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Should boys be vaccinated against HPV--yes.

The human papillomavirus (HPV) vaccine is licensed for boys as well as girls in several countries. Disease simulation models on 12-year-olds in the US were used to assess the cost-effectiveness of including boys in a routine HPV vaccination programme for girls. With 75% coverage and an assumption of complete, lifelong vaccine efficacy, routine HPV vaccination of 12-year-old girls was consistently less than $50,000 per quality-adjusted life-year (QALY) gained, compared with screening alone. Including boys in the programme for girls resulted in higher costs that generally exceeded $100,000 per QALY--the conventional threshold of good value for money--even under favourable conditions of vaccine protection and health benefits. Uncertainty still exists in many areas that can either strengthen or attenuate these findings. (1)

An editorial suggests that where the uptake of HPV vaccination is poor in girls, vaccination of boys may become better value by improving herd immunity. Vaccination of boys can also be advocated on ethical grounds, to promote equality and social responsibility. Targeting young women for vaccination and screening older women in developing countries--where 80% of the annual cervical cancer cases occur--would have a bigger effect than widespread HPV vaccination of young men in developed countries, however. The best policy is to ensure that pre-adolescent girls are vaccinated worldwide. (2)

A letter in response claims that the paper and editorial ignored some male-specific HPV-related diseases that should be considered in future cost-effectiveness analyses. Firstly, by vaccinating girls only, men would remain carriers and could transmit the virus to non-vaccinated women and men. Secondly, the percentage of HPV-related diseases is high in some groups of men--for example, oropharyngeal cancer, conjunctival squamous cancer, genital warts, and anal and penile cancers in homosexual, bisexual, and HIV-positive men. Thirdly, HPV in ejaculated sperm may be associated with reduced sperm motility and male infertility, which often needs to be treated with expensive assisted reproduction techniques. Lastly, HPV was recently found in six of 100 cryo-preserved semen samples from men with testicular cancer or infertility, which would have been used for assisted reproduction if not found. (3)

(1.) Kim JJ, Goldie SJ. Cost effectiveness analysis of including boys in a human papillomavirus vaccination programme in the United States. BMJ 2009;339:b3884.

(2.) Castle PE, Scarinci I. Should HPV vaccine be given to men? BMJ 2009;339:b4127.

(3.) Foresta C, Felin A, Garolla A. What about male specific HPV related diseases? BMJ 2009; 339:b4514.

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Title Annotation:ROUND UP: Service delivery; human papillomavirus
Publication:Reproductive Health Matters
Geographic Code:1USA
Date:May 1, 2010
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