Oct 27, 2011
GAME CHANGER- ADVISORY COMMITTEE RECOMMENDS HPV VACCINATION FOR BOYS
The week of October 24 the highly influential U.S. Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommended HPV vaccination of boys ages 11 and 12, and “catch up” vaccination for males ages 13-21 who have not previously been vaccinated. The Committee specifically recommended the “quadrivalent” vaccine (Gardasil®), which prevents infection with the two most common cancer-causing HPV strains (HPV 16 and 18) and the types responsible for 90% of genital warts (HPV 6 and 11). The bivalent vaccine, Cervarix®, has not been studied in males but remains an option for females if HPV 6 and 11 are not serious concerns.
While the basis of the vaccine is recent studies demonstrating that males who received the vaccine are at reduced risk for anal and throat cancers, studies also show that the quadrivalent vaccine reduces risk of genital warts in males and, in theory, may reduce the risk of acquiring infections which could then be transmitted to sex partners. The Committee specifically recognized that one benefit of immunizing boys is to help prevent infection in exposed girls and women who have not been vaccinated themselves. Committee approval usually is accepted as the basis for formal guidance by CDC itself and other professional agencies. In addition, private health insurance companies typically will cover immunization recommended by the Advisory Committee but may not pay if a vaccine has not been formally recommended. The ACIP had previously stated that the vaccine could be used for males but had not formally recommended it. A further benefit of the new recommendation is that approval for males may increase HPV vaccine uptake by girls and women. Many experts believe that the different emphasis on immunizing girls and boys been confusing to doctors, their patients, and young persons’ parents, perhaps causing reduced immunization of girls.
While many questions remain about HPV and its relationship to various kinds of cancer, the quadrivalent vaccine is now proven safe and effective and has been enthusiastically endorsed by many health care providers and public health agencies. We add our strong personal endorsement of routine HPV immunization of all young people before they become sexually active, plus catch-up vaccination of young people who have already begun sexual activity.
Edward W. Hook III, MD
H. Hunter Handsfield, MD