Starting September 2016, Ontario extended the human papillomavirus (HPV) vaccination program to all Grade 7 students free of charge. The Gardasil® vaccine, approved for use in 2006, is now being distributed in schools across the province. This vaccine is directed against low-risk HPV strains 6 and 11, as well as high-risk HPV strains 16 and 18. Although HPV vaccination has been free for girls since 2007, this marks the first time the province has included boys in the publicly funded vaccination program, a decision strongly advocated by the Canadian Cancer Society.
Why did the province extend the vaccine to boys?
HPV is the most common sexually transmitted infection. Approximately 75% of all sexually active people will acquire at least one HPV infection in their lifetime. While the majority of HPV infections are asymptomatic and clear up on their own, infection with high-risk strains of HPV can lead to anogenital or oropharangeal (throat and mouth) cancers in both women and men. Although mortality due to HPV infection disproportionately affects women due to cervical cancer, the incidence of anal and oral cancers related to HPV infection in men is on the rise. Due to the sexually transmitted nature of the infection, vaccinating both sexes during their preteen years improves the overall herd immunity to the virus. This has been shown to lead to a decrease in the incidence of HPV-associated disease including genital warts and cancer. Additionally, the only screening method currently available for HPV infection-related disease is the cervical cytology (Pap Test) for women. Most importantly, there is currently no cure for HPV. The few treatments available are directed at HPV-associated conditions, not the infection itself.
Why did it take so long?
In general, HPV vaccination has been opposed by the public for many reasons. Some parents believe that vaccinating children against a sexually transmitted infection may encourage early sexual activity. Many also question the value of the vaccine since it only provides protection from a few of the many HPV strains and since the virus itself is transient in the majority of cases. Anti-vaccination proponents have also touted several anecdotes of adverse health effects after vaccination, although these have been proven to be unrelated to the vaccine in follow-up studies.
For boys in particular, HPV vaccination was not initially seen as a priority since the virus is most often associated with cervical cancer. Officials believed that vaccinating girls would be sufficient to provide herd immunity; however, many parents are still refusing to vaccinate their daughters, rendering this argument invalid. In Ontario, it was estimated that only 55% of eligible girls had been vaccinated in 2012. Another barrier to extending the vaccine to boys was the increased total cost of the vaccination program. For those not covered by the vaccination program, the vaccine series (3 shots) typically costs between $300-500 per person. In 2007, the predicted annual economic burden of HPV was already $300 million. This was thus a major deterrent for many government officials as well as taxpayers.
Conclusion
HPV infection is very common, and most of the time it resolves itself. However, sometimes the virus results in severe disease, and there is currently no way of predicting who will present with symptoms. Since the virus can affect both men and women, it is imperative that both boys and girls get vaccinated before their first exposure to sexual activity. This September, all children in Ontario were granted access to a potentially life-saving vaccine – and we are all the better for it.
References:
- Anic GM & Giuliano AR. Genital HPV infection and related lesions in men. Prev Med. 2011; 53 (S1): S36-S41.
- Dehaas J. Ontario extending free HPV vaccine to boys. CTV News [web]. Published April 21, 2016.
- HPV – Questions and Answers. Centers for Disease Control and Prevention [web]. Updated Nov 28, 2016.
- HPV and Cancer. NIH National Cancer Institute [web]. Updated Feb 19, 2015.
- HPV and Men – Fact Sheet. Centers for Disease Control and Prevention [web]. Updated Jan 3, 2017.
- Moscicki A & Palefsky JM. HPV in men: an update. J Low Genit Tract Dis. 2011; 15(3): 231-234.
- Ontario’s HPV Immunization Program. Ontario Ministry of Health [web]. Updated Dec 22, 2016.
- Palefsky JM. Human Papillomavirus-Related Disease in Men: Not Just a Women’s Issue. J Adolesc Health. 2010; 46(S4): S12-S19.
- Schmeler KM & Sturgis EM. Expanding the benefits of HPV vaccination to boys and men. The Lancet. 2016; 387: 1798-1799.
Lisa Hung
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