In a previous Pediatric Points column I wrote a few years ago, I made
the case for offering the (then new) HPV Vaccine against Human Papilloma Virus (HPV) to girls. HPV is the most common sexually transmitted infection. Within two years of first having sex, nearly 40% of young women are infected with one or more types of these viruses. Younger women are more susceptible to infection with HPV for several reasons including a lack of adequate cervical mucus production and incomplete immune systems.
The good news is that they will very often clear these viruses on their own. But for those young women in whom infection persists, the risks of eventually developing cervical cancer increases. Cervical cancer is the second leading cause of cancer deaths among women worldwide. Over 1/4 of a million women die from this disease each year. 70% of all cases of these cancers are caused by two especially high risk types of HPV numbered 16 and 18. Gardasil is the name of the shot that protects against these two HPV types as well as against types 6 and 11 which are responsible for 90% of genital warts. These kinds of warts affect both men and women. The Food and Drug Administration approved HPV vaccine for boys in 2009. The Advisory Committee on Immunization Practices voted in October 2011 to
recommend the routine vaccination of boys between the ages of 11 and 21.
Although women are affected in larger numbers by HPV-related cancer (approximately 15,000 HPV 16- and 18-associated cancers each year) men are also affected by this sexually-transmitted virus. Approximately 7,000 cases of HPV-associated cancers, including anal, penile and oropharyngeal, occur each year in men. The HPV vaccine has been found to be very effective in males. In studies of men not previously infected who received all three shots, efficacy for prevention of HPV-related genital warts approached 90%. HPV vaccine for girls, in my opinion, is essentially a vaccine against cancer and I recommend it whole-heartedly to my patients. If I had girls of my own, I would vaccinate them in a heartbeat. But currently fewer than 50% of girls have completed the three-dose series.
Many pediatricians I have spoken to are reluctant to tackle this new recommendation for boys when we haven’t yet been successful with the population many of us feel would benefit enormously from vaccination. Some of us are skeptical that the vaccine for boys is truly cost-effective. Some also point to the Australian experience where mandatory vaccination of girls led to a decrease in genital warts in both men and women, suggesting successful herd immunity.
Also, we pediatricians are spending increasingly more of our time
defending proven, effective, life-saving vaccines to nay-sayers, reluctant
parents, and media pressure. To quote Dr. Stacey Humphries from a recent issue
of Consultant for Pediatricians, “To add controversial vaccination of boys to the mix with limited data available may only further taint vaccine acceptance.” So for now, while Dr. Moran and I will certainly give the HPV vaccine to any boy whose family requests it, for now, we’re now going to be pushing this one.