Despite lackluster acceptance among girls for a vaccine to prevent cancer-causing sexually transmitted viruses, the American Academy of Pediatrics is fully recommending that boys get the shots as well.
Boys 11 and 12 should be immunized routinely, with three doses of a vaccine against human papillomavirus (HPV), the AAP said Monday in its online issue of Pediatrics. This formally updates the academy’s previous policy of “permissive recommendation” for vaccination of males.
The AAP has recommended since 2007 that girls ages 11 and 12 receive the HPV vaccine.
The new policy should end any resistance among health insurers to covering HPV vaccines for boys. Each HPV shot cost about $130 in July; three shots are needed for the vaccine to be fully effective.
Merck & Co.’s Gardasil is the only approved HPV vaccine for males; both Gardasil and Cervarix, made by GlaxoSmithKline, are approved for females.
The HPV vaccine exploded into a presidential political issue last year when Texas Gov. Rick Perry entered the race.
In 2007, when the first HPV vaccine was approved for girls ages 11 and 12, Mr. Perry issued an executive order mandating it for Texas girls. An outcry ensued over the usurping of parental rights and the idea that the vaccine gave tacit permission for children and teens to engage in premarital sex.
The Texas Legislature quickly overturned the order, and as a presidential candidate, Mr. Perry called it “a mistake” he regretted because he didn’t discuss it “with the people of the state of Texas.”
Republican presidential candidate Rep. Michele Bachmann of Minnesota also hit a buzz saw of controversy when she said that the HPV vaccine “can have very serious side effects,” and that a mother had told her that her daughter had become mentally damaged after receiving the HPV vaccine.
The AAP quickly said there was “absolutely no scientific validity” to the claim that the vaccine “is dangerous and can cause mental retardation.”
As for safety, the National Vaccine Injury Compensation Program says that as of early February, a total of nine claims have been filed for HPV-vaccine-related deaths and 163 claims filed for injuries. So far, 25 claims have been compensated and 33 have been dismissed, the federal program said.
Some 40 million HPV vaccine doses have been administered to girls in the past five years, and “no discernible, vaccine-specific adverse effect, with the exception of rare anaphylaxis to vaccine components, has been detected,” the AAP said in its new policy. Anaphylaxis refers to an allergic reaction with symptoms such as difficulty breathing, nausea and rashes.
HPV is the nation’s most commonly transmitted sexual infection. While there are dozens of HPV strains that resolve themselves without ill effects, a handful of HPV strains cause cancer. HPV 16 and 18, for instance, cause 15,000 cancer cases in women and 7,000 cases of cancer in males every year, the AAP said.
HPV vaccines are given at a young age because they only work against HPV strains before they are acquired, and most sixth-graders have not yet engaged in any sexual activity.
Research finds the vaccines are highly effective in preventing HPV-related precancerous conditions in men and women. Studies are still needed to see how the vaccines work against the growing problem of HPV-caused head and neck cancers.
Dr. Michael Brady, chairman of the AAP’s Committee on Infectious Diseases for 2011-2012, said the AAP changed its HPV policy on boys because “it has become apparent that HPV causes infection and [the resulting conditions] in both females and males.”
It was initially hoped that providing HPV vaccine only to girls would interrupt sexual transmission and provide protection to boys as well, Dr. Brady said. But instead of seeing 80 percent vaccination coverage in girls, only 32 percent have gotten the three doses, which is inadequate to dent transmission, he said. “Also, providing girls only with HPV vaccines does not interrupt transmission in those males who have sex with males.”
So AAP decided to concur with the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices’ decision in October that the HPV vaccination policy be “broadened to include both genders,” Dr. Brady said.
Older teens and young adults, including those who have engaged in sexual activity, also are advised to get vaccinated, as it can still protect them if they haven’t already acquired the dangerous HPV strains.
The Christian Medical & Dental Associations (CMDA) and American College of Pediatricians (ACPEDS) both endorse HPV vaccinations as long as they are not mandated or required for school entry.
However, the CMDA opposes “safe-sex” marketing messages that might give the erroneous idea that the HPV vaccines provide “total protection” against disease and other negative consequences of a promiscuous lifestyle, said Dr. David Stevens, chief executive of CMDA.
Also, 30 percent of cervical cancers are caused by HPV strains that are not covered by vaccines, ACPEDS said in its newly revised HPV policy.
Currently, the District of Columbia requires all sixth-grade girls to receive the HPV vaccine unless their parents or guardians sign an “opt out” certificate.
Virginia also mandates HPV vaccinations for girls, with a parental opt-out. But its House of Delegates and a state Senate committee recently passed a bill repealing the mandate, and the issue is now before the Senate.