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HIQA recently announced a public consultation on extending the HPV vaccine to boys. We were also encouraged by An Taoiseach Leo Varadkar's comments last week about his intention to introduce the vaccine for boys from next year. We are aware of the vaccine programme for girls and thankfully, the increased uptake recorded over the past few school terms.
Here, Consultant in Acute Medicine and Infectious Diseases at Cork University Hospital explains the reasons why we must extend the vaccine in order to protect our boys from HPV-related cancers and other conditions.
HPV now causes almost 5% of cancers worldwide including cervical cancer, oropharyngeal (throat/mouth) cancer, anal cancer, penile cancer, vulval and vaginal cancer. In addition, HPV causes ano-genital warts also affecting both males and females.
In developed countries, where effective cervical cancer screening programmes are in place, the burden of HPV associated disease affecting males and females is now almost equal.
The incidence of HPV associated oropharyngeal cancer and anal cancer, which affect both males and females, are increasing and will soon surpass the burden of cervical cancer.
The HPV vaccine has potential to prevent HPV infection and subsequent development of HPV associated cancer, as well as the significant associated morbidity and mortality.
The HPV vaccine has been shown to be extremely effective in primary prevention of HPV infection in both boys and girls in large clinical trials. The vaccine elicits the greatest immune response and protection in young boys and girls prior to sexual activity and exposure to HPV.
Clinical trial findings have been further reinforced and strengthened by real world data. Countries such as Australia, where effective HPV immunisation programmes are in place have reported near eradication of genital warts (an early indicator of HPV vaccine efficacy) as well as significant decreases in incidence of high-risk or cancer associated HPV infection and associated cervical pre-cancers (medium-term indicators of vaccine efficacy).
The safety of HPV vaccine has been demonstrated in both boys and girls in large clinical trials. Post-licensing monitoring of the HPV vaccine (with over 200 million doses administered worldwide), as well as international reviews undertaken by organisations such as the World Health Organisation Global Advisory Committee for Vaccine Safety and the European Medicines Agency, have identified no safety concerns attributable to or associated with the HPV vaccine.
The HPV vaccine has been offered to girls in Ireland since 2010. Female only HPV vaccine programmes will confer direct protection against HPV infection to vaccinated girls. Where vaccination uptake is high, males will benefit from indirect protection conferred through herd immunity.
Herd immunity is dependent on high levels of vaccination uptake in females. HPV vaccine coverage varies significantly from country to country and even within countries. Coverage can vary significantly over time, as we have observed in Ireland.
Unvaccinated men may be exposed to HPV infection if they come in contact with unvaccinated females either at home or if they travel to countries where HPV vaccine coverage is low. In addition, female only vaccination programmes provide no protection for men who have sex with men, a group who are disproportionately affected by HPV associated anal cancer.
Unlike cervical cancer, there are no reliable screening methods to prevent other HPV associated cancers such as oropharyngeal cancer or anal cancer from developing. Prevention of these cancers through vaccination therefore represents the only effective intervention to decrease the burden of these cancers in the future.
Vaccinating both boys and girls will further strengthen herd immunity and, if high uptake is achieved, could lead to potential eradication of HPV infection.
Withholding an effective vaccine from any group of individuals at risk of developing a vaccine-preventable disease is inequitable and unethical.
The Health Information and Quality Authority (HIQUA) have recently commenced a national public consultation on offering the HPV vaccine to boys. The public must be informed of the facts and the compelling evidence to extend HPV vaccine to boys given the potential health benefits for the wider population.
Gender-neutral HPV vaccination represents the optimal and most equitable strategy to prevent HPV infection and protect all of our children against the risk of developing life threatening HPV associated cancer in the future.
The HIQA Public Consultation is open until 7th September 2018. For further information and how to participate, click below