Review
HPV vaccine and males: Issues and challenges

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Abstract

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.

Introduction

Research has demonstrated that both the quadrivalent and bivalent human papillomavirus (HPV) vaccines stimulate immunogenicity in males and females [1], [2]. More recently, evidence has shown that the quadrivalent vaccine is safe and efficacious against HPV infection and external genital lesions in young men [3], [4]. There is a reasonable expectation that it will also be protective against HPV-related cancers in males and will help to prevent transmission of the virus. On October 16, 2009, the US Food and Drug Administration (FDA) approved the use of the quadrivalent vaccine in males 9–26 years old, for the prevention of genital warts [5]. Subsequently, the Advisory Committee on Immunization Practices (ACIP) declined to recommend the quadrivalent vaccine for routine immunization of males, instead issuing a permissive recommendation, which leaves the decision to the discretion of health care providers (HCPs) [see: http://www.cdc.gov/vaccines/recs/provisional/downloads/hpv-vac-dec2009-508.pdf]. The ACIP did recommend that the costs of male HPV vaccination be covered by the Vaccine for Children (VFC) program, which will largely remove vaccine cost as an obstacle to vaccination. This recommendation for male vaccination is in contrast to the recommendation issued in 2006 for routine, universal vaccination of females 9–26 years of age [6]. It is of note that even with the recommendation of routine vaccination of females, national data from 2008 indicate that only about 35% of 13- to 17-year-old girls in the United States have received one or more doses of vaccine [7]. These data suggest strongly that male vaccination rates will likely remain quite low unless parents and physicians decide that vaccinating adolescent boys is an important way to protect their health and contribute to public health. For this reason, it is particularly important to examine the attitudes of parents, young men, and HCPs toward HPV vaccination.

In this paper, we review attitudinal research about male HPV vaccination and vaccination against other sexually transmitted infections (STIs). Three sets of literature are discussed: parental views about vaccinating sons, adolescent and adult male attitudes about receipt of vaccine, and HCPs' willingness to recommend vaccine for their male patients. Finally, we address some of the controversies and challenges associated with provision of HPV vaccine to males.

Section snippets

Vaccine acceptability research

Over the past several years much of the focus of information provision regarding HPV infection and HPV-associated diseases has been directed at young women and parents of girls. As a result, many men are quite ill-informed about HPV infection and unaware of its consequences for male health [8], [9], [10], [11]. It is important, therefore, to interpret the acceptability findings in the context of this overall poor knowledge about HPV infection, disease, and transmission related to males.

Why vaccinate males?

In many countries HPV vaccine programs have been instituted with a particular (or sole) focus on girls and young women [55]. However, HPV vaccine has been approved for use with males in Australia, Mexico, and several other countries, though actually implementation of male vaccination typically has not been a priority. As noted above, the FDA just recently licensed the quadrivalent vaccine for males 9–26 years old in the United States for prevention of genital warts and the ACIP issued a

Discussion

HPV vaccination of males has been shown to be safe and efficacious. Vaccination of males has been approved in the United States and several other countries, though public health efforts have emphasized female vaccination. Most likely due to this focus on vaccine for adolescent girls, there remains limited knowledge among men about the implications of male HPV infection for men's and women's health. Regardless of whether a country pursues a female-only or a gender-neutral HPV immunization

Key points

  • Most research shows that parents are interested in vaccinating their sons against HPV and other sexually transmitted infections (STI).

  • Most research indicates that adolescent and adult males are interested in receipt of HPV vaccine, as well as other vaccines for prevention of STI.

  • Studies of health care providers indicate a willingness among most to recommend HPV vaccine for their male patients, though there was a general preference for vaccinating females.

  • In light of the “permissive”

Conflict of interest statement

Within the past 2 years Dr. Zimet and Dr. Rosenthal have served as paid research consultants on studies implemented by Merck, Inc. Both Drs. Zimet and Rosenthal are investigators on investigator-initiated research studies funded by the Merck Investigator-Initiated Studies Program.

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