Boys should get HPV vaccine too, panel says

ATLANTA — 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 today. The expensive vaccine, which protects females against cervical cancer, hasn’t been popular. And doctors admit it will be a tough sell to parents of 11- and 12-year-old males, too. For males, the vaccine is licensed to prevent genital warts and anal cancer. Experts say another key benefit of routinely vaccinating boys could be preventing the spread of the human papilloma virus to others through sex — making up somewhat for the disappointing vaccination rate in girls. The Advisory Committee on Immunization Practices made the recommendation Tuesday. Federal health officials usually adopt what the panel says and asks doctors and patients to follow the advice. The vaccine has been available to boys for two years but Tuesday’s vote was the first to strongly recommend routine vaccination. Officials acknowledged the disappointing rate in girls encouraged them to take a new, hard look. Just 49 percent of adolescent girls have gotten at least the first of the recommended three HPV shots, which have been recommended for girls for five years. Only a third had gotten all three doses by last year. “Pretty terrible,” said Dr. Anne Schuchat, a U.S. Centers for Disease Control and Prevention administrator who oversees the agency’s immunization programs. She attributed the low rates for girls 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 begins having sex. The vaccine is approved for use in boys and girls ages 9 to 26; but it is usually given to 11- and 12-year olds when they are scheduled to get other vaccines. The committee also recommended the vaccination for males 13 through 21 years who have not been vaccinated previously or who have not completed the three-dose series. Tuesday’s vote follows recent studies that indicate the vaccine prevents anal cancer in males. A study that focused on gay men found it to be 75 percent effective. But while anal cancer has been increasing, it’s still a fairly rare cancer in males, with only about 7,000 cases in the U.S. each year that are tied to the strains of viruses targeted in the HPV vaccine. In contrast, about vaccine-preventable 15,000 cervical cancers occur annually. Some feel it’s unlikely that most families will agree to get their sons vaccinated primarily to protect girls. An estimated 50 percent to 80 percent of men and women are infected with HPV in their lifetimes, although most clear the infection without developing symptoms or illness, according to the CDC. The threat of genital warts hasn’t been persuasive yet, either: Some data suggest that less than 1.5 percent of adolescent males have gotten the vaccine. Its use against anal cancer may not be much of a selling point, said Dr. Ranit Mishori, a family practice doctor in Washington, D.C., and an assistant professor at the Georgetown University School of Medicine. Some parents may say “‘Why are you vaccinating my son against anal cancer? He’s not gay! He’s not ever going to be gay!’ I can see that will come up,” said Mishori, who supports the committee’s recommendation. There are two vaccines against HPV, but Tuesday’s vote applies only to Merck & Co.’s Gardasil, which costs $130 a dose. The other vaccine wasn’t tested for males.