(Courtesy of USA Today)
All 11- to 12-year-olds — both boys and girls — should be routinely vaccinated against HPV, a family of viruses that causes more than 25,000 cases of cancer a year in the USA , a federal advisory panel recommended Tuesday.
Vaccinating boys will protect both them and their sexual partners from HPV-related cancer, say doctors with the Centers for Disease Control and Prevention. Although HPV, the human papillomavirus, is best known for causing cervical cancer, it also causes cancers of the vagina, vulva, anus, penis and back of the throat, as well as genital warts. And just this week, a study suggested that HPV also is linked to heart disease in women.
“Today is another milestone in the nation’s battle against cancer,” says Anne Schuchat of the CDC‘s National Center for Immunization and Respiratory Diseases. Vaccinating all adolescents against HPV is an “opportunity to protect the generation of today from the cancers of tomorrow.”
For girls, the CDC has recommended routine HPV vaccination for five years, in order to protect them against cervical cancer, which kills about 4,000 Americans a year. Two years ago, the CDC’s Advisory Committee for Immunization Practices issued a “permissive recommendation” for boys, which has allowed boys to get the shots for free.
Tuesday’s vote upgrades that to a “routine” recommendation — its highest recommendation — for both boys and girls. The decision, once approved by the CDC, will add HPV shots to the routine childhood immunization schedule, Schuchat says.
Although many insurance plans already cover the cost of the shots for both boys and girls, this expanded recommendation may encourage others to pay for the vaccines, she says. The vaccines cost about $100 to $130 for each of three required shots, given two months apart, Schuchat says.
The CDC, which typically adopts the committee’s recommendations, is likely to formally recommend the shots within a couple of months, Schuchat says.
Vaccinating boys will prevent them from spreading HPV to their sexual partners, indirectly protecting their future girlfriends or wives from cancer, Schuchat says. That’s especially important, given the “disappointing” number of girls who have received all three HPV shots. Only 44% of girls have received one HPV shot, and 27% have received all three shots, which are required for full protection.
Only 1.5% of boys today are being vaccinated against HPV, Schuchat says.
Preventing these cancers in boys is important, says pediatrician Janet Englund, a former member of the committee. Cervical cancer screenings have dramatically reduced death rates from that disease, because regular tests allow doctors to detect and remove precancerous lesions before they become malignant. But there is no way to screen for other HPV-related cancers, such as those of the throat and anus. Actress Farrah Fawcett died in 2009 of anal cancer.
“We are clearly seeing an epidemic of HPV-related head and neck cancer — the numbers are rising dramatically,” says Robert Haddad, chief of head and neck oncology at Boston’s Dana-Farber Cancer Institute. “HPV is a cause of many cancers, so it is really important to support endeavors to vaccinate.”
The committee voted to bring the recommendation for boys in line with the one for girls, voting 13 in favor, with one member abstaining.
The HPV vaccine briefly became a political football in the Republican presidential debates, when Texas Gov. Rick Perry was criticized for trying to mandate the shots for girls. That measure failed in Texas. Today only Virginia and the District of Columbia require that girls get the shots to attend school, although both jurisdictions allow parents to easily opt out.
Rep. Michelle Bachmann, R-Minn., was widely criticized for suggesting HPV shots could be dangerous and even cause mental retardation. She later backed down from that charge.
Schuchat noted that HPV shots are very safe. The vaccines were tested in clinical trials before being approved by the Food and Drug Administration. Since then, 40 million doses have been given out. The most common side effects are sore arms, fevers and headaches.
Although some people have claimed that their children became very sick after getting the shots, none of those claims have been substantiated. A national system, the Vaccine Adverse Events Reporting System, allows anyone, from parents and doctors to trial lawyers, to report alleged injuries. The CDC monitors these complaints closely and investigates patterns.
“We don’t believe there is any evidence to suggest any severe, life-threatening outcomes with this vaccine,” Schuchat says.
Some parents have questioned the notion of vaccinating children against a sexually transmitted virus at such young ages. Doctors note that the virus can be spread very easily, even without intercourse, and that condoms offer only partial protection, because HPV can live on skin not covered by condoms.
While it’s been known for years that HPV can spread through sex, doctors don’t know whether HPV can be spread through nonsexual contact, such as kissing.
Among men with HPV-related throat and tongue cancer for example, virtually all of their wives also carry HPV in their saliva, says physician John F. Deeken, director of the head and neck oncology program at Georgetown’s Lombardi Comprehensive Cancer Center.
Doctors in recent years have seen a huge increase in HPV-related head and neck cancers, such as those of the back of the throat, tonsils and tongue. Doctors don’t know what is driving the change, however.
“Many of us think this isn’t just caused by changes in sexual habits, because people were kissing before the 1970s,” he says. “Maybe the virus itself has changed.”
The CDC committee recommends giving the shots when children are young for several reasons. Their immune systems respond most strongly to the shots at this age, offering them the best cancer protection, Schuchat says. Also, the vaccine is only effective if given before people have sex, and doesn’t prevent cancer once people have been exposed to HPV. Studies show that most people are exposed to HPV within a year or two of becoming sexually active. Giving the vaccine at age 11 or 12 is also convenient, pediatricians say, because children receive other routine vaccinations at this time, including shots to prevent meningitis and whooping cough.
“Many of us pediatricians think the best use of healthcare dollars is to prevent disease, not by mandarory vaccination, but by making it available to those who want it,” Englund says. “I think we should be encouraging it for both boys and girls.”