Vaccinating against HPV: Why so early? Why boys?

Vaccinating against HPV: Why so early? Why boys?
Vaccinating against HPV: Why so early? Why boys?

BOSTON – Human papillomavirus vaccine uptake in the United States continues to lag far behind rates in other developing countries at around 30%, compared with rates ranging from 75% to 90% in Australia, Canada and the United Kingdom.

“We've always wanted a vaccine against cervical cancer. We've got it, so why aren't we using it?” H. Cody Meissner, MD, of Tufts Medical Center in Boston, told an audience at the 2014 National Association of Pediatric Nurse Practitioners Annual Conference.

An estimated 79 million Americans are infected with HPV. Nearly everyone will be infected with HPV in their lifetime. Approximately 6 million new cases of HPV occur each year and around 26,200 new HPV-related cancers occur each year.

A lack of understanding and education about disease caused by HPV on the part of parents, lack of education about what the vaccine does, and less than-emphatic recommendations to immunize against HPV on the part of healthcare providers are contributing to overall low vaccine coverage rates.

“Many primary care providers will tell you it's hard to have a conversation about sexual behaviors. But ask an oncologist and they will say it's a harder conversation to tell a woman she is going to die, because she didn't receive a vaccine,” Meissner said.

Most HPV infections occur during the end of the teenage years, when people tend to become sexually active, and into the beginning of the third decade of life. However, high-grade cervical epithelial lesions peak around ages 30 to 40 years, and the median onset of cervical cancer occurs around age 49 years.

The long interval between infection and disease onset can make it hard for a parent to understand the importance of vaccinating to prevent cancer.

Research shows 23% of boys and 21% of girls have sex by the age of 15 years, with the rates increasing to 78% and 84%, respectively by age 20 years.

Vaccinating at 11 or 12 years of age, as current recommendations state, increases the likelihood of protecting children before they become sexually active and research shows that vaccinating earlier achieves a better antibody response.

Parents may also be unaware of newer recommendations to immunize boys with the quadrivalent HPV vaccine. HPV types 16 and 18, which are included in the vaccine, account for more than half of penile, anal and oropharyngeal cancers in males – an estimated 7,550 of the average annual 12,002 cases of these types of cancers that occur annually.

For girls and women, approximately 70% of cervical cancer types are preventable with the currently available HPV vaccines. Drug manufacturer Merck recently filed an application to license a new 9-valent HPV vaccine. If approved, the proportion of vaccine-preventable cancer types would increase to 90%.

“It is unfortunate that this vaccine got wrapped up and classified as a vaccine to prevent sexually transmitted disease, because more importantly this is a vaccine that prevents cancer. Parents should know that this and should understand that it needs to be administered before the infection occurs to be effective,” Meissner said.

References

  1. Meissner HC. #202. “Pediatric & Adolescent Immunization Update.” Presented at: 2014 National Association of Pediatric Nurse Practitioners Annual Conference. March 11-14, 2014; Boston.
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