HPV vaccine recommendations

In October 2011, the CDC began recommending that adolescent males receive the HPV vaccine. In February 2015, the CDC incorporated the recently approved HPV9 vaccine in the recommendations for HPV prevention, thus rendering HPV9 or HPV4 vaccines accessible and approved for males.10 For a vaccine schedule initiated at age 11, the second dose is recommended 6 to 12 months after the initial dose (see Table 1). In instances in which the providers do not know which HPV vaccine was previously administered, the HPV vaccine available to the provider may be administered to continue or complete the series for males; if the vaccine schedule is interrupted, the series does not need to be restarted.10 In May 2017, HPV9 became the only HPV vaccine available in the United States.11 Most recent updates from the CDC11 now recommend that when administered to adolescents between the ages of 11 and 14 years, two doses of the vaccine, at least 6 months apart, provide effective protection; however, teens who begin the series at age 15 must complete the 3-dose series.11 Heterosexual males must complete the series by age 21.

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Special populations

Men who have sex with men (MSM), transgender persons, and certain immunocompromised males are a subgroup of males with an even higher risk for contracting HPV; oncogenic subtypes of HPV are transmitted via anal intercourse, penetrating the anogenital mucosa and leading to infection and possibly anal cancer. The incidence of HPV is higher in individuals who engage in anal intercourse, especially the receptive partner.12 The average age of disclosure of sexual orientation among MSM is the early 20s, and most MSM have had an average of 8 sexual partners by the time they disclose their sexual orientation.12 Moreover, the prevalence of HPV in MSM may be as high as 30%, compared with approximately 8% in heterosexual men.13

Because of the strong relationship among HPV, anal intercourse, and anal cancer, current CDC guidelines for HPV vaccination differ for MSM and their heterosexual counterparts because MSM have an increased risk for contracting HPV and not clearing the virus. For MSM who were not vaccinated as adolescents or did not complete the 3-dose series, the CDC recommends HPV vaccination up to age 26 years.14

The guidelines are different for MSM who are infected with the human immunodeficiency virus (HIV). According to current CDC guidelines, persons with an immunocompromising disease such as HIV need to receive the 3-vaccine series.15 As their immune function declines, patients with HIV have an even greater risk for developing an HPV-related cancer. One concern about administering the HPV vaccine to HIV-positive young adult men is the potential diminished immune response to the vaccine. Although data are limited, one study of 109 HIV-positive men aged 18 years or older found the quadrivalent HPV vaccine safe, without appreciable effect on the subjects’ CD4 cell counts or viral loads, and highly immunogenic, with seroconversion rates of 95%.16

Vaccine promotion in the clinical setting

Missed opportunity is a significant impediment to HPV vaccination in the male adolescent population. Bernstein and Bocchini17 noted that 65% of parents never received a recommendation for their child to receive the HPV vaccine, although provider recommendation has been shown to have a very positive influence on vaccination uptake.18 In a national survey, 600 men aged 18 to 59 years were asked about their willingness to be vaccinated against HPV. The results revealed that 60% wanted to receive the vaccine when told it could prevent cancer, compared with 42% who were willing to receive the vaccine when told it would protect only against genital warts. The study results emphasized the importance of healthcare providers educating parents and young male adults that HPV vaccination is a cancer prevention measure.19 Another study recently reported that a 3-dose regimen of the 4-valent HPV vaccine was immunogenic, clinically effective, and generally well tolerated in preadolescents and adolescents throughout 10 years of follow-up.20

Related Articles

Although routine vaccinations and follow-ups continue to occur during childhood and adolescence, the opportunity may be missed for providers to emphasize the value of HPV vaccine as cancer prevention of males and females during these visits. Recent studies indicate that HPV vaccines can be safely administered when giving routine adolescent immunizations such as tetanus, diphtheria, pertussis, and meningococcal.21 When advising young males and their parents to consider HPV vaccination, providers should remind them that men continue to be susceptible to HPV infection with increasing age.19

Patricia A. Obulaney, DNP, RN, ANP-C, is an assistant professor, clinical; Lydia T. Madsen, PhD, RN, CNS, is an assistant professor, clinical; and Kristin Ownby, PhD, RN, ACHPN, AOCN, CNS-BC, is an associate professor, clinical, Department of Acute and Continuing Care, Cizik School of Nursing, University of Texas Health Science Center at Houston.


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