Boys need HPV vaccine, too

[Ekiqa]

http://www.thestar.com/article/522361

Boys need HPV vaccine, too

Nobel winner says males carry cancer-linked virus
Oct 23, 2008 04:30 AM
Comments on this story (15)
Trish Crawford
Living Reporter

Boys, not just girls, should also be vaccinated against the human papillomavirus (HPV), says the Nobel-prize winning doctor who discovered the dangerous link between the virus and cervical cancer.

Dr. Harald zur Hausen, who spoke to 400 researchers and health specialists in Toronto Tuesday night at the MaRS Centre on College St., recommended mandatory HPV vaccination for girls aged 15 to 24 as a first step. But he argued that males should be included, as well.

"Boys and young males, it should be mandatory for them, too," says the 72-year-old German scientist and doctor who was named as the Nobel Prize winner for medicine just two weeks ago.

Although almost all cervical cancers are caused by high-risk HPV, it also plays a large role in penile and anal cancer affecting males, he says. Males both get and give the virus so need to be protected too, he says.

He added it would be a show of "gender solidarity."

The theory that having 60 per cent of women vaccinated against HPV will afford males "herd protection" is far from reality, says zur Hausen, as fewer than 60 per cent of women are getting vaccinated.

"It couldn't do harm to have a higher degree of protection," says zur Hausen, who as well as the Nobel won this year's Canada Gairdner International Award – considered a predictor of the Nobel Prize – for his ground-breaking research that began in 1967 and culminated in this year's accolades.

The scientist whose life's work helped bring the world its first vaccination against cancer says it is an "act of responsibility" for parents to immunize their daughters against HPV.

In Canada, it is offered free to Grade 8 girls but the uptake has hovered around 50 per cent as parents balked at dealing with a method to prevent a sexually transmitted virus and some religious leaders lobbied against it. To be effective, the vaccine must be administered before a woman becomes sexually active.

"If a person was totally monogamous and had a partner who was totally monogamous, then I would be happy. But, if one partner has had (an outside) sexual experience, there is danger," zur Hausen said in an interview before his speech.

"I feel it is an act of responsibility to vaccinate all the daughters," says the researcher, whose grandmother died of cervical cancer before he was born and whose 16-year-old granddaughter has recently been vaccinated against the disease.

The vaccine is as safe as others widely administered to children, he says, with side effects that are "relatively minor." Zur Hausen is not financially connected to the vaccine makers.

The medical difficulties (such as the delivery of premature babies) and discomfort of conditions like genital warts and lesions caused by HPV alone would merit the use of the vaccine, zur Hausen says.

The suffering is great as well, says the doctor, who has visited women dying from cervical cancer, particularly in Africa.

"I've seen quite a number of cases. I know the devastation."

Throughout the world, 500,000 women are diagnosed with cervical cancer each year and 230,000 die as a result of the disease. In Canada, it's estimated there will be 1,300 new cases of cervical cancer diagnosed this year and 400 women will die of the disease.

Zur Hausen, 72, has been researching viruses since the early 1960s. His initial suspicion that the herpes simplex virus caused cervical cancer was ruled out in 1974, and within the few years that followed he showed that two HPV strains were present in 70 per cent of cervical cancers. By 1991, HPV was proved to cause virtually all cervical cancer.

He says he never felt defeated by false trails. "I was convinced I had something, that I was on the right track," he says.

Zur Hausen continues his research in Germany and has shifted his gaze to another cancer. He's now focusing on childhood leukemia in his search for viral causes.

"I want to do something for people affected by these viruses, to reduce the global cancer burden," he says.

After his speech, Dr. Joan Murphy, head of gynaecologic oncology at Princess Margaret Hospital, said, "We welcome this innovation with open arms.

"This is a preventable disease."

Posted without comment.

[Solauren]

It's a CANCER, and it's spread by a virus.

Apparently anyone can get it now. ANYONE.

You can not make any arguments against this vaccination now, without deliberatly putting a great many lives in danger.

[Tsyroc]

You could make an argument against the vaccine based on it being relatively new so it doesn't have a long track record to look at to be certain that there aren't any long term complications that would outweigh the benefits of protecting against a few of the strains of HPV, some of which can lead to cancer. That's more or less how my dad is looking at it when advising girls/women who ask him about this vaccine. He's a pharmacist who works extensively in pediatrics, and women's health related areas of the hospital we both work at. He does recommend it to girls/women who have a history of cervical cancer in the family and/or engage in activities that would put them at a higher risk for catching one of the types of HPV covered by the vaccine. Normally he's very pro-vaccine but he's being a little conservative in recommending this one.

That being said, if they did offer it to boys/men I'd probably get it because I tend to think that men probably spread HPV more than women do, but women are under greater risk once they get it. Plus I like the idea of putting the squeeze on the HPV from both sides.

[Tsyroc]

It's a CANCER, and it's spread by a virus.

Apparently anyone can get it now. ANYONE.

You can not make any arguments against this vaccination now, without deliberatly putting a great many lives in danger.

Do you mean the virus or the vaccine?

Anyone human can certainly catch the Human papillomavirus (HPV)

Actually, I think the virus can cause cancer to develop in an infected person's cells but a person doesn't automatically get cancer when he/she gets the virus.

I haven't heard of any physicians offering the vaccine to boys/men yet. I guess none of the clinical trials tested it in boys/men so in the US it hasn't been approved for males yet.

[montypython]

Vaccination is particularly important for viruses like HPV which too often is asymptomatic in males, enabling the virus to be spread unknowingly in addition to its carcinogenic effects. If the side effects are merely minor discomfort, that should hardly be a reason not to have it.

[FireNexus]

I think most parents would probably agree with male HPV vaccination. First, there's no desire to control sexuality in males. Second, and probably as a corollary of the first, most people who would flip shit if their daughter were having sex would think "you know how boys are...". Finally, the most common treatment for penile cancer is... not ideal.

This may have been the best idea for putting forward this vaccine in the first place.

[The Dark]

While the vaccine overall seems to be a good thing, there are some potential issues:

1. It was rushed through the approval process due to being a health-critical vaccine, and there's limited information on low-rate or long-term side effects.

2. To the best of my knowledge, there's been zero completed testing on side effects on males. The first test of Gardasil began late last year.

3. The vaccine is more difficult to properly administer than most, requiring three visits over the course of a few months (it's also somewhat more expensive, at $360 wholesale for the course)

4. The HPV vaccine is no more than 70% effective - the HPV strains that cause ~30% of cervical cancer are not included in the vaccine.

5. Due to the lack of long-term testing, it's unknown how long the vaccine is effective.

None of these are definite reasons to say a male shouldn't be vaccinated, but there are still a lot of questions to be answered about the vaccine to ensure its safety and efficacy.

[Tsyroc]

While the vaccine overall seems to be a good thing, there are some potential issues:

1. It was rushed through the approval process due to being a health-critical vaccine, and there's limited information on low-rate or long-term side effects.

2. To the best of my knowledge, there's been zero completed testing on side effects on males. The first test of Gardasil began late last year.

3. The vaccine is more difficult to properly administer than most, requiring three visits over the course of a few months (it's also somewhat more expensive, at $360 wholesale for the course)

4. The HPV vaccine is no more than 70% effective - the HPV strains that cause ~30% of cervical cancer are not included in the vaccine.

5. Due to the lack of long-term testing, it's unknown how long the vaccine is effective.

None of these are definite reasons to say a male shouldn't be vaccinated, but there are still a lot of questions to be answered about the vaccine to ensure its safety and efficacy.

Thanks for the information.

I've been a little wary of some places making the vaccine mandatory so soon, and making it mandatory in girls of younger ages than the original test groups. With all the anti-vaccine whack jobs these days we really don't need to have some sort of vaccine related problem pop-up that would give their arguments more traction.

It still might be a good idea to push it for the high school and college aged males and females because that's the most likely time period for people to have multiple sexual partners.

[Ekiqa]

3. The vaccine is more difficult to properly administer than most, requiring three visits over the course of a few months (it's also somewhat more expensive, at $360 wholesale for the course)

The multiple visits is no different than the old Hepititis vaccines. Fairly simple to do in a school, just every so often march the kids to the nurses.

For the costs, weigh it against what HPV would cost, and what cancer would cost.

[Tsyroc]

I think the Hep B vaccine still requires three shots a few months apart.

I don't consider having to get a series of shots much of an issue for a vaccine but then I got the Hep B vaccine voluntarily through work. I suppose multiple shots at different times might be an issue with some people but you'd think it wouldn't be much of one for people having regular medical check ups.

If they do make this vaccine mandatory it would probably be best just to have clinics and give it to all the kids at each school. That way they could bang them all out and have decent records of who got what.

Has anyone gone through the series of shots for typhoid? The military give them in a series a few weeks apart and then followed up with a booster or two in a year or so, I don't recall that part. That immunization sucks. It needs to be in a muscle and it hurts. If you don't use that muscle it will not up and hurt even more when you do use it. It's usually best to just suck it up and have it put in the deltoid or triceps of your dominant arm just to keep things moving.

[The Dark]

I think the Hep B vaccine still requires three shots a few months apart.

Hep B requires the second shot at least one month (and up to five months, IIRC) after the first, and the third six months after the first. HPV requires the second shot two months after the first, and the third six months later. It's not a big difference, but it's less flexible.

I don't consider having to get a series of shots much of an issue for a vaccine but then I got the Hep B vaccine voluntarily through work. I suppose multiple shots at different times might be an issue with some people but you'd think it wouldn't be much of one for people having regular medical check ups.

For most people, no, but a lot of the lower-income families in America (who are the most prone to HPV infection) don't get regular check-ups.

For the costs, weigh it against what HPV would cost, and what cancer would cost.

Weigh it against having food or paying the rent. It's easy to say it's cheaper than having cancer, but from an actuarial standpoint, it mitigates at most 70% of the risk of cancer, and it's three times the cost of the Hep B vaccine that's required. I know people who already have trouble paying for the current schedule of required vaccinations. Making it mandatory would involve paying a $165 head tax to have your kid in school, unless we're going to do it for free through the schools, in which case you'll have a mighty bitching about taxing people for the "sex vaccine". You'd also get into the question of which branch of Big Pharma to subsidize with tax money - Merck (Gardasil) or GSK (Cervarix)

It still might be a good idea to push it for the high school and college aged males and females because that's the most likely time period for people to have multiple sexual partners.

True, but another issue is every test screened out patients to include only those who had 2-4 sex partners over their lives. I've no clue why, but that's just a method of picking test subjects.

Also, I was looking it up a bit further, and the American Cancer Society does not recommend males be vaccinated for HPV. There are adverse effects in 69% of Gardasil patients and 86% of Cervarix patients, although the vast majority are low-grade illness (along with adverse injection site events in 83% of Gardasil and 94% of Cervarix patients). In women who became pregnant within 30 days of a Gardasil injection, 5 had congenital problems possibly related to teratogenic effects (although the total number who became pregnant is unknown). Gardasil's longest-term study was 1.5 years, and Cervarix 4.5 years, so there's no evidence at this time of long-term efficacy, and ACS' study suggests it'll be 25-35 years before we know for certain, as most diagnoses of cervical cancer occur around age 48.

[Tsyroc]

Also, I was looking it up a bit further, and the American Cancer Society does not recommend males be vaccinated for HPV. There are adverse effects in 69% of Gardasil patients and 86% of Cervarix patients, although the vast majority are low-grade illness (along with adverse injection site events in 83% of Gardasil and 94% of Cervarix patients). In women who became pregnant within 30 days of a Gardasil injection, 5 had congenital problems possibly related to teratogenic effects (although the total number who became pregnant is unknown). Gardasil's longest-term study was 1.5 years, and Cervarix 4.5 years, so there's no evidence at this time of long-term efficacy, and ACS' study suggests it'll be 25-35 years before we know for certain, as most diagnoses of cervical cancer occur around age 48.

I should have quantified my comment that if it is approved for males it should be encouraged at least at the same level as for females.

Are the studies you are referring to on the ACS website? I'm just asking because I'd like to direct my dad and some of the other people I work with to the information.

[The Dark]

Also, I was looking it up a bit further, and the American Cancer Society does not recommend males be vaccinated for HPV. There are adverse effects in 69% of Gardasil patients and 86% of Cervarix patients, although the vast majority are low-grade illness (along with adverse injection site events in 83% of Gardasil and 94% of Cervarix patients). In women who became pregnant within 30 days of a Gardasil injection, 5 had congenital problems possibly related to teratogenic effects (although the total number who became pregnant is unknown). Gardasil's longest-term study was 1.5 years, and Cervarix 4.5 years, so there's no evidence at this time of long-term efficacy, and ACS' study suggests it'll be 25-35 years before we know for certain, as most diagnoses of cervical cancer occur around age 48.

I should have quantified my comment that if it is approved for males it should be encouraged at least at the same level as for females.

Are the studies you are referring to on the ACS website? I'm just asking because I'd like to direct my dad and some of the other people I work with to the information.

I got a lot of it from MedScape. The ACS does mention it at this page, stating it's not available for males because it has not been proven to prevent HPV infection in males (studies are in-process).

[Tsyroc]

Thanks.

[Broomstick]

3. The vaccine is more difficult to properly administer than most, requiring three visits over the course of a few months (it's also somewhat more expensive, at $360 wholesale for the course)

The multiple visits is no different than the old Hepititis vaccines. Fairly simple to do in a school, just every so often march the kids to the nurses.

In the US, school nurses - where they even still exist (many, if not most, districts have eliminated them entirely) - aren't even allowed to dispense aspirin, much less a vaccine. Then there's the problem of parental consent. In the US this would probably have to be administered in a doctor's office, and insurance companies will strongly resist a multi-visit vaccine requirement, if they cover it at all (which they may not, for men).

For the costs, weigh it against what HPV would cost, and what cancer would cost.

Well, if those slutty girls would just virgins until they marry, and only marry virgin men, they wouldn't get ANY STD's and at no dollar cost to society! Selfish bitches, wasting health care dollars! [/right wing religious wacko]

I think the Hep B vaccine still requires three shots a few months apart.

I don't consider having to get a series of shots much of an issue for a vaccine but then I got the Hep B vaccine voluntarily through work. I suppose multiple shots at different times might be an issue with some people but you'd think it wouldn't be much of one for people having regular medical check ups.

In the US, even many people with health insurance don't get regular check-ups. We have 50 million people who are uninsured and probably do not visit the doctor unless severely ill, so no vaccines for them.

If they do make this vaccine mandatory it would probably be best just to have clinics and give it to all the kids at each school. That way they could bang them all out and have decent records of who got what.

First, there would be an incredible uproar if you tried that in the US. It's stupid and idiotic and a hundred other variations on fucking dumb but you'll have everything from Fundies to woo-woo New Agers screaming bloody murder.

Second, I think the HIPAA regulations would fuck with the school keeping these records.

Third, this would not reach the homeschooled, a large number of whom are from Fundy families and won't be getting the information they need on sexual health to make an informed decision about this anyhow.

Fourth, there are certain categories of people who should NOT receive vaccinations for legitimate health reasons. Simply lining everyone up and zapping them is an invitation to disaster. Someone is going to have an allergic reaction or something, it will hit the news, and frighten the fuck out of 90% of the morons in the nation.

I think the Hep B vaccine still requires three shots a few months apart.

Hep B requires the second shot at least one month (and up to five months, IIRC) after the first, and the third six months after the first. HPV requires the second shot two months after the first, and the third six months later. It's not a big difference, but it's less flexible.

I don't consider having to get a series of shots much of an issue for a vaccine but then I got the Hep B vaccine voluntarily through work. I suppose multiple shots at different times might be an issue with some people but you'd think it wouldn't be much of one for people having regular medical check ups.

For most people, no, but a lot of the lower-income families in America (who are the most prone to HPV infection) don't get regular check-ups.

For the costs, weigh it against what HPV would cost, and what cancer would cost.

Weigh it against having food or paying the rent. It's easy to say it's cheaper than having cancer, but from an actuarial standpoint, it mitigates at most 70% of the risk of cancer, and it's three times the cost of the Hep B vaccine that's required. I know people who already have trouble paying for the current schedule of required vaccinations. Making it mandatory would involve paying a $165 head tax to have your kid in school, unless we're going to do it for free through the schools, in which case you'll have a mighty bitching about taxing people for the "sex vaccine".

^ What he said.

Remember, in the US we do NOT have either universal coverage or state-subsidized medical care. Those most able to pay out of pocket are those most likely to have insurance coverage (some policies do cover this). Those least able to pay out of pocket will almost certainly not have insurance coverage for this (any likely not for anything else).

It still might be a good idea to push it for the high school and college aged males and females because that's the most likely time period for people to have multiple sexual partners.

True, but another issue is every test screened out patients to include only those who had 2-4 sex partners over their lives. I've no clue why, but that's just a method of picking test subjects.

Consistency.

Virgins seldom get cervical cancer because they seldom get HPV in the genital area. So you need people with at least one sex partner. But you want some consistency among test subjects, so you don't want 60% with 3 partners and 25% with 10 and 15% with 30+ partners.

Also, I was looking it up a bit further, and the American Cancer Society does not recommend males be vaccinated for HPV. There are adverse effects in 69% of Gardasil patients and 86% of Cervarix patients, although the vast majority are low-grade illness (along with adverse injection site events in 83% of Gardasil and 94% of Cervarix patients).

What do they mean by "low-grade" illness? The slight fever feeling and sore arm you get with almost any vaccination?

In women who became pregnant within 30 days of a Gardasil injection, 5 had congenital problems possibly related to teratogenic effects (although the total number who became pregnant is unknown).

Well, hell, if you don't know the total number of subjects who became pregnant that's useless stat, isn't it? "Congenital problems" occur in something like 3-5% of births on average anyway. If a 100 women on the program became pregnant then that rate of "congenital problems" is the normal average.

Gardasil's longest-term study was 1.5 years, and Cervarix 4.5 years, so there's no evidence at this time of long-term efficacy, and ACS' study suggests it'll be 25-35 years before we know for certain, as most diagnoses of cervical cancer occur around age 48.

And yet, we start Pap smears as soon as sexuality activity starts - which may be as early as 12. For that matter, I had an aunt diagnosed with very early stage cervical cancer in her late 20's. If this vaccine works we should start to see it with a drop in very early cervical cancer (which does occur), well before 25-35 years run out.

[Tsyroc]

I should have thought of the HIPPA issues. Even if there weren't all the other issues with trying to give medicines or vaccines in schools the HIPPA guidelines as they are now would be a nightmare for schools to try and adhere to. It would be just another avenue for lawsuits waiting to happen.

[The Dark]

Also, I was looking it up a bit further, and the American Cancer Society does not recommend males be vaccinated for HPV. There are adverse effects in 69% of Gardasil patients and 86% of Cervarix patients, although the vast majority are low-grade illness (along with adverse injection site events in 83% of Gardasil and 94% of Cervarix patients).

What do they mean by "low-grade" illness? The slight fever feeling and sore arm you get with almost any vaccination?

Given how it was phrased, I believe that's what was meant. Frankly, I don't know how common those effects are, since I've only ever gotten them with the meningitis shot I received at college.

In women who became pregnant within 30 days of a Gardasil injection, 5 had congenital problems possibly related to teratogenic effects (although the total number who became pregnant is unknown).

Well, hell, if you don't know the total number of subjects who became pregnant that's useless stat, isn't it? "Congenital problems" occur in something like 3-5% of births on average anyway. If a 100 women on the program became pregnant then that rate of "congenital problems" is the normal average.

True - I worded that poorly. The number who became pregnant is known, but the synopsis of the study didn't state the number, so I don't know it.

Gardasil's longest-term study was 1.5 years, and Cervarix 4.5 years, so there's no evidence at this time of long-term efficacy, and ACS' study suggests it'll be 25-35 years before we know for certain, as most diagnoses of cervical cancer occur around age 48.

And yet, we start Pap smears as soon as sexuality activity starts - which may be as early as 12. For that matter, I had an aunt diagnosed with very early stage cervical cancer in her late 20's. If this vaccine works we should start to see it with a drop in very early cervical cancer (which does occur), well before 25-35 years run out.

Also true, but with the size of the studies, there may not be a statistical significance to a drop in early cervical cancer, since the sample size may not be large enough for there to be more than a case or two as the "expected" rate of incidence, with a broad enough margin of error to allow for a zero result to not be significant. Also, given that the duration of the vaccine's usefulness is unknown, it could protect for (just as an example) 20 years, preventing the early uterine cancer, but not protecting once the patient reaches their mid-30s, still leaving them vulnerable to mid-life incidents of HPV.

[pieman3141]

"Anal cancer"????
Geez... that's just scary.