Key Panel Recommends Routine HPV Vaccination For Boys

Oct 25, 2011
Originally published on October 25, 2011 6:40 pm

If you thought the HPV vaccine against cervical cancer was controversial before, things are just warming up.

A panel of experts that advises the Centers for Disease Control and Prevention on vaccine policies has recommended routine vaccination of 11- and 12-year-old boys with Gardasil, Merck's vaccine against human papillomavirus. Vaccinations could start as early as age 9 and extend to 21-year-old men who weren't previously vaccinated.

"Today is another milestone in the nation's battle against cancer," said the CDC's Dr. Anne Schuchat, head of the National Center for Immunization and Respiratory Diseases, in a media briefing about the recommendation.

Vaccinating boys against the sexually transmitted virus can help protect them from genital warts and may protect them against cancers of the head and neck, as well as the anus. Immunizing boys against HPV can also reduce the infection risks for girls, adding to the overall protective effect of the vaccine for cervical cancer.

But the HPV vaccine is expensive — it runs more than $100 a dose. Three shots are recommended.

Data presented at the panel's meeting in Atlanta estimated the costs of vaccinating boys at $136 million in the first year.

Estimating the value of health benefits is harder. The value of male HPV vaccination is higher when the rate of immunization among females is lower. About 18,000 HPV-related cancers strike American women each year, Schuchat said. For men, the figure is around 7,000.

But the health benefits in the form of prevented disease take years to accrue.

Despite the uncertainty, the Advisory Committee on Immunization Practices unanimously recommended routine use of Gardasil for boys as worthwhile. The CDC is expected to make the recommendation official.

In the past, the CDC has said doctors are free to offer the HPV vaccine to males ages 9 to 24. But the agency didn't say it should be routine.

In a statement e-mailed to Shots, Merck said its analysis shows that HPV shots for boys make economic sense, assuming the immunizations cut the transmission of HPV and decrease the development of genital warts. The company notes, however, that the clinical studies incorporated in its model didn't address transmission.

The most common side effects from HPV vaccination are pain and swelling at this site of injection, headache and fever.

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Advisers to the Centers for Disease Control and Prevention say vaccinations against a virus called HPV should be more than just an option for preteen boys. The panel says doctors should be routinely telling parents of 11- and 12-year- old boys they need the vaccine against HPV. The panel says it will lower boys' risks of some cancers later in life.

Here's NPR's Richard Knox.

RICHARD KNOX, BYLINE: For five years now, the CDC has urged parents to get their 11- and 12-year-old daughters vaccinated against HPV, and that female teens and adults up to age 26 should get it, too. That's been controversial, partly because the CDC is urging protection against a sexually transmitted virus well before most girls are sexually active.

Now, CDC advisers say all 11- and 12-year-old boys should get the HPV vaccine, and older boys and young men up to 21 should also get it if they missed it earlier. The reason: The human papillomavirus is strongly associated with five different kinds of cancer.

DR. ANNE SCHUCHAT: Frankly, the idea of having a vaccine that can prevent cancer is a pretty compelling argument.

KNOX: That's Dr. Anne Schuchat, head of the CDC's immunization division. She says 20 million Americans are infected with HPV, but the vaccination rate among girls has been disappointing.

SCHUCHAT: HPV's vaccine is not being highly taken up by teenaged girls. The vaccination of males offers an opportunity to decrease disease in both males and females.

KNOX: HPV is strongly associated with cervical and other reproductive cancers in women; in men, cancer of the penis. In both sexes, it can cause genital warts, anal cancer, and cancers of the mouth and throat. The idea is to vaccinate against HPV before boys and girls begin having sex because the vaccine doesn't do any good once somebody's already infected.

Dr. Rodney Willoughby, a Milwaukee pediatrician, says it's a great idea.

DR. RODNEY WILLOUGHBY: There's a lot of common sense to saying that if you want to interrupt it, you need to address it in boys as well as girls.

KNOX: The CDC says vaccinating boys will save money in the end, even though it costs more than $400 for a course of three shots. Schuchat says the CDC hopes that by making this an equal-opportunity vaccine, some of the controversy will die down.

SCHUCHAT: We are interested in seeing whether a universal recommendation makes it easier for providers to remember the vaccine and offer it routinely, or perhaps even makes it more acceptable to parents because they're thinking about it for both their sons and their daughters.

KNOX: But, she quickly adds, we don't know that yet. Richard Knox, NPR News. Transcript provided by NPR, Copyright NPR.