HPV vaccine and males: Issues and challenges

Section of Adolescent Medicine, Indiana University School of Medicine, Health Information & Translational Sciences, Indianapolis, IN 46202, USA.
Gynecologic Oncology (Impact Factor: 3.77). 05/2010; 117(2 Suppl):S26-31. DOI: 10.1016/j.ygyno.2010.01.028
Source: PubMed


The quadrivalent vaccine has been shown to be safe and efficacious against HPV infection in men. It is expected, though, that male vaccination rates will remain low. Therefore this literature review examines the attitudes of parents, young men, and HCPs toward HPV vaccination and other sexually transmitted infections (STI). It appears that parents are interested in vaccinating their sons against HPV and other (STI). In addition, adolescent and adult males are interested in receipt of HPV vaccine and other vaccines for prevention of STI. Health care providers have a general preference for vaccinating females, but they indicate a willingness to recommend HPV vaccine for their male patients. This is important given the "permissive" recommendation for male HPV vaccination issued by the US Advisory Committee on Immunization Practices (ACIP). Cost effectiveness studies have shown that vaccinating males and females is less cost effective than vaccinating females alone. With low female vaccination rates, both cost effectiveness and health benefits increase. It is clear that males have poor knowledge of HPV infection, morbidity, transmission and prevention. Regardless of vaccination strategies adopted, efforts should be made to educate males about HPV and its health implications. In addition, there are more challenges to overcome before male vaccination can be successfully implemented.

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    • "Since HPV vaccination has been limited to females in most countries so far, the extension to males has been a hotly debated issue [10] . The sex limitation implies that this vaccination cannot by definition achieve a 'herd immunity' effect in epidemiology, hence 'positive externalities' in an economic per- spective [11]. "
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    ABSTRACT: The human papillomavirus (HPV) is closely related to cervical cancer. In 2007, the EMA approved two vaccines, a bivalent and a quadrivalent one, launched at three-dose schedules and very high prices worldwide. We describe what happened in the EU and what might change in the near future from an economic perspective. HPV vaccination is now established in most EU countries. The main target group of the programs is girls aged 10-14 years. Many western countries used competitive tendering to purchase the two vaccines, achieving considerable savings. The extension to males has been a hotly debated issue. The sex limitation implies that this vaccination cannot by definition achieve a 'herd immunity' effect. EMA recently approved a two-dose schedule for both vaccines that should lead to savings, although it is hard to predict how the forthcoming nonavalent vaccine will affect the market situation. Several economic evaluations based on long-term models have been published on the HPV vaccination in the recent years, using official list prices as a baseline. Most of these models can be considered mere exercises in long-term forecasting. Recently, further long-term models have been published with two- and three-dose schedules as alternatives, and the nonavalent vaccine. We wonder what added value they give for public policy purposes.
    Full-text · Article · Mar 2015 · Expert Review of Pharmacoeconomics & Outcomes Research
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    • "The relatively high parental acceptability of hypothetically vaccinating their sons with HPV vaccines is also consistent with commentaries from elsewhere [10], [19], [37]. It has been argued that vaccinating boys could be a viable complement to HPV vaccination of girls to avoid stigmatizing females as a source of STIs, improve social acceptability of HPV vaccines, eradicate HPV, protect boys from HPV infection, reduce HPV transmission, increase herd immunity, and prevent other HPV associated diseases [19], [37]. "
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    ABSTRACT: The Ministry of Health in Uganda in collaboration with the Program for Appropriate Technology for Health (PATH) supported by Bill and Melinda Gates Foundation in 2008-2009 vaccinated approximately 10,000 girls with the bivalent humanpapilloma virus (HPV) vaccine. We assessed parent's knowledge, risk perception and willingness to allow son(s) to receive HPV vaccines in future through a cross-sectional survey of secondary school boys aged 10-23 years in 4 districts. 377 questionnaires were distributed per district and 870 were used in analysis. Parents that had ever heard about cervical cancer and HPV vaccines; those who would allow daughter(s) to be given the vaccine and those who thought that HPV infection was associated with genital warts were more willing to allow son(s) to receive the HPV vaccine. Unwilling parents considered HPV vaccination of boys unimportant (p = 0.003), believed that only females should receive the vaccine (p = 0.006), thought their son(s) couldn't contract HPV (p = 0.010), didn't know about HPV sexual transmissibility (p = 0.002), knew that males could not acquire HPV (p = 0.000) and never believed that the HPV vaccines could protect against HPV (p = 0.000). Acceptance of HPV vaccination of daughters and likelihood of recommending HPV vaccines to son(s) of friends and relatives predicted parental willingness to allow sons to receive HPV vaccines. Probable HPV vaccination of boys is a viable complement to that of girls. Successfulness of HPV vaccination relies on parental acceptability and sustained sensitization about usefulness of HPV vaccines even for boys is vital.
    Full-text · Article · Sep 2014 · PLoS ONE
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    • "It is probable that those who have the least information are less likely to participate than those with solid/improved information. The average, complete nonacceptability does not exceed 10–15% [96–106] but can be further reduced with health education. According to numerous studies, women and men in general are unaware of the causality between HPV and cervical cancer, and it can be assumed that the connection between HPV and HPV-related cancers is even less generally known. "
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    ABSTRACT: Cervical cancer and other human papillomavirus- (HPV-) related cancers are preventable, but preventive measures implemented in developing countries and especially in low-income rural regions have not been effective. Cervical cancer burden derived from sexually transmitted HPV infections is the heaviest in developing countries, and a dramatic increase in the number of cervical cancer cases is predicted, if no intervention is implemented in the near future. HPV vaccines offer an efficient way to prevent related cancers. Recently implemented school-based HPV vaccination demonstration programmes can help tackle the challenges linked with vaccine coverage, and access to vaccination and health services, but prevention strategies need to be modified according to regional characteristics. In urban regions WHO-recommended vaccination strategies might be enough to significantly reduce HPV-related disease burden, but in the rural regions additional vaccination strategies, vaccinating both sexes rather than only females when school attendance is the highest and applying a two-dose regime, need to be considered. From the point of view of both public health and ethics identification of the most effective prevention strategies is pivotal, especially when access to health services is limited. Considering cost-effectiveness versus justice further research on optional vaccination strategies is warranted.
    Full-text · Article · Jul 2011 · Infectious Diseases in Obstetrics and Gynecology
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