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HPV: should men be vaccinated?
February 9, 2011 – Should adolescents and young men be vaccinated against human papillomavirus (HPV) or not? The debate could resurface, with the publication of a study according to which the Gardasil® vaccine would reduce the appearance of condyloma in men by 90%.
Genital warts – or condylomas – are the most common manifestation of HPV in young men, according to the Society of Obstetricians and Gynecologists of Canada (SOGC)1. In fact, the risk of having condylomas during his life is said to be 10% in men.
Developed and funded by Merck & Co., which markets the Gardasil® vaccine, the study2 was carried out with more than 4 men aged 000 to 16, from 26 countries – including Canada. It aimed to measure the effectiveness of the vaccine against that of a placebo in preventing genital lesions, including warts (or condyloma). The study took place over a period of less than 18 years.
Before the start of the study, all participants had to have had at least 5 different sexual partners. About 85% had had relationships exclusively with women.
Fewer lesions and fewer condylomas
In young men who had never been infected with any of the 4 strains of HPV that the vaccine would prevent, vaccination reduced both the appearance of external genital lesions and condyloma by 90%, compared to those who received the placebo.
Specifically, 1,58 cases of condyloma were observed for every 100 participants in the group vaccinated with the placebo, against 0,52 cases in those who received the vaccine.
However, when those who had already been infected before being vaccinated were included in the group, the efficacy of the vaccine was only 65% against external lesions, and 60% against warts.
Universal vaccination?
Is it relevant to vaccinate all men aged 16 to 26 to reduce genital lesions, but also the number of cases of infection in general?
Several factors must be taken into account, according to Jane J. Kim, who signs an editorial3 appeared in the same edition of the journal that published the study.
“Several studies show that when the vaccination rate in girls is high, the vaccination of boys is not cost-effective,” she says. But in the case of the United States, where only 26,7% of girls aged 9 to 26 have received the 3 doses of the HPV vaccine, vaccination of boys would be desirable, ”she argues.
Kim said the cost of the vaccine should also be considered. Gardasil® is among the most expensive vaccines in the world, at $ 400 for 3 doses.
Another important factor: the duration of the study does not make it possible to establish whether the vaccine is safe in the long term, nor what is the duration of the protection it provides.
It should also be remembered that vaccines against HPV in women are considered to be a potential weapon – but not yet demonstrated – to prevent cervical cancer. In boys, they are only effective against genital lesions, according to the study.
HPV vaccines in Canada
In Canada, 2 vaccines are approved for the prevention of HPV infections: Gardasil® and Cervarix®.
Gardasil® is a vaccine that protects against 4 types of HPV, namely strains 6, 11, 16 and 18.
Cervarix® is a vaccine that protects against 2 strains of HPV, namely 16 and 18.
These 2 vaccines are recommended for women aged 9 to 26 years old, while Gardasil® is also recommended for men aged 9 to 26 years old.
To learn more about HPV infections and vaccination, see our report HPV vaccination: what you need to know. |
Martin LaSalle – PasseportSanté.net
1. On this subject, see the site http://infovph.ca, sponsored by the SOGC. [accessed February 9, 2011]
2. Giuliano AR, Palefsky JM, et al, Efficacy of Quadrivalent HPV Vaccine against HPV Infection and Disease in Males, New England Journal of Medicne, February 3, 2011, vol. 364, No. 5, 401-11.
3. Kim JJ, Weighing the Benefits and Costs of HPV Vaccination of Young Men, New England Journal of Medicne, February 3, 2011, vol. 364, No. 5, 393-5.