Boys and HPV Vaccine

Routine Vaccination Against HPV Recommended for 11- and 12-Year-Old Boys

Print This Post Print This Post

October 25, 2011—Members of the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) have voted to recommend boys ages 11 and 12 years should routinely receive three doses of the quadrivalent human papillomavirus (HPV) vaccine.[1] In a second vote, the committee voted to extend routine HPV vaccinations to boys and men through age 21. In a third vote, the panel voted 13-0-1 to recommend the vaccine for men between the ages of 22 and 26 if they have sex with men or a weakened immune system.

There are currently two FDA-approved vaccines against HPV, but this recommendation vote applies only to Gardasil (Merck & Co). The other is a bivalent vaccine (Cervarix; GlaxoSmithKline) and has not been tested in males.

In 2009, CDC recommended that boys could be given the vaccine. Today’s recommendation takes that a step further by emphasizing that boys 11 and 12 years old should be offered Gardasil as a routine vaccination. It is approved for boys as young as age 9. Gardasil can also be offered as a catch-up vaccination to older teens and young men who have not completed the three-shot series.

According to Anne Schuchat, MD, Assistant Surgeon General of the CDC, approximately 20 million people are currently infected with HPV, which is associated with cancers of the cervix, anus, vagina, and the head and neck, as well as genital warts. Among U.S. women, 18,000 HPV cancers affect women, with cervical cancer the most common. About 7,000 HPV associated cancers each year affect men in the United States, with cancers of the head and neck the most common. HPV also causes most cases of genital warts, which affect approximately 1 in 100 U.S. sexually active adults. The quadrivalent vaccine prevents against the type of HPV that causes cervical cancer in women, anal cancer in men, and genital warts in both.

The recommendations are the result of the committee’s review of safety and efficacy data that became available after the vaccine’s initial approval in 2009. The data suggest that the vaccine has the greatest impact on boys before there is exposure to the virus through sexual contact. Nearly 40 million doses of the vaccine have been distributed in the United States and the CDC has reported 34 confirmed deaths. Nevertheless, Dr. Schuchat reiterated that the committee believes the vaccine to be both effective and safe, despite reports of troublesome injection site reactions, headaches, and fever.

It’s estimated that it will cost $140 million to vaccinate young boys annually, although administering the catch-up vaccines will cost millions more. When speaking of cost effectiveness, Dr. Schuchat noted, “Male vaccination is most cost effective when coverage of females is low,” which is currently the case in the United States. According to data published by the CDC, 40.5% of all girls between the ages of 13 and 17 have received at least one dose of the HPV vaccine, and just half of those had received all three doses.[2] Therefore, there is some hope that vaccinating younger boys will also protect girls who have not yet received the vaccine, although it is still unclear as to what the uptake of the vaccine will be among boys. To date, only about 1% of boys have received the vaccine.

Many parents will want to know if the vaccine is covered by insurance plans. In 2009, the Vaccines for Children Program—which covers children who are Medicaid eligible, uninsured, American Indian or Alaskan native, and underinsured—has included HPV vaccines for boys through age 18 years. Many insurance companies have been covering the HPV vaccine for girls and boys, but it depends on the particular plan. If the CDC follows the ACIP recommendation and makes HPV a recommended vaccine, it’s likely that under the Affordable Care Act, insurance plans will pay for it without requiring a co-payment.

The recommendation must now go to the CDC for consideration over the next few months. If approved by CDC, these new recommendations will be published in the February issues of Morbidity and Mortality Reports and Pediatrics.

In a separate decision, the ACIP also voted to recommend routine vaccination against the hepatitis B virus (HBV) for people with diabetes under age 60 years. The recommendation is based on findings that U.S. adults with diabetes have twice the risk of contracting hepatitis B.[3] The infection is thought to result from blood glucose monitors that are handled by more than one person, such as might occur in clinicians’ offices, pharmacies, and assisted living facilities. Patients with diabetes who are 60 years and older may get vaccinated as well, but the panel recommended the vaccine for younger people because that is when the immune system responds best to vaccination. ACIP advised that people get the HBV vaccine as soon as the diabetes diagnosis is made, with a 3- or 4-dose series conferring lifetime protection against HBV.
Jill Shuman, MS, ELS
Published October 27, 2011

References

  1. ACIP recommends all 11-12 year-old males get vaccinated against HPV – Press briefing transcript. Centers for Disease Control and Prevention Website. http://www.cdc.gov/media/releases/2011/t1025_hpv_12yroldvaccine.html. October 25, 2011. Accessed October 26, 2011.
  2. Dorell CG, Yankey D, Santibanez TA, Markowitz LE. Human papillomavirus vaccination series initiation and completion, 2008-2009. Pediatrics. 2011; Oct 17. [Epub ahead of print].
  3. Reilly M, Poissant T, Vonderwahl C, et al. Incidence of acute hepatitis B among adults with and without diabetes, 2009-2010. Presented at the IDSA Annual Meeting, October 22, 2011, Boston, MA. Abstract #1286. http://idsa.confex.com/idsa/2011/webprogram/Paper31404.html