HPV vaccine may soon be approved for use in boys

By Deborah Kotz, Globe Staff

A federal advisory committee recommended today that 11- and 12-year-old boys routinely receive a vaccine that girls have been given the past five years to stop a sexually transmitted virus -- a move that could help increase acceptance of the human papillomavirus shot.

Boston-area physicians said the Advisory Committee on Immunization Practices’ recommendation, which is likely to be adopted by the US Centers for Disease Control and Prevention, will make them more willing to urge parents to seek the vaccine for their sons. Until now, doctors could give the vaccine to preteen boys, but without the official blessing of the nation’s leading disease prevention agency.

I will now recommend it more strongly,” said Dr. Lydia Shrier, an adolescent medicine physician at Children’s Hospital Boston. “I had to be more vague in the past, saying it was available but wasn’t recommended; usually, parents do what I recommend.”

About 20 million Americans are infected with human papillomavirus -- known commonly as HPV -- which has been associated with genital warts and a variety of cancers, including cervical, anal, penile, and an increasing incidence of throat cancer. An estimated 7,000 men develop HPV-related cancers every year.

While the CDC will issue its final recommendation in the next few months, it usually follows the lead of its advisory panel on immunizations, which voted unanimously to support giving the vaccine to 11- and 12-year-old boys. The panel was less united on whether males 13 to 21 should get the vaccine, with eight of 14 members voting in favor.

The vaccine was initially approved and recommended in 2006 to girls and women up to age 26 to prevent cervical cancer and genital warts. Two years ago, the US Food and Drug Administration approved the HPV vaccine for teenage boys and men up to age 26, but the CDC declined to recommend it, stating only that they “may get HPV vaccine.”

That lack of a CDC endorsement led some insurance companies, including Blue Cross Blue Shield of Massachusetts, to decline to cover the vaccine coverage for males even while providing coverage for females. In August, Blue Cross decided to cover the vaccine in boys and men following a Globe story but required doctors to submit requests for coverage for individual patients. The insurer issued a statement today saying that it would now provide full coverage without pre-approval for those who fall within the recommended age range, which will 9 to 21 if the CDC follows the advisory committee’s recommendations.

In determining whether to overturn its initial decision not to recommend the vaccine for males, the committee took into account new research documenting an increase in HPV-related head and neck cancers and showing that the virus was responsible for more than 80 percent of anal cancers, according to Dr. Anne Schuchat, director of the CDC’s National Center for Immunization and Respiratory Diseases.

A study this month in the Journal of Clinical Oncology found that the percentage of throat cancers caused by HPV rose from 16 percent in the 1980s up to 72 percent during 2000 to 2004.

“These HPV-related cancers have become an epidemic, and we don’t understand why,” said Dr. Robert Haddad, chief of the center for head and neck oncology at the Dana-Farber Cancer Institute. The vast majority of the throat cancer he treats, he said, is HPV-related -- transmitted via oral sex -- rather than because of smoking or alcohol abuse and is twice as common in men than women. He and other specialists said they believe the HPV vaccine could reduce the incidence of these cancers although HPV vaccine manufacturers haven’t examined this in studies.

Only two-thirds of Massachusetts girls ages 13 to 17 have received one dose of the HPV vaccine, and just 47 percent have received all three doses required to give full protection against the virus. The federal panel lamented that more teen girls have not received the vaccine. The panel noted that “male vaccination is most cost effective when coverage of females is low,” because it provides a bigger benefit by preventing transmission of the virus from males to unvaccinated females, Schuchat said in a press briefing.

Whether parents will readily embrace the vaccine for their prepubescent sons remains to be seen. While many have been reluctant to get their daughters vaccinated, fearing that it might be perceived as giving them the green light to have sex, they may not have the same hesitation for boys, according to Shrier.

CDC officials said they hope that enough time has passed since the vaccine’s introduction to prove to parents that it’s safe -- the most common side effects include injection site reactions, headaches, and fever -- and they’re trying to get doctors to spread the word that it’s most effective in 11- and 12-year-olds. New research has shown that they have stronger immune responses to the vaccine than older teens and young adults.