COMMENTARY

Dismal Rates of HPV Vaccination in Boys

Paul A. Offit, MD

Disclosures

December 13, 2012

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Hi. My name is Paul Offit. I am talking to you today from the Vaccine Education Center at Children's Hospital of Philadelphia. I thought I would talk about human papillomavirus (HPV) vaccine for boys.

The HPV vaccine was licensed in 2006, and the first vaccine to be licensed was the quadrivalent vaccine that contains serotypes 6, 11, 16, and 18. That vaccine was known to protect against cervical cancer in girls, preventing approximately 70% of the strains that cause cervical cancer. It was also known to prevent anal and genital warts because it contained serotypes 6 and 11; roughly 90% of the strains that cause anal and genital warts would be prevented. So, the original vaccine was licensed for girls for the prevention of cervical cancer and anal and genital warts.

It was another 3 years (2009) before the vaccine was considered for use in boys. It wasn't until 2010 that the vaccine received licensure from the US Food and Drug Administration for the prevention of cancers in boys, specifically anal cancer.

If you take a step back and look at the number of boys who develop cancers caused by HPV, it is actually quite large. About 8000 boys and men develop cancers caused by HPV every year. About 6000 of those cancers are oropharyngeal cancers. During the October 2012 meeting of the Advisory Committee on Immunization Practices, the Centers for Disease Control and Prevention presented data showing that the HPV vaccine could prevent oropharyngeal infection in boys, depending on the serotype. The vaccine was 93% effective against HPV serotype 16 and 100% effective against HPV serotype 18.

We now have a vaccine that can prevent oropharyngeal infection in boys. We know that 6000 oropharyngeal cancers in boys and men annually are HPV-related. We have a vaccine that can clearly prevent infection and therefore, by definition, prevent cancer because the cell can't be transformed to become cancerous unless it is infected.

Yet, of boys who are recommended to receive this vaccine, only 1% received it in 2010, which is woeful. Only 8% received at least 1 dose of vaccine but didn’t complete the series. The HPV vaccine has suffered from the fact that the original recommendation was for girls. The public perception is that this is a vaccine to prevent cervical cancer rather than a vaccine that prevents a number of cancers including oropharyngeal cancers, which are quite important in boys and young men.

We need to get on the ball and make sure that we get this vaccine into adolescent boys so that we can prevent them from developing oropharyngeal cancers 20 or 25 years down the road.

Thank you.

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