Medical experts say boys, too, should get HPV vaccinations
By Judy Peres
Copyright © 2007, Chicago Tribune
Published February 20, 2007
While politicians argue over whether to make preteen girls get vaccinated against HPV, medical experts already have moved on to the next topic: giving the vaccine to boys as well.
HPV, or human papillomavirus, causes virtually all cases of cervical cancer. So a new vaccine that prevents infection with four common strains of the virus has been hailed as a big step toward eliminating a potentially lethal cancer that affects nearly 10,000 Americans a year.
Of course, men can't get cervical cancer, but millions of them get HPV, which they can pass to their partners.
HPV is the most common sexually transmitted disease, infecting an estimated 20 million Americans. Experts say about 50 percent of all U.S. adults have the virus, although most never know it. Currently, sexually active people have no way to protect themselves from HPV if their partner is infected.
The U.S. Food and Drug Administration approved a vaccine, Gardasil, last June. A few weeks later the U.S. Centers for Disease Control and Prevention recommended that all girls be inoculated at ages 11 or 12 or before they become sexually active.
Now legislatures in at least 18 states, including Illinois, are considering whether to require the vaccine for school attendance, like inoculations against polio and measles.
Public-health experts say making HPV shots mandatory is a good way to achieve broad coverage, or "herd immunity." But an even better way to do that would be to make Gardasil an equal-opportunity vaccine.
"Men serve as a source of transmission for the virus," said Dr. Yvonne Collins, assistant professor in gynecologic oncology at the University of Illinois Medical Center at Chicago.
HPV can cause diseases that affect men, too, she said, including other cancers of the genital area and of the mouth and throat.
"We have an opportunity to clear a large burden of cancer with this vaccine," Collins said.
Merck, the pharmaceutical giant that developed Gardasil, tested it in boys and found it safe and effective at producing immunity to the virus. That was enough to persuade regulatory authorities in Australia and the European Union to approve the vaccine for both sexes.
But the company does not yet have data proving the vaccine prevents disease in men as it does in women.
"Those studies are ongoing," said Dr. Rick Haupt, Merck's executive director of medical affairs. "We hope to have that data in 2008."
The FDA approved Gardasil for use in females ages 9 to 26 after Merck proved the vaccine blocks infection with HPV and prevents cervical cancer, precancerous conditions of the cervix and genital warts in that group.
Haupt said the boys and young men in the ongoing trials will be followed to see if they develop HPV, genital warts or precancer of the penis or anus.
According to an editorial in the British medical journal The Lancet, restricting the vaccine to girls would be significantly less effective at reducing HPV infection in women than giving the vaccine to boys as well.
The journal noted that Britain's rubella immunization program involved only girls for the first 25 years of its existence, because rubella (German measles) is most dangerous to developing fetuses. But in 1995, after a rise in the number of pregnant women contracting the disease, the rubella program was expanded to include boys.
"For effective and long-term eradication of HPV, all adolescents must be immunized," the journal's editors wrote.
The American journal Obstetrics & Gynecology also has argued that the HPV vaccine should be gender-neutral.
The author of that commentary, Dr. Bradley Monk of the University of California at Irvine, is in favor of giving the vaccine to nearly everyone, regardless of age, gender or risk factors.
"We need to move toward a paradigm where this is a universal vaccine," he said. "To have a vaccine that prevents cancer and not use it would be one of the greatest tragedies."