HPV Vaccine Recommendation for Boys Viewed as Necessary

Ezra E.W. Cohen, MD

Associate Professor, Section of Hematology/ Oncology, Department of Medicine

Co-Director, Head and Neck Cancer Program

Director, Hematology/Oncology Fellowship Program

University of Chicago Medical Center

Chicago, IL

As the incidence of head and neck cancers linked to the human papillomavirus (HPV) continues to rise, a federal advisory panel has recommended that all 11- and 12-year-old boys be vaccinated against the virus, igniting further controversy in an area where acceptance of a public health policy has been slow.

The recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) would expand the use of the vaccine beyond the original target population of 11- and 12-year-old girls for whom it is recommended as protection against cervical cancer.

Ezra E. W. Cohen, MD, firmly supports the latest recommendation. “It’s the right move by the CDC,” he said in an interview. “I think it’s a long time coming.”

Cohen said that the fact that the original recommendations targeted cervical cancer created a cultural perception that the vaccine was only intended for girls.

Yet the HPV virus affects men as well. According to the CDC, HPV is associated with about 18,000 cancers in women and 7000 cancers in men each year.

Overall, the incidence of HPV-positive oropharynx cancers increased by 225% between 1988 and 2004, according to National Cancer Institute research. There were an estimated 6700 cases of HPV-positive oropharynx cancers in 2010, up from 4000 to 4500 in 2004.

Cohen said he believes such numbers are going to continue to rise. Even by taking proactive steps in 2011, the vaccine is only intended for children and young adults. HPV that is already circulating will continue to be spread and lead to the development of cancer in certain people who contract it.

“Even if vaccinations were made mandatory, we will not see the effects on cancer for decades,” Cohen said. “Just simply recommending it is probably not going to be enough.”

Indeed, the CDC has found that public acceptance of the HPV vaccine for girls has lagged behind adoption rates for other vaccines. The recommendation has been controversial because HPV is spread through sexual activity, leading many parents to protest over the notion that their children could be engaging in sexual activities at a young age.

Key HPV Vaccination Statistics

• Coverage for 1 dose of HPV vaccine for girls increased by only 4.4 percentage points to 48.7% in 2010 versus 44.3% in 2009.
• For girls who received the recommended 3 doses of HPV vaccine, coverage increased 5 points to just 32% in 2010 versus 26.7% in 2009.
• Of the girls who began the HPV vaccine series, 30% did not receive all 3 doses.
• Completion of the 3-dose HPV series was lower among blacks and Hispanics than whites.
• Coverage for 3 doses of HPV vaccine was lower for those living below poverty levels.
• Poor and minority teens are less likely to receive all 3 recommended doses of the HPV vaccine.

Source: Centers for Disease Control and Prevention. Teen vaccination coverage. 2010 National Immunization Survey (NIS)—Teen. www.cdc.gov/vaccines/who/teens/vaccination-coverage.html#nis-tables. Published August 25, 2011. Accessed November 7, 2011.

The HPV vaccine was first recommended for 11- to 12-year-old girls as well as for teenage girls and women through age 26 in 2006, yet less than one-third of those who started the vaccine series received all 3 doses (Key Statistics, Left).

The FDA has approved 2 products, the quadrivalent Gardasil (Merck) and the bivalent Cervarix (GlaxoSmithKline), as vaccinations against HPV. For girls and young women, both vaccines are recommended as protection against cervical cancer, while Gardasil also protects against anal, vaginal, and vulvar cancers.

The only HPV vaccine recommended for males is Gardasil, a CDC official said in discussing the new recommendations in October.

In a study published in The New England Journal of Medicine in October, a phase III trial demonstrated that Gardasil was 77.5% effective in reducing the rates of anal intraepithelial neoplasia associated with 4 HPV types among 602 healthy men ages 16 to 26 years who have sex with men.

Despite the vaccine’s ability to protect patients from HPV, the vaccine does not protect against a wide variety of other sexually transmitted diseases, including the human immunodeficiency virus.