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ACIP recommends routine HPV vaccination for 11- to 12-year-old boys
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The CDC's Advisory Committee on Immunization Practices today approved routine recommendation in favor of administering the quadrivalent HPV vaccine for boys aged 11 to 12 years.
Committee members decided that the vaccine (Gardasil, Merck) was safe, efficacious and cost-effective enough to warrant routine usage in this population. The recommendation issued in 2009 was permissive, meaning providers could give the vaccine to boys, but it was not routinely administered. This change would put the HPV vaccine into the regular vaccination schedule. The three-vaccination series can start as early as age 9 years.
"The committee recommended that routine vaccination of males aged 11 or 12 years with three doses of quadrivalent vaccine be given to prevent HPV infection and HPV-related disease," Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said in a phone call with reporters. "Boys and young men 13 to 21 years of age who have not already received the vaccine should be vaccinated."
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Insurance companies typically cover HPV vaccine in boys, but that is not necessarily the case for a permissive recommendation, according to Schuchat, who said a routine recommendation for a vaccine usually translates into coverage without co-pays.
The committee voted 8-5 with one abstention in favor of recommending vaccination for young men up to age 21 years with permissive recommendation for men aged 22 to 26 years. The committee considered recommending vaccination up to age 26 years, which would have harmonized recommendations for men and women, but concluded that the vaccine was not cost-effective in men aged older than 21 years.
According to the committee, in extending the quadrivalent vaccine to young men, the vaccine was 89% effective against genital warts and 75% effective against precancerous anal intraepithelial neoplasia. Schuchat said the number of girls receiving vaccinations has been disappointing, and there is hope that vaccinating boys will protect both young women and young men.
"HPV vaccination for males offers an opportunity to decrease the burden of HPV-related disease in both males and females," Schuchat said. "So in addition to providing direct benefit to boys by preventing future genital warts or anal cancer, there's the potential that vaccinating boys will reduce the spread of HPV from males to females and reduce some of the HPV-related burden women suffer from."
About 20 million Americans currently have an HPV infection. According to the CDC, an estimated 7,080 men and 14,720 women develop cancers associated with HPV types 16 and 18 every year. An estimated 80% of anal cancers, 65% of vaginal cancers, 50% of vulvar cancers, 35% of penile cancers and nearly all cervical cancers are HPV-related. Roughly 60% of oropharyngeal cancers are associated with HPV, and HPV-related disease costs an estimated $8 billion annually.
Committee staff said vaccinating boys aged 11 to 12 years would cost $24,000 to $62,000 per quality-adjusted life year and would become more expensive per quality-adjusted life year as more girls are vaccinated.
The recommendation will now go to the full CDC. Schuchat said the agency will likely vote on the recommendation in a few months. - by Jason Harris
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I’ve always argued that boys should get vaccinated, and I’m glad to see that the CDC has confirmed that position. What we are seeing now is that the incidence of tonsil cancer is increasing at an alarming rate in both men and women, more so in men, due to HPV. We are at the front end of an epidemic of HPV-related oropharyngeal cancer. A study recently published in the Journal of Clinical Oncology (2011;doi:10.1200/JCO.2011.36.4596) predicts that the annual number of oropharyngeal cancers caused by HPV will surpass the annual number of cervical cancers by 2020. We’re talking about a vaccine for a virus that causes cancer 10 years down the road, and 10 years from now the rate of cancer caused by that virus will be higher for men than for women. For that reason, it makes sense to vaccinate both boys and girls.
– David M. Cognetti, MD
Co-Director of the Jefferson Center for Head and Neck Surgery, Philadelphia
Disclosure: Dr. Cognetti reported no relevant financial disclosures.
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Finally! This recommendation was made in HemOnc Today some two years ago. As important as prevention of genital and anal neoplasia, the likely inhibition of the recent epidemic of head and neck cancers in nonsmokers is predictable. Moreover, we recently noted in these pages studies that two vaccinations are just as efficacious as the currently recommended three (www.hemonctoday.com/article.aspx?rid=87443).
– Harry S. Jacob, MD, FRCPath(Hon)
HemOnc Today Chief Medical Editor
Disclosure: Dr. Jacob reported no relevant financial disclosures.
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