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The evidence needs time to mature.

The issue of immunizing males against HPV often comes down to whether they should receive the vaccine to protect females. Doing so is honorable and even reasonable, but at this point there is little evidence suggesting that this is cost effective.

Early cost-benefit analyses of this idea showed that a large number of males would need to be immunized to achieve even a minimal increase in protection for females. At the same time, adding males to the equation would significantly increase the cost of the immunization program. So, until there are more compelling data to show that immunizing males will protect large numbers of females, the right thing to do is to immunize the people we are trying to protect--girls and women themselves. For the time being, we need to focus on getting a high number of women and girls immunized, and then we can start thinking about what to do with men and boys.

This said, there are other compelling reasons to consider vaccinating males. Newer data are beginning to show that HPV does more in men than might have been appreciated just a decade ago. A significant portion of head and neck cancers, anal cancers, and cancer of the larynx are caused by HPV When you start adding up the number of cases of cancers in males attributable to HPV you end up with roughly the same number as the amount of cervical cancer cases in the United States. Not to be forgotten is the significant morbidity associated with genital warts. So the reasons to immunize males will likely have more to do with protecting males against the diseases they get, rather than protecting women from cancer.

The catch with male immunization is that the studies showing that HPV vaccines prevent these cancers in men do not yet merit changing our vaccination strategy. When the data are available, I expect we will have sound reasons to immunize males against HPV But studies showing that these vaccines prevent genital warts have not yet been published, and it will be perhaps 3-5 years before we see strong evidence regarding cancer prevention benefits.

Although we are not yet in a position to offer males routine HPV immunization, we need to ensure that all the women who are eligible for this vaccine have the opportunity to receive it. Also, depending on the maturity of the patient, physicians can begin a discussion about issues of sexuality and sexually transmitted diseases at the 11- to 12-year-old visit.

DR. ALEXANDER is chief of pediatric infectious diseases at the University of Chicago and is on speakers bureaus for Merck & Co. and GlaxoSmithKline, the two HPV vaccine manufacturers in the United States.

BY KENNETH ALEXANDER, M.D.
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Title Annotation:Is universal vaccination of boys the next step in fighting HPV?
Author:Alexander, Kenneth
Publication:Internal Medicine News
Geographic Code:1USA
Date:Mar 1, 2009
Words:450
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