On May 28, 2010, the Advisory Committee on Immunization Practices (ACIP) published its guidance for use of the quadrivalent HPV vaccine in males. While noting that the vaccine was approved by the FDA for use in males ages 9 through 26 to reduce their likelihood of acquiring genital warts and that it therefore could be given for this purpose, the statement released by ACIP did not recommend routine HPV vaccination of males. The Society for Adolescent Health and Medicine (SAHM) feels this position is not sufficiently supportive of an important public health intervention and recommends strongly that 9- to 26-year-olds receive HPV vaccine, regardless of gender.
In June 2006, the FDA approved a quadrivalent HPV vaccine for 9- to 26-year-old females, to prevent HPV infections that cause genital warts and cervical cancer. In October 2009, the FDA approved a bivalent HPV vaccine for 9- to 26-year-old women, and at the same time approved the use of the quadrivalent human papillomavirus vaccine for 9- to 26-year-old males for the prevention of genital warts. Both the FDA and the ACIP also acknowledge that HPV infection is also associated with penile, anal and oropharyngeal cancers among males, even though the data for this have not been reviewed for licensure at this time.
Despite not recommending the vaccine for routine use in males, the ACIP has designated that vaccination of males should be covered under the Vaccines For Children (VFC) Program, providing the vaccine free of cost through the age of 18 years for those who are uninsured, have Medicaid, or are underinsured and attend a federally qualified health center or a rural health center.
Unfortunately, since allowing the vaccine to be provided via these government programs doesn't guarantee that the private insurance industry will allow the vaccine to be provided to their subscribers, this sets up the possibility that youth who have private health insurance may be denied coverage for HPV vaccine based on the lack of a more definite recommendation for the routine use of the vaccine in males. In addition, the lack of a recommendation for routine vaccination of males may discourage clinicians from utilizing the vaccine for their male patients.
A universal recommendation to vaccinate males as well as females, ages 9-26 years, benefits everyone. Males benefit directly from both the prevention of genital warts and the prevention of infection with types of HPV associated with anal, penile and oral cancers. Sexual partners of men who are vaccinated may also benefit by lessening their chances of acquiring HPV infection from these vaccinated males. SAHM acknowledges that vaccination of males is not as cost-effective as vaccination of females as a means of preventing HPV-related cancer, but mathematical modeling has shown that vaccination of males is more cost-effective when the rate of immunization in females is less than 80%. At this time, coverage rates among females are low (less than 25% for all three of the HPV vaccinations) making HPV vaccination an important alternative strategy for preventing cancer-causing infections in females.
Therefore, since routine use of HPV vaccine in males provides direct benefits to men, may benefit their sexual partners, will increase overall immunization rates among both males and females and may be cost-effective, SAHM strongly recommends routine use of HPV vaccination in males as well as in females. We urge clinicians and insurance organizations to consider the benefit of routine vaccination for all age-appropriate patients, regardless of gender, in an effort to support the primary prevention of disease among adolescents and adults.
SOURCE Society for Adolescent Health and Medicine