It's no longer enough to vaccinate pre-teen and adolescent girls against the human papillomavirus, or HPV, a sexually transmitted virus that can cause cervical cancer later in life. A new recommendation presented today by the American Academy of Pediatrics says that boys in the same age range should be immunized as well, to protect them from HPV-linked cancers resulting from oral and anal sex and to prevent them passing the virus on to girls.
The academy included the HPV vaccine for boys as part of its revised standard immunization schedule for children and teens. Its inclusion follows a recommendation made in October by the Advisory Committee on Immunization of the Centers for Disease Control and Prevention in Atlanta.
The vaccine is expensive, running about $360 for three doses over a six-month period that would provide full protection. The cost for girls is covered by many private insurance policies because it is part of the routine schedule. Adding boys to the list makes coverage more likely for them as well. Highmark, for example, already covers the vaccine for girls as part of its preventive benefits package. Boys may be covered in certain policies already, but they will be part of the preventive benefits package in 2013, said Phil Majewski, medical director of quality at Highmark.
HPV immunization has been controversial in some quarters because the diseases it prevents stem from sexual activity: 15,000 preventable cases among women a year, according to the CDC, including cervical, anal, vaginal, vulvar and throat; and 7,000 among men, mostly oral. HPV also causes genital warts, which appear in 1 percent of sexually active adults in the U.S. at any given time, the CDC reported.
Some critics have charged that the shots promote promiscuity. But a CDC study on that topic showed no such effect, said Michael Brady, chairman of the Committee on Infectious Diseases for the American Academy of Pediatrics and chairman of pediatrics at Nationwide Children's Hospital in Columbus, Ohio.
Nor does the vaccine cause mental retardation, a specious claim made by Minnesota Rep. Michele Bachmann during her recent presidential bid.
The recommendation for boys as young as 9 could raise hackles since the targeted male cancers -- throat and anal -- are related to homosexual sex. But, Dr. Brady said, "Given the amount of cancer in both genders, most people recognize the rationale. Adding males from a cost-effective perspective was the right thing to do."
In 2006, the same CDC panel advocated immunizing females age 11 and 12 up to 26 against HPV, but the rates of those doing so are lagging. Only 45 percent to 50 percent of adolescent girls have received at least one dose, and only a third have completed the entire series.
"That's one reason to make the recommendation gender-neutral," Dr. Brady said. "We assumed if we could get good coverage in women we could interrupt transmission, but to achieve that we needed 80 percent of uptake among females."
Immunizing boys will protect them as well as future sexual partners who haven't had the shots.
Another reason: "Boys who grow up to be men who have sex with men are at particular risk for HPV infection," Dr. Brady said. "If you immunize only girls, you wouldn't improve protection of that population."
The reason for targeting children ages 11 and 12 are several, he said.
"You want the protection prior to the onset of sexual activity. Once a boy or girl becomes sexually active, within about three months a large proportion will have been infected with at least one of the strains of HPV."
Also, he said, the production of antibodies peaks at ages 11 and 12, so immunizing during that period gives the greatest benefit and the longest protection.
Jonathan Pletcher, clinical director of adolescent medicine at Children's Hospital of Pittsburgh, said he saw some resistance to vaccinating girls early on, but that now the parents of both boys and girls are more accepting.
"The majority of those we see want to get the vaccine," Dr. Pletcher said. "I recommend it 100 percent."
There are 80 or 90 strains of the HPV virus, Dr. Brady said, but four are responsible for the vast majority of cancers. Both of the available vaccines, Gardasil from Merck and Cervarix from GlaxoSmithKline, have antigens for the two strains that cause cervical cancer.
The academy's revised schedule of immunization includes two other changes. The meningococcal vaccine can now be given to children as young as 9 months if they are at increased risk from travel to countries with epidemic disease. Routine immunization with the meningococcal vaccine should begin at ages 11 to 12, with a booster dose at 16.
Also, for children 6 months to 8 years old who did not get a flu shot the previous year, the flu vaccine should be given in two doses, according to the schedule. Children who received one dose last season require one dose for the 2011-12 flu season.
Sally Kalson: firstname.lastname@example.org or 412-263-1610.