and public health" section. ComfyKem (talk) 00:36, 30 August 2013 (UTC)

This Article is totally discredited by default

This vaccine raises tremendous controversy. and nothing about it in this article.

Looks more like a Gardasil promotion page79.182.198.143 (talk) 11:34, 31 October 2013 (UTC)

UK vaccination schedule

As far as I am aware, and the rest of the article says, Boys are not targeted in the UK. This is, in fact, a source of much controversy.

Sleevicus (talk) 13:30, 8 June 2014 (UTC)