HPV Vaccine: What’s Good For the Goose Is Good For the Gander
Oct 26, 2011

There has certainly been a great deal of media coverage regarding yesterday’s vote from the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) in favor of recommending Human Papillomavirus (HPV) vaccine for boys.
As the mother of five girls, I am happy to hear this.  Although my daughters will all receive the HPV vaccine, I’ve always wondered why females were being tasked with reducing the spread of a virus that can be transmitted through genital contact.   After all, HPV transmission often involves parties from both sexes.  So, while previous recommendations to vaccinate girls have had the potential to lower the rates of HPV transmission, unless there is a large majority of girls vaccinated (which, as of yet, there isn’t), the fact is HPV will continue to be spread among a sexually active population that includes both men and women.
So, a new decision has been made and the ACIP recommendation is to vaccinate boys as well.  But it’s wasn’t such a simple matter.  The recommendation was based on specific evidence that illustrated a cost-benefit of vaccination that will reduce the incidence of certain cancers in males.
What we know about the HPV virus.
What many people may not realize is that HPV infection is very prevalent among the sexually active population (and sexually active does not necessarily mean promiscuous).  To be honest, until I began researching the HPV vaccine, I never knew that most sexually active men and women will be infected with HPV at some point in their lives.  
It’s important that people realize that it is possible to be infected with HPV, but never suffer any symptoms, never realize you are infected and continue to pass it onto various partners.  It’s also possible for some people to clear the infection without any medical intervention.  However, because of the serious risks that HPV can present, we must recognize that this is not always the case.
In some cases, HPV can lead to various complications, such as genital warts or cancer, including cervical, vaginal, vulvar, penile, anal and throat cancers. Additionally, as more research is conducted, we’re learning that there may be a link between HPV and heart disease in women, a possibility that was suggested earlier this week and a concern that warrants additional research.
Unfortunately, a large study that covered 83% of the U.S. population during 1998–2003 estimated that about 24,900 HPV-associated cancers occur each year with more than 17,300 HPV-associated cancers occurring yearly in women, and almost 7,600 occurring yearly in men.  Shockingly, nearly all cervical cancers are caused by HPV, while 90% of anal cancers, 65% of vaginal cancers, 50% of vulvar cancers, 35% of penile cancers and about 60% of oropharyngeal cancers – which are cancers of the back of the throat, including the base of the tongue and tonsils – are all attributed to an HPV infection.
What we know about the HPV vaccine.
Given the statistics above, it is not surprising that the HPV vaccine is often hailed – and rightly so – as a cancer preventing vaccine.  The HPV vaccine has undergone rigorous testing and it’s estimated that approximately 35 million doses have been administered since the CDC first began recommending the series.
While staunch anti-vaccine critics often refer to VAERS reports suggesting incidence of death related to the vaccine, the specific investigations into these reports have not linked these incidences to vaccination, but rather death after vaccination, which is not related to the vaccine.  (For an excellent visual illustration of HPV vaccine safety I encourage you to check out this blog post on Information in Beautiful.)
This is just one of the many unfounded suggestions that have been the focus of anti-vaccine sentiment, all helping to contribute to parental hesitation regarding the HPV vaccine.  In addition to safety concerns, some parents question why they should get their children vaccinated if the vaccine only protects against some of the many HPV strains that exist.  Other parents wonder how long the vaccine will be effective and whether their will be a need for a booster. While there is currently no evidence that suggests that a booster will be necessary, some parents have expressed a preference to wait until their child is older and more likely to engage in sexual activity.  Still other parents are distracted by the fact that the HPV infection is transmitted through genital contact.  They worry what messages they could be sending their daughters if they decide to have them vaccinated at a young age and therefore some have opted avoid the vaccination entirely.
Unfortunately, all these issues have resulted in disappointing vaccination coverage and recent data indicates that only 44.3% -48.7% of adolescent girls, 13-17 years of age, have received one or more doses and only 26.7% to 32.0% have received all three of the recommended doses.
Of course, what we do know is that the vaccine is most effective if administered before a child becomes sexually active, as there is considerable risk that they may contract the virus before vaccination.  Knowing that national statistics suggest that more than one in five children are sexually active by the age of 15, it is understandable that the vaccine is recommended for well before that age and in line with other recommended vaccines that children could expect to receive at physician well-visits.
The new recommendation for boys.
Although the HPV vaccine has not been previously recommended for boys, it has been approved by the FDA for such purposes.  In our discussions on our Vaccinate Your Baby Facebook page, I’ve heard from many parents who have realized the benefits of the HPV vaccine and have since taken the initiative to vaccinate their sons prior to these official recommendations. (Just yesterday, I even heard Dr. Richard Besser, of ABC News, explain why he vaccinated his own two sons and why he anticipated yesterday’s ACIP recommendation to be voted through.)
What we need to consider now is what implications these new recommendations will have.  For instance, most private insurers will pay for vaccines that are on the CDC’s recommended schedule.  Since the HPV vaccine is rather expensive, at approximately $390 for the three dose series, this translates into a policy with monetary implications for insurance companies, while offering considerable cost advantages for parents who had planned to have their boys vaccinated regardless of the recommendations.
The official recommendation voted on yesterday states that boys, ages 11 and 12, should be vaccinated and males between the ages 13 through 21 should also receive the complete three shot series.  Additionally, the decision was made that vaccination may be given to boys as young as 9 and to men between the ages of 22 and 26.
Now that we have these recommendations to go on, all that’s left to wonder is how long it will take before the vaccination rate among boys will beat the rate we’ve had for girls. Personally, I’m curious to see if there will be similar concerns about the HPV vaccine being a suggestion of acceptable sexual behavior among the parents of boys as we have witnessed with the parents of girls.  I can only hope that this won’t be as much of an issue, but that these parents will recognize that their boys have just as much responsibility as our girls to prevent the spread of HPV.


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