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AAP now recommends HPV vaccine for boys and girls
AAP Committee on Infectious Diseases. Pediatrics. 2012;doi:10.1542/peds.2011-3865.
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The American Academy of Pediatrics Committee on Infectious Diseases issued an updated policy statement on human papillomavirus vaccination and now recommends that boys and girls be immunized.
Currently, there is one approved HPV vaccine (HPV4; Gardasil, Merck) for boys and two vaccines — HPV4 and HPV2 (Cervarix, GlaxoSmithKline) — approved for girls. The AAP policy statement outlines the need for vaccination. The statement explains that besides reducing incidence of the sexually transmitted infections, “persistent infection with high-risk HPV types is responsible for most cervical and anal cancers in females. In males, high-risk HPV types are responsible for a large proportion of cancers of the mouth and pharynx, which are increasing in recent years, and of anal and penile cancers.”
The AAP committee recommended that:
- Girls and boys aged 11 to 12 years (but starting as young as 9 years with physician discretion) should routinely receive three doses of HPV4; for girls, immunization with HPV2 intramuscularly at 0, 1 to 2, and 6 months, even if they are already sexually active.
- Girls, boys and women aged 13 to 26 years previously not immunized or who are missing a vaccination should complete the full series.
- Men aged 22 to 26 years not immunized previously or who are missing a vaccination may receive the HPV4 series, but “cost-efficacy models do not justify a stronger recommendation in this age group.”
According to the committee, a special emphasis should be given to immunizing men who have sex with men aged up to 26 years.
The committee also said patients with abnormal Pap tests or those who already have been diagnosed with one type would likely still derive benefit from immunization. The statement also recommended that cervical cancer screening should continue in women receiving the vaccine.
Panel members said HPV vaccine can be administered when a patient is immunocompromised due to disease or medication and when a female patient is breast-feeding. However, pregnant women should not receive the HPV vaccine.
Disclosure: The researchers report no relevant financial disclosures.
I am in favor of HPV vaccine for males. I was involved in the safety testing of the Merck HPV vaccine for males and we found it was a safe vaccine. More importantly, HPV is the major cause of rectal cancer in males, the second leading cause of throat and neck cancer in males and the primary cause of penile cancer (although that is extremely rare in the US). Most importantly, HPV is the primary cause of cervical cancer and cervical dysplasia in women. Women almost always get HPV from a male. We will not have the herd effect to protect women unless we immunize males. Let us give all the adolescent males HPV vaccine, and then we will not have any possibility of women getting cervical cancer.
- Gary A. Emmett, MD, FAAP
Professor of pediatrics, director of Hospital Pediatrics,
Thomas Jefferson University and Thomas Jefferson University Hospitals
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