DEAR DR. ROACH: What are your thoughts on the pros and cons of HPV vaccine for boys? — L.P.B.
ANSWER: There are risks and benefits to the individual, but also benefits to society.
The HPV vaccine should really be considered an anticancer vaccine, since its goal is to reduce infection from the kinds of human papilloma virus strains that can lead to cancer. Cervical cancer is the most common HPV-related cancer, but some throat cancers, anal cancers and genital cancers also are HPV-related. The Centers for Disease Control and Prevention estimates that there are about 30,000 HPV-related cancers in the U.S. annually. It is possible but unproven that the HPV vaccine will provide protection against some or all of these.
When given to girls or women who have not been infected with HPV, the HPV vaccine is nearly 100 percent effective at preventing persistent infection with the strains of HPV most likely to lead to cancer. In males age 16-26 years, the efficacy of the vaccine at preventing high-risk HPV-related warts was about 90 percent. However, the HPV vaccine is relatively new, and it is not clear how long immunity will last. It has been proven to last only eight to nine years, but studies looking at protection up to 15 years are ongoing. It is possible that additional boosters may be necessary.
All vaccines have some degree of risk. The most serious risk of HPV vaccine is anaphylaxis, a possibly fatal allergic reaction to the vaccine. There have been 36 cases of anaphylaxis reported in the world literature and through the Vaccine Adverse Event Reporting system, according to the Institute of Medicine’s 2012 report on adverse effects of vaccines. There have been 67 million doses given, with a 0.003 percent rate of all adverse events, 90 percent of which were not considered serious. The most common nonserious adverse events in men were redness and soreness at the injection site, dizziness, headache and fainting. Among the adverse events considered serious, the most common were headache, nausea, vomiting and fever.
The societal benefit to vaccinating boys is that they are less likely to spread infection to others. Since essentially all cases of cervical cancer are HPV-related, males are the most common source of infection (although it can be transmitted female to female).
By vaccinating your boy, you are reducing his risk of developing HPV infection and might be decreasing his risk of several types of HPV-related cancer, at a small risk of an adverse event, which is usually minor. However, probably the most compelling reason is to protect your son’s future sexual partners. Put in the starkest terms, you are reducing the risk that your future daughter-in-law will develop cervical cancer.
DEAR DR. ROACH: I have just read your question and answer about the shingles vaccine and have a question. I am an English person living over here, and last time I was back in England and visiting my old doctor, I asked about getting the shingles vaccine there. I was informed that there was no such vaccine in England. This made me wonder about the legitimacy of the vaccine; if it was that vital to people’s health, surely other countries would be offering it as well. Is this just another way for doctors to cash in on health insurance payments? — C.B.
ANSWER: The National Health Service in the United Kingdom recommends the same shingles vaccine, Zostavax, that is used in the U.S. and Canada.
Most physicians make very little or no money on vaccination. We recommend them because we care about our patients and want to prevent suffering.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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