Panel: Boys need STD vaccine too

  • Article by: SHARI ROAN , Los Angeles Times
  • Updated: October 25, 2011 - 11:19 PM

HPV shots may be tough sell to parents of 11- and 12- year-old boys.

A doctor holds the human papillomavirus vaccine Gardiasil. The controversial HPV shot given to girls should also be given to boys, in part to help prevent the spread of the virus through sex, a government medical panel said Tuesday.

Photo: Charles Rex Arbogast, Associated Press

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A vaccine that protects against the sexually transmitted human papillomavirus should be routinely given to boys ages 11 and 12 to help prevent the cancer-causing virus, a government advisory committee said Tuesday.

Though many parents may not wish to contemplate the future sex lives of their pre-adolescent children, vaccinating them young is the best way to protect against the virus that can cause anal and throat cancers, experts said.

The recommendation by the panel, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, is likely to transform the use of the vaccine, since most private insurers pay for vaccines once the committee recommends them for routine use.

It also is sure to ignite further debate among the Republican presidential candidates who have focused on whether the vaccine, called Gardasil, is appropriate for girls -- who receive it for prevention of cervical cancer -- let alone for boys.

Texas Gov. Rick Perry was criticized by his fellow Republican presidential candidates for ordering mandatory HPV vaccination in girls in his state in 2007. The mandate was overturned by the Legislature and Perry eventually withdrew his support for the idea.

Another presidential hopeful, Michele Bachmann, suggested that Gardasil can cause "mental retardation."

Public health groups quickly criticized Bachmann for the remarks and the federal advisory committee, prior to its Tuesday vote, took time to state for the record that the vaccine does not cause mental retardation.

The vote of 13-0 (with one abstention) in favor of routine HPV vaccination of boys supersedes a 2009 vote by the panel recommending Gardasil be available to males ages 9 to 26 to prevent genital warts but not recommending routine vaccinations. Since then, several studies have shown that the human papillomavirus is responsible for many cases of anal cancer in addition to cervical cancer and genital warts, and that the vaccine can curb this risk, warranting a shift to stronger recommendations, the panel said. The vaccination of boys also will help protect unvaccinated females, the panel added.

Gardasil has been advised since 2006 for girls 11 to 12 as well as for older unvaccinated females to prevent cervical cancer.

In addition to routinely administering Gardasil to boys age 11 to 12, the panel also advised vaccination for boys as young as 9 and for males ages 13 to 21 who have missed the ideal vaccination age window of 11 to 12.

HPV infection is the most common sexually transmitted disease -- between 75 percent and 80 percent of U.S. females and males will be infected at some point. Most will overcome the infection with no ill effects. But in some, infections lead to cellular changes that cause warts or cancer, including cervical, vaginal and vulvar cancers in women and anal cancer in men.

Men who have sex with men are at highest risk for anal cancer. For that reason, some experts proposed recommending the vaccination only to gay or bisexual men. "But it's not necessarily effective or perhaps even appropriate to be making those determinations at the 11- to 12-year-old age," said Kristen Ehresmann of the Minnesota Department of Health and a committee member.

And a growing body of evidence suggests that HPV also causes throat cancers in men and women as a result of oral sex. HPV infection is now thought to account for more cases of oral cancer than tobacco use, said Dr. Jessica Kahn, associate professor of pediatrics at Cincinnati Children's Hospital and chair of the vaccinations committee for the Society for Adolescent Health and Medicine, which supported the recommendation.

A way to de-stigmatize shot

"This is cancer, for Pete's sake," said Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University School of Medicine and a nonvoting member of the committee. "A vaccine against cancer was the dream of our youth."

Dr. Joel Palefsky, a professor of medicine at the University of California, San Francisco, and director of the UCSF Anal Neoplasia Clinic, said the recommendation "also serves to equalize the burden of vaccination to not just one gender." He also said, "a routine vaccination recommendation de-stigmatizes the vaccine."

It's not clear how well parents will embrace vaccination of their adolescent sons. Some parents distrust the safety of vaccines, especially newer products. Others don't want to think about their children having sex one day, or worry that the vaccine essentially promotes promiscuous behavior.

Those who are dubious should know that vaccination against HPV may help prevent other types of cancers, such as ones of the penis, head, neck and mouth, Kahn said. She said vaccine is just as safe and effective in boys as in girls. The key to acceptance, she added, will be in making sure that parents understand the range of diseases that HPV might cause in their sons. Its role in cervical cancer is broadly known, she said. "But we fall short in explaining what HPV can cause in boys and men."

Cost may be another hurdle

In reaching their conclusions, the panel debated whether routine vaccination of boys was necessary if girls were already vaccinated. As more girls and women are vaccinated, they create a "herd immunity" effect, reducing the amount of virus that circulates in a community and thus lowering infection rates in both women and men.

However, as of 2010, only about one-third of U.S. girls had received the three-dose vaccine, and the rates are hitting a plateau, said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases.

She attributed the low rates to confusion or misunderstanding by parents that they can wait until their daughter becomes sexually active. It works best if the shots are given before a girl or boy begins having sex.

Another potential barrier to routine use is money. The vaccine is unusually expensive: Its three doses cost pediatricians more than $300, and pediatricians often charge patients hundreds more. Vaccinating the nation's 11- and 12-year-old boys will cost almost $140 million annually, but the one-time catch-up among males 13 to 21 will cost hundreds of millions more. The government generally pays for about half of all vaccinations.

The New York Times and Associated Press contributed to this report.

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