CDC recommendation for HPV vaccination for boys may be a tough sell


ATLANTA — The Centers for Disease Control this week issued a finding that young boys, as well as girls, should be given the controversial vaccination against human papillomavirus, or HPV.

The recommendation by the CDC‘s Advisory Committee on Immunization Practices is designed to to protect young people from HPV infection before they become sexually active. Federal health officials usually adopt what the panel says and asks doctors and patients to follow the recommendations.

Dr. Anne Schuchat, a U.S. Centers for Disease Control and Prevention administrator who oversees the agency’s immunization programs notes:

“HPV infection is the most common sexually transmitted disease — between 75 percent and 80 percent of females and males in the United States will be infected at some point in their lives,” said Dr. Anne Schuchat, a CDC administrator who oversees the agency’s immunization programs.

“Most will overcome the infection with no ill effects. But in some people, infections lead to cellular changes that cause warts or cancer, including cervical, vaginal and vulvar cancers in women and anal cancers in men and women. A growing body of evidence suggests that HPV also causes throat cancers in men and women as a result of oral sex. HPV infections cause about 15,000 cancers in women and 7,000 cancers in men each year,” Schuchat said.

The vaccination program is controversial as evidenced by disagreement between GOP candidates for president. Texas Gov.Rick Perry — who issued an executive order in 2007 mandating girls get the HPV vaccine as part of a school immunization program which was later overturned by a court — was disparaged for his advocacy for HPV vaccinations for girls by rival candidate, Rep. Michelle Bachmann (R-Minn.), who during a recent GOP debate, had accused Perry of putting kids at risk for complications like mental retardation.

CDC experts had advised the panel there is no evidence the HPV vaccine can cause mental retardation.

Schuchat acknowledged that due to misinformation, the campaign for routine vaccination is a tough sell.

According to the CDC’s own findings, 49 percent of adolescent girls had gotten at least the first of the recommended three HPV shots, however, only one third had received the required three doses.

Schuchat said that the statistics were “pretty terrible,” attributing the low percentage for girls to confusion or misunderstanding by parents that they can wait until their daughters became sexually active. Dr. Schuchat cautions that the HPV vaccine will only work if the shots are given prior to a girl being exposed to the virus, which occurs during sexual activity.

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. But that could be a challenge, stigmatism may stop boys from receiving the HPV vaccine.

Recent studies have indicated that the vaccine prevents anal cancer in males with one study that focused on gay males finding 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.

Dr. Ranit Mishori, a family practice doctor in Washington, D.C., and an assistant professor at the Georgetown University School of Medicine, notes that the vaccination’s use against anal cancer may not be much of a selling point, there will be parents who 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.

“It’s a conundrum,” said Dr. James Turner, immediate past president of the American College Health Association and a liaison to the Advisory Committee on Immunization Practices (ACIP). “The conundrum is many times boys or teenagers don’t really fully understand or clarify their sexual orientation for years.” In addition, there’s the danger that the stigma of a vaccine aimed only at young gay and bisexual boys and men would hinder use. “I’m advocating it for all boys,” Dr. Turner said.

That means a vaccine targeted to young men who know they’re gay or bisexual likely wouldn’t reach many of the males who may need it, or reach them early enough. With boys, as with girls, the HPV vaccine is most effective when it’s given before sexual activity exposes people to the virus, federal health experts say.

Cost is another factor with some health care providers as well as parents balking at covering the expensive vaccine which costs $130 a dose. The vaccinations for boys 11-14 is expected to cost about $140 million annually.

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.

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