ATLANTA — The HPV shot given to girls should also be given to boys, in part to help prevent the spread of the virus through sex, a government medical panel said Tuesday.
The expensive vaccine, which protects females against cervical cancer, hasn’t been popular. And doctors admit it will be a tough sell to parents of 11- and 12-year-old boys, too.
For males, the vaccine is licensed to prevent genital warts and anal cancer. Experts say another key benefit of routinely vaccinating boys could be preventing the spread of the human papillomavirus to others through sex - making up somewhat for the disappointing vaccination rate in girls.
The recommendation by the panel, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, is likely to transform the use of the HPV vaccine, since most private insurers pay for vaccines once the committee recommends them for routine use. The HPV vaccine is unusually expensive: Its three doses cost pediatricians more than $300, and pediatricians often charge patients hundreds more.
The committee recommended that boys ages 11 and 12 should be vaccinated. It also recommended vaccination of males ages 13 through 21 who had not already had all three shots. Vaccinations may be given to boys as young as 9 and to men between the ages of 22 and 26.
The vaccine has been available to boys for two years but Tuesday’s vote was the first to strongly recommend routine vaccination. Officials acknowledged the disappointing rate in girls encouraged them to take a new, hard look.
Just 49 percent of adolescent girls have gotten at least the first of the recommended three HPV shots, which have been recommended for girls for five years. Only a third had gotten all three doses by last year.
“Pretty terrible,” said Dr. Anne Schuchat, a U.S. Centers for Disease Control and Prevention administrator who oversees the agency’s immunization programs.
She attributed the low rates for girls to confusion or misunderstanding by parents that they can wait until their daughter becomes sexually active. It works best if the shots are given before a girl begins having sex.
The vaccine is approved for use in boys and girls ages 9 to 26; but it is usually given to 11- and 12-year olds when they are scheduled to get other vaccines.
The committee voted 8-5, with one abstention, to approve a recommendation that males 13 to 21 be vaccinated, with those voting against the recommendation hoping to make the upper age limit 26.
Tuesday’s vote follows recent studies that indicate the vaccine prevents anal cancer in males. A study that focused on gay men found 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 15,000 cases of vaccine-preventable cervical cancers occur annually.
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. 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 cancer in men. A growing body of evidence suggests that HPV also causes throat cancers in men and women as a result of oral sex.
The threat of genital warts hasn’t been persuasive yet, either: Some data suggest that less than 1.5 percent of adolescent males have gotten the vaccine.
Its use against anal cancer may not be much of a selling point, said Dr. Ranit Mishori, a family practice doctor in Washington, D.C., and an assistant professor at the Georgetown University School of Medicine.
Some parents 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.
There are two vaccines against HPV, but Tuesday’s vote applies only to Merck & Co.’s Gardasil, which costs $130 a dose. The other vaccine wasn’t tested for males.
Information for this article was contributed by Mike Stobbe of The Associated Press and by Gardiner Harris of The New York Times.
Front Section, Pages 4 on 10/26/2011